A CCG in the Midlands has highlighted a conflict of interest facing GP practices with regards to ordering flu vaccine, concluding that practices should order a majority at a price that will disadvantage them financially.
Although the arguably more effective flu vaccine – quadrivalent (QIV) – is cheaper to practices due to a large, 50%, discount offered by one manufacturer, the cost to the NHS to reimburse practices is higher.
Meanwhile, a vaccine that provides protection to fewer strains of influenza – trivalent – is more expensive to practices, but cheaper for the NHS when it comes to reimbursing practices.
Manufacturer Sanofi offers GPs discounted QIV at £4 per dose, but the current NHS list price for its product is £8 per dose, NHS Dudley CCG has found.
The CCG said there are two clinically approved trivalent vaccines with NHS list prices of £5.22 and £5.25 per dose respectively. It has now decided to ask GPs to ensure that at least three quarters of the vaccines they order are at the lower cost.
It said in a board paper from last week: ‘Following a review of the recommended flu vaccines for the 2017-2018 season we are recommending that GP practices in Dudley review their ordering/purchasing and make changes to ensure at least 75% of vaccines purchased are below an NHS list price of £6.’
The CCG acknowledged that Public Health England’s Green Book 2016 for vaccinations states that ‘all other things being equal, QIV are preferable’, but added that there was ‘no robust evidence to support this’.
The paper said: ‘Public Health England is currently undertaking a cost effectiveness analysis for QIV compared to trivalent vaccines and until further guidance is forthcoming, [NHS] Dudley CCG does not consider the QIV vaccines to be cost effective for the adult immunisation programme.’
But GPC dispensing and pharmacy policy lead Dr David Bailey told Pulse that although GPs could make ‘marginally’ more profit by ordering QIV in this instance, they should make their judgement based on what is best for patients.
He said: ‘It is undeniable that the quadrivalent vaccine will prevent more cases in total and thus at an individual level is better for the patient in front of you
‘GPs should always make the best decision for the individual patient – all things being equal having some regard to cost.
‘Should there be an outbreak of the influenza B strain covered by one but not the other it would be the GP who might be criticised for providing the less effective of the two available products.’
NHS Business Services Authority, which reimburses GPs for vaccines in line with the NHS list price without asking how much they paid, said this was ‘in accordance with the Drug Tariff and the GMS Statement of Financial Entitlements Directions 2013’.
A Sanofi spokesperson said: ‘QIVs offer a broad protection against influenza by helping to protect against four influenza strains (two A strains and two B strains).
‘Sanofi provides discounts to healthcare professionals in the UK on influenza vaccines similar to those offered by other influenza vaccine manufacturers.
They added that its QIV NHS list price ‘is currently the lowest of all available QIVs’ from any manufacturer ‘aligned with Sanofi’s commitment to addressing affordability issues in the NHS’, and that ‘reimbursement criteria to practices are driven by the NHS as one of the tools to increase vaccination coverage rates’.