As summer approaches, and patients travel to exotic climes, they will often come to us for their travel vaccinations. But can we charge for them? The situation is clear as mud, in the best tradition of GMS regulations.
Which vaccines do I have to administer without charge?
To look at what immunisations you can or cannot charge for, we must turn to the Red Book, which has been incorporated into the GMS contract. All of the vaccines that were in the Red Book as part of GMS before the 2004 contract are to be administered to patients free, as the fees we used to claim were rolled over into the global sum. The list is short: typhoid and paratyphoid, cholera (doesn’t specify injection, merely vaccination so applies to oral vaccine as well), poliomyelitis, hepatitis A (called infectious hepatitis in the Red Book) and smallpox. We are expected to provide these under GMS, and, where they are not supplied centrally, we should issue NHS prescriptions for them.
Which vaccines can I charge patients for?
Everything else (vaccines not mentioned in the Red Book) must be done privately, and for an appropriate fee. These include: Japanese B encephalitis, tick-borne encephalitis and rabies. Yellow fever vaccination can only be undertaken at an approved centre.
How much should I charge?
While competition rules prevent me suggesting an exact fee, a suitable fee should be set according to the time taken to vaccinate and record, the salary band of the vaccinator and the costs associated with maintaining the cold chain if you provide the vaccines in house. Alternatively, you can give the patient a private prescription for obtaining the vaccine from a pharmacy and then calculate the administration cost of the vaccine. Remember, you are a business and are expected to include a profit element in your calculation.
Which vaccines can I choose to give on the NHS or privately?
More confusingly, there are some vaccines you can give on the NHS or privately, for example hepatitis B and meningitis ACWY. There may be local provisions for this, but there is no GMS funding for hepatitis B for travel. If you do these on the NHS, you could claim reimbursement through the drug personal administration scheme or issue the patient with a prescription for them to get the vaccine from a pharmacy.
As these are not Red Book vaccines and as payment may not be forthcoming from the NHS the prudent advice might be to charge for them unless specifically requested (and funded) by the NHS.
The combined diphtheria, tetanus and polio and combined hepatitis A and B injections are contentious. You cannot claim for hepatitis B, tetanus or diphtheria, but are expected to provide them when they are in combined vaccines that you cannot charge for.
Should I be advertising this service?
You can publicise your service, but the GMC still has some rules about advertising. Waiting-room posters, clearly mentioning the private nature of most of these services are useful, and it should certainly be included in your practice leaflet. If you are on good terms with your local pharmacist, they might publicise the service for you. It would also be worth contacting all the travel agents in your area and give them details of your service – many holidays are still booked without going online.
What about patients who get all vaccines for free?
Those working abroad under certain circumstances in certain industries may get travel vaccinations for free. Again, these specific occupations are defined in the Red Book. However, based on the precedent from flu immunisation, the employer or work organiser should be responsible for funding this. Check first whether the responsibility lies with the employer. There are also a number of people going abroad to do voluntary work, and in my practice we have provided vaccinations at reduced cost to this group.
What needs to be done to solve the confusion?
A definite policy on travel vaccinations needs to be established by the Government in order to avoid the confusion that seems to reign at present. I am often asked if a vaccine can be prescribed on the NHS, as very few are ‘blacklisted’, and there doesn’t seem to be a definitive answer.
Currently we appear to be contractually bound to provide those outlined in the Red Book, but beyond that it is unclear.
Dr Phil White is a GP in North Wales, secretary of North Wales LMC and GPC Wales negotiator and immunisation lead