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Practices to miss out on funding as NHS opens up DES to competition

Exclusive GPs are concerned about their finances after an NHS England regional team opened up the DES for practices to administer flu and pertussis vaccinations for pregnant women to competition from trusts. 

NHS England has asked hospital trusts across the West Midlands if they will sign up to carry out the DES, offering the same tariff price as GP practices receive (£9.80).

So far, eight trusts have expressed an interest with a pilot likely to start for this winter’s flu season, NHS England said.

The area team claim that only 50% of pregnant women in the region have these vaccinations, compared with 75% across the rest of the country, and this new scheme will help increase access. 

But GP leaders said the move could lead to GPs losing ‘a large amount of money’ and being left with unused flu vaccine.

The news comes as over half of GP practices were left with unused flu vaccine at the end of the last flu season following the last-minute introduction of a national pharmacy scheme that encouraged patients to get their flu jabs from their pharmacist, while a third said they lost out financially as a result.

Earlier this year, a BMJ Open study of the pan-London seasonal influenza programme – which was set up in 2013/14, before a similar national scheme was rolled out – found uptake did not change after pharmacies started offering the flu jab to eligible groups of patients in the 2013/14 flu season.

But, despite this, the NHS England West Midlands local area team are looking to roll out the flu and pertussis vaccination for pregnant women DES to secondary care providers. 

NHS England (West Midlands) said that currently in the West Midlands only 50% of pregnant women have had these vaccinations, compared to 75% nationally and that ‘therefore the aim of the pilot is to improve pregnant women’s access to immunisations, improve uptake and reduce the number of cases of flu and pertussis in pregnant women and in vulnerable newborn children’.

Nicola Benge, NHS England (West Midlands) consultant lead for screening and immunisation, said: ‘NHS England (West Midlands) has asked all maternity services in Coventry, Warwickshire, Herefordshire, Worcestershire, Birmingham, Solihull and the Black Country to express interest in providing flu and pertussis immunisations to pregnant women.

‘Eight maternity services, including Walsall Healthcare NHS Trust, have expressed interest in service provision and if details can be agreed with those trusts, a pilot scheme could commence in time for the 2016/17 flu season.

NHS England said this was ‘in line with national guidance which states that NHS England will explore ways of commissioning midwifery services to provide flu vaccinations’ and pregnant women could still see their GP or pharmacist if they prefer.

Ms Benge added that NHS England will ‘now work with local GPs and LMCs on next steps’.

But Walsall LMC medical secretary Dr Uzma Ahmad said that ‘bringing in competition’ over a DES would ‘of course lead to a large amount of money lost from general practice overall’.

She added that she realised NHS England had to tackle low take-up figures but that her preferred route would have been to engage with practices to boost take-up via the LMC – especially as women visit their GP more often than hospitals during pregnancy.

She said: ‘My concern is that we have got a 100% sign up to this DES, meaning there is a willingness to provide the service. There might be practices which do not have enough uptake, and there may be practices which have a good uptake. So practices providing a good service are going to lose it out from next year.

‘It causes implications because we buy the vaccines but we don’t know how many patients will end up [having their vaccinations] over there [in the hospital instead], because it is a competitive service.’

She said that since NHS England was not asking GP practices to stop providing the vaccinations, they would have to ‘anticipate the same uptake as last year’ and may therefore be left with unused vaccine.

Dr Ahmad added: ‘At the end of the day, the meaning is that if this is going to go ahead, then another DES is gone from us. As it is a DES, there should be some discussion and, as the LCM we could have pushed the practices to do it.’

Pulse today revealed that CCGs have increased funding into enhanced services by 75% since 2013/14.