This site is intended for health professionals only

GP leaders warn central procurement ‘will hit flu vaccine uptake’

Government proposals to centrally procure flu vaccine will be a 'pay cut' for practices and will result in them abandoning the vaccination programme, the BMA and the RCGP have warned.

The GP leaders also warned there is no evidence the change would prevent the flu vaccine shortages seen in last year's vaccination campaign, or increase uptake rates in at-risk clinical groups.

They say they are 'unconvinced' by the Government's economic modelling as 'recent experiences of the central supply of Pandemrix have show that central procurement was ineffective at providing influenza immunisation.'

The Department of Health has consulted on a new system of procurement for flu vaccine, which would strip GPs of the role of ordering stocks for their own clinics and deny them any profits made, in order to ‘tender for a direct contract of flu vaccine – distribution by manufacturers or specialised cold chain distributor.'

The DH has estimated that the change would cost GPs ‘about £20m, or £555 each', which ministers offered to reimburse, at least in part, through the GP contract.

But in its response to the consultation, which closes today, the BMA defended the current system, insisted it worked well in England, and warned that ‘moving central procurement of seasonal flu vaccine would risk making matters worse.'

Both the BMA and the RCGP responses argued the proposals would decrease the incentive for practices to run flu vaccination clinics and make them financially unviable.

The RCGP said: 'The proposed changes reduce incentives for GP practices. This may be followed by a reduction in the uptake and rate of flu vaccination. High immunisation rates rely on the enthusiasm of the team and removing incentives could have negative effects on this.'

'In order to run the flu vaccine clinics alongside normal working time, staff hours need to be paid for. GPs need to finance extra clinics such as weekend and evening clinics and the removal of incentives could have an effect on the survival of these out-of-hours clinics and the immunisation rate could drop.'

'The net result might be that the administration of vaccines would be much less of a priority for the already financially squeezed surgeries.'

While the BMA said that it believed that the Government had overestimated the potential savings and 'was not convinced that bulk procurement of vaccine would achieve savings.'

‘This proposal could actually reduce the incentives for practices that currently have a huge incentive to use their immunisations on the margins of their order unless they have sale or return.  Even then, with on-cost incentives to immunise, rates are almost guaranteed to be higher.'

‘Although having providers competing for these bulk purchases would drive costs down initially, the fact that many GPs might find that there was little economic argument to continue vaccinating may result in the costs of vaccinating rising, as few other vaccinators could do it at the marginal costs delivered by NHS GPs.'

Instead the current system should be maintained the BMA said, ‘where GPs would continue to procure flu vaccinations, but concentrate on increased uptake and some kind of central reserve stock.'

It proposed ‘build on the existing system by giving legal permission for practices and PCTs to share stocks, and for PCT clusters and their successors to hold emergency stocks that could be called on in exceptional situations.'

‘Consideration needs to be given to how flu vaccines will be delivered to practices when PCTs no longer exist', it added.

GPC chair Dr Laurence Buckman told Pulse: ‘GPs drive a tougher bargain than most of the NHS does. It's a knee jerk reaction to finding out not everybody wants to be vaccinated and it's convenient to blame GPs.'

‘This is effectively going to be a pay cut for English practices. There are lost of things that GPs could do, as part of a DES or through the central contract, and we would discuss this if ministers want to push this through but we would urge them to heed our advice.'