Cuts to GPs’ SMS funding could lead to missed vaccinations, GP leader tells Lords

ICB cuts to SMS funding for GP practices could lead to large numbers of missed children vaccinations, a House of Lords committee has been told.  

The BMA’s GP committee chair Dr Katie Bramall and RCGP chair Professor Victoria Tzortziou Brown appeared today in front of the the Lords’ childhood vaccinations committee, as part of its inquiry into childhood vaccination coverage in England.

It comes as recent UK Health Security Agency (UKHSA) figures revealed every region of England has seen cases of measles this year.

Dr Bramall told the committee that GP practices have been relying on SMS messages to remind parents to attend vaccinations, and that cuts to funding imposed by some ICBs could impact childhood vaccination rates.

Pulse has reported on several ICBs imposing the cuts, and most recently revealed that one ICB delayed implementing a cost-cutting measure limiting funding for SMS messages, following pressure from GP practices.

Dr Bramall said: ‘Unfortunately, so many ICBs are now cutting SMS funding. This has not been explicitly shared with us, but reports are coming through from increasing numbers of ICBs across the country.

‘I think it particularly impacts those who may not speak English as a first language and who may not have access to a smartphone.

‘I think people sometimes live in their own bubble, and they don’t realise how the majority of the population communicate, live, work, and how chaotic their lives are.

‘And we’ve got to tailor our offer to the vast majority of the population who may not be signed up to the NHS App.’

NHS England said that the NHS App should become the ‘default option’ for GP practices to contact patients starting from this financial year.

But Dr Bramall added that ‘even small degrees of friction’ such as stopping SMS messages to parents could lead to large numbers of missed vaccinations.

She said: ‘I think parents want simple booking, text reminders, and local, familiar settings they can walk to without being reliant on public transport. So that’s why their GP surgeries are still preferred, because I think even small degrees of friction will lead to quite a large scale of missed vaccinations.’

The committee also questioned Dr Bramall on changes to the GP contract for this financial year, which are meant to incentivise improved vaccination rates.

Dr Bramall told the committee that the changes do not go far enough, adding: ‘It’s a few pence for extremely challenging populations, and you’ll only get it if you manage to make quite a significant uplift.

‘It’s short termism, we know that’s in the contract this year, but short-term funding pots don’t really do very much, so I think that commissioning needs to reward coverage and equity, not just the throughput.

‘And unfortunately, this year’s imposed contract changes reward the throughput and the access is designed around the system, not around families.’

Professor Tzortziou Brown told the committee that ICBs have the opportunity to ‘target funding where there is more need’.

She said: ‘It’s not just about funding, I would say it’s also about targeted workforce distribution too, because in practices serving more deprived populations, we have fewer GPs and also fewer numbers of other members of staff that can be very valuable for the delivery of the vaccination programme.

‘So in summary, I would say that the GP-led model for childhood vaccinations is fundamentally strong and has a proven track record of high performance, and the challenge we face now is not redesigning that model, but ensuring that it is adequately supported to meet current demands and reverse the recent decline in uptake.’

She pointed to the UKHSA parental attitude survey last year which found that the GPs were ‘the most trusted individual source’, with 67% of parents ranking them in their top three most trusted sources.

Professor Tzortziou Brown added: ‘This demonstrates that both GPs and our practice nurses are well equipped to have these conversations [about vaccinations]. They can communicate well with parents.

‘But I think this is not so much a matter of training or having the knowledge to do it. It is more a matter of applying it in practice, and therefore it becomes a matter of capacity and the time to have these conversations when we are so inundated with so many other demands.’