This site is intended for health professionals only

GPs told to refuse shingles vaccination for 71 to 78 year olds

GPs are being told to turn down requests from people aged 71 to 78 years for the shingles vaccination even though this goes against patients’ rights under the NHS constitution.

Pulse has learned that in many areas patients over 70 but under 79 years have been asking for the vaccination after hearing reports about the national programme, with GPs having to explain why they are not yet covered.

Public Health England (PHE) said everyone aged 70 to 79 years is entitled to the vaccination under the NHS Constitution, as recommended by the Joint Committee on Vaccinations and Immunisations (JCVI). However, to make the best use of limited vaccine supplies, the programme is being rolled out to patients aged 70 and those aged 79 years to begin with.

The national shingles vaccination programme began in September this year, following JCVI advice that the Zostavax vaccine is cost-effective for reducing shingles and post-herpetic neuralgia in the 70–79 years age group.

A PHE Q&As document for health professionals released when the programme was launched stated: ‘Vaccine supply from the manufacturer is at present limited, and between 1 September 2013 and 31 August 2014, there will only be enough vaccine to fully vaccinate two birth cohorts - the routine cohort, and one catch-up cohort (those aged 79 on 1 September 2013).

‘JCVI recommended that everyone aged 70 to 79 should be offered shingles vaccine; therefore, under the NHS Constitution everyone aged 70 to 79 years has a right to receive the vaccine.

‘Given the amount of vaccine available, the most equitable approach is to vaccinate 79-year-olds firsts, in addition to the routine cohort, as 79-year-olds will be too old to be eligible for vaccination in 2014/2015, when more vaccine becomes available.’

Dr Rob Barnett, secretary for Liverpool LMC, said it can be ‘very difficult’ to explain to patients they are not eligible for the vaccination but that as long as GPs are honest patients should not complain.

He said: ‘Everyone has to take a pragmatic approach, and what’s being done is better than nothing but it’s not the most ideal. The Government has made a political decision that only people within certain age brackets can have it because we’ve only got enough vaccine for that – and that’s it.’

He added: ‘I have the Q&A sheet, which I show to patients, and I explain to them it is not a decision I have made, it is a decision the Government has made and that is it – it is purely based on available supplies. As long as GPs are honest in their response there is nothing else to do - if a patient was to complain I would send that through to the Department of Health for them to respond.’

Dr Jim Kennedy, medical secretary at Berkshire, Buckinghamshire and Oxon LMCs, told Pulse: ‘I would say just about every practice in Thames Valley has had some patients who are not in the target groups saying “I hear there is now a shingles vaccine, can I have some?”’

He added: ‘It is not confined to people in their 70s – people of all ages are asking for it, particularly people who have had several doses of shingles in the past and those who are at high risk of it because they’re immunocompromised.

‘What we advise GPs is, show patients the guidance, the information that there is no separate supply available for anyone outside those groups. They wonder why they are not prioritised, but we have to explain this is the way it’s going to make the most benefit from the stuff we have.

‘The vast majority of patients understand when you explain that there is a limited supply.’

Dr John Grenville, secretary of Derbyshire LMC, said: ‘This is yet another area where two bits of legislation or guidance conflict and it’s time the Department of Health sorted itself out so it’s not drawing up contradictory legislation or guidance.

‘GPs have to just decide what to do and they end up having to explain it to patients. And my advice is - if patients don’t like what I’m telling them, I say: “All I’m telling you is what the law is and if you don’t like it then complain to your MP.”’