Exclusive Concessions to the controversial childhood immunisation programme, which would allow practices in England to exception report in specific circumstances, have not been included in the official contract documents, Pulse has learned.
As part of the letter announcing the contract imposition last month, NHS England said it would allow practices to exception report for the childhood immunisations QOF indicators when patients registered at the practice too late in the financial year or are too old for the programme.
Although these were minor concessions, they were widely seen as being the only positive elements of the contract imposition for GPs.
However, the latest official documents for the contract explicitly exclude this form of exception reporting.
NHS England and the BMA have both said that practices will be allowed to exception report in these circumstances, but experts have said that it seems that these changes have been ‘dropped or forgotten’.
There has been huge controversy around the immunisations indicators, with practices in deprived areas especially missing out on payments because they have been unable to exception report patients who refuse to respond to multiple attempts at contact.
In the contract imposition letter, NHS England stopped short of remedying this, but did state: ‘A new Personalised Care Adjustment [exception report] will also be introduced for patients who registered at the practice too late (either too late in age, or too late in the financial year) to be vaccinated in accordance with the UK national schedule (or, where they differ, the requirements of the relevant QOF indicator).’
However, the Government’s Statement of Financial Entitlements (SFE) and QOF guidance published by NHS England explicitly stated that the only form of exception reporting allowed for the three childhood immunisations indicators was related to clinical contraindications, with no changes to the previous years’ contracts (see fact file).
What the SFE and QOF guidance state
Page 79 of the SFE lists five reasons for exception reporting, listed (a) to (e), that include: (a) a service being unavailable; (c) the patient being unwilling to receive the intervention; (d) the patient failing to respond to requests to invitations; and (e) issues around timing for newly registered or diagnosed patients.
However, it states ‘only criterion (b) will apply to the following indicators: VI001, VI002 and VI003’, which are the childhood immunisation indicators. Criterion (b) states: ‘The intervention described in the indicator is clinically unsuitable for the patient. This may be due to specific reasons such as the patient being on maximum tolerated doses of medication, allergies, contraindications or other medication intolerances or broader reasons such as it being clinically inappropriate to review disease parameters due to particular circumstances such as being at the end of their life or having a supervening condition against which QOF interventions need to be balanced.’
Meanwhile, page 95 of the QOF guidance says that patients vaccinated overseas can be counted as a ‘success’ for QOF purposes. However, for each of the indicators, it states: ‘The only personalised care adjustment applicable is where the intervention described in the indicator is contraindicated for the patient.’
NHS England told Pulse that the personal care adjustment mentioned in the letter is ‘active’, and that they do not routinely list all of the PCAs currently active.
Meanwhile, Dr Clare Bannon, BMA England GP committee deputy chair, said: ‘We are pleased to see the NHS England has implemented this change that we fought hard for during negotiations, so that practices do not miss out on vital funding through no fault of their own, and we’d urge NHS England to promote this in its guidance to reassure practices.
‘Unfortunately though, it does not go far enough, as it currently does not include those people who refuse the vaccine despite practices’ best efforts to educate and support them to have it.’
But Swindon GP Dr Gavin Jamie, who runs the QOF database, told Pulse that the SFE is the ‘definitive source of contractual information – everything else is just comms’.
He added: ‘The wording on the SFE has not changed since the last two years. To me this looks like it has been dropped, or at least forgotten.
‘The SFE is quite explicit and the [NHS England] response that it is not exhaustive does not make a lot of sense. The only document to mention exception reporting for impossible patients is the letter and this is, contractually, the weakest of the three.’
Please note there is an update to this story here
READERS' COMMENTS [3]
Please note, only GPs are permitted to add comments to articles
so, Government lied again.
Is anybody surprised?
Does this now make doing childhood imms non-viable and a pure charity case at partners’ personal expense? Many practices will have had no reimbursement for 22/23 for extensive clinical and admin time/effort. Does the GPC now need to give new advice to cease this activity?
Dont we just except them under that code then?