The GP model isn’t why the childhood vaccination programme is failing
Pulse editor Sofia Lind argues that the GP-based childhood vaccination programme doesn’t need fixing – but general practice as a whole does
England’s childhood vaccination programme is clearly not working, with measles making a comeback in every region of the country this year. Entirely preventable, and definitely someone’s fault.
The House of Commons Health and Social Care Committee very reasonably urged the Government to declare the programme a ‘failure’ earlier this year, encouraging it to throw out the model and start over.
This week though, the Government said it would not do that. Unusual as it may be for me to agree with Government policy on general practice in this blog, in this case I do.
As BMA GP Committee chair Dr Katie Bramall and RCGP chair Professor Victoria Tzortziou Brown both argued while giving evidence to the House of Lords’ vaccination committee last week, childhood vaccination sits correctly and naturally with GP practices and their registered patient lists.
Having said that, the Government’s response to the health select committee did not make particularly uplifting reading – it was mainly a list of ‘this is what we’re already doing’, and general practice was mentioned in the usual ‘we’ve already given it more funding’.
This year’s QOF updates did include an incentive for practices that successfully boost childhood vaccination uptake. But as the GPC and RCGP leaders pointed out, there are much larger problems that have undermined the childhood vaccination programme in general practice.
Not too long ago, the MMR vaccine was meeting or near-meeting the NHS’s 95% uptake target so what has changed since? Yes, the post-Covid rise of vaccine scepticism being peddled on social media probably has something to answer for, but studies have shown that the most trusted sources for vaccine information is health professionals.
And regardless of rhetoric in the past decade – including the current Government – it is the precise opposite of continuity of care that is being incentivised in general practice via contracts. Focusing on digital tools and same-day access is not going to help GP practices do the desired ‘outreach’ to tackle vaccine hesitancy.
It is the age-old dilemma, but little pots of funding are not going to resolve the problem of recurrence of childhood illnesses that children do not need, and should not, acquire in our modern times.
Economic inequalities have also been growing in the timeframe during which vaccine uptake has been slipping and that is no coincidence. The ongoing Carr-Hill formula review is therefore another avenue where the problem could be tackled more meaningfully (although it will not be as effective as reducing the health inequalities themselves would be).
The health select committee urged the Government to expedite its pilots of health visitors taking on more childhood vaccination responsibilities. While they very likely have a huge role in discussing vaccines with patients , there is a risk to fragmenting the model.
Taking childhood vaccination off GPs is not going to solve the problem, but fixing general practice as a whole has great potential.
Sofia Lind is editor of Pulse. Find her at [email protected] or on LinkedIn
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READERS' COMMENTS [6]
Please note, only GPs are permitted to add comments to articles
As we head towards another global crisis, it’s clear our political and managerial class (still pursuing failed neoliberal economics while the global order of capital and its flow is being reshuffled), have not been fit for the purpose of making the UK work. No lessons have been learned from the 2008 crash so that credit-creating bankers are still running wild with private debt. Await another, possibly bigger, crash happening soon.
In a way, you can understand the rise of a Trump and his America First as the symptom of this general failure of western economic policies based on extraction, failure to abide by the limits set by the laws of thermodynamics, and unsustainability. Who will pay the piper for successive governments slavish indulgence of gamblers in the finance sector?
It’s time for the ascendancy of economic theories of co-operation rather than competition. “We’re all in together”.
In my working lifetime, GPs ran the vaccination scheme perfectly well, until it was screwed up by interference from stupid, captive politicians.
I was in GP from 1974 to 2020.a propos vaccination I would talk to my mums in late pregnancy and post natally re this (and contraception) and sort any queries in passing. I remember explaining the relative risk to a dad who stopped me to say “What did you do with your children?” “got them done” “OK carry on” end of discussion. GP is an ongoing relationship over decades building trust and, frankly, getting it right for patients far more often than not.
To borrow from Bill Clinton ” It’s the continuity stupid”. Trust may still be higher for health care professionals than others but it is falling as part of a general decline in public trust for institutions. Inequality has been fairly static or gone down slightly in the last decade (ONS GINI data) and the pattern is international so we cannot put all the blame here.
Of course we can have little influence over many of the factors responsible but we are not alone in this. All of us see patients who are struggling in a system over which they have little control. We can be sympathetic and understanding but our job is to help give them agency in areas where they can make some change. Perhaps we need to do the same ourselves.
Paul, I read your comment with interest. You diagnose a “general decline in public trust for institutions” but make no effort to name any possible causes for what could have caused the decline eg in the NHS (eg funding, political interference), but instead you comment about “declining inequality” , quoting ONS Gini index.
The UK is the 9th most income unequal country in the OECD. And wealth inequality is even more severe.
You do know the outdated Gini coefficient, invented in 1912, cannot hope to capture the nature of inequality in an entire country……..but many Adam Smith Institute types and Tory politicians are always careful to just refer to Income Inequality. But accumulated wealth is now a very important component of inequality: 10% of the UK population own over 45% of total wealth (ONS).
Also, there are separate Gini indices for property wealth, financial wealth and private pension wealth, also published by the ONS, that all have much higher values than the index for income (care to comment?). For poorer people, unlike us GPs, effective disposable incomes are also crucial.
For a detailed critique of why the Gini index is outdated and misleading, try Piketty.
I think most people are tired of Adam Smith Tory types spin after their 14 years of ruinous misrule.
Inequality increased under Labour redistributive tax and benefits policies Bird.
Agree with you, Guy, that income inequality increased under Bliar’s Labour. But for the reason that incomes at the top end shot up under neoliberal policies.
The redistribute tax and benefits policies helped the poor but they couldn’t keep up with the magic money tree increases for the rich.
If we are to have this “democracy” instead of communism or fascism, then our uniparty politicians need to start understanding that they’re elected, by definition, to serve the majority and not just the rich and corporates (that would be oligarchy).
Oh, and consider abolishing independence for the BoE and “nationalising” the Square Mile (hear bankers gnash their ravening teeth). Food for thought.