NHS England wrote off £4.2m ‘overpayment’ to GPs for childhood immunisations

NHS England has said it will not claw back £4.2 million ‘overpayment’ from GP practices who did not meet vaccination targets last year.

In its annual report, NHS England listed the figure in a section on cash losses after a review found that practices were struggling to hit targets for reasons outside their control.

After a review of a ‘large number of commissioner and practice queries’ it became apparent that ‘practices were struggling to meet the performance threshold’, the report said.

It confirmed that ‘some contractors could not meet the vaccination targets that were set in relation to routine childhood vaccination and immunisation’, which resulted in an overpayment.

The vaccinations and immunisations repayment mechanism ‘is intended to limit financial gain by practices with lower levels of performance’, it said.

But it noted: ‘The main reasons for this are issues outside of a practice’s control such as increased vaccine hesitancy, people either not coming forward when invited or declining, less ability to opportunistically offer vaccination when children are present in practice for another reason.’

The review also found that the Covid-19 pandemic has impacted on practice capacity, NHS England said.

It follows a new QOF system introduced in 2021/22 where an item of service payment of £10.06 now applies to each vaccine dose administered and if fewer than 80% of children have the jab then practices may face a clawback equivalent to half the cohort. 

Concerns had been raised that the new system was overly complex and had the potential to increase inequalities impacting deprived practices more.

It was not clear from the report if overpayment was decided on a case-by-case basis and how many practices were affected. Pulse has asked NHS England for clarification.

Professor Azeem Majeed, professor of primary care and public health at Imperial College London, said: ‘I don’t think my practice was allowed to retain QOF payments for childhood vaccination.

‘Like many practices in inner city areas, we have high levels of deprivation and challenges in addressing vaccine hesitancy amongst parents.

‘Population mobility is a major challenge as we can vaccinate children but then they leave the practice before the QOF target is calculated.’

He added: ‘We do eventually get vaccination rates up to a high level but this takes a lot of work in contacting families and addressing data issues because vaccine data is often missing from medical records when patient register with the practice.

‘This work often goes unfunded because we can’t meet the target in time for the QOF payments.’

‘I hope these challenges for practices in areas where vaccination targets are hard to achieve can be recognised by NHS England. The current system is very rigid and is very demoralising for practices in areas with high levels of vaccine hesitancy.’

GPs should get paid for their work even if parents choose to decline childhood immunisation offers, the England LMC conference said in November.

Other overpayments highlighted within NHS England’s annual report included £1m paid to two suspended GPs in error and over £28m worth of overpaid seniority payments. NHS England is seeking to partially reclaim these millions, pending legal advice and a criminal case.