Vaccination Guidance for Primary Care Practitioners
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Vaccination Guidance for Primary Care Practitioners
Introduction
This guidance has been developed to clarify national guidance on which immunisations may be
prescribed on the NHS and which should be privately prescribed when requested prior to travel, for
occupational reasons and for patients in at-risk groups. Confusion can arise between the clinical
advice for when to administer a vaccine, as set out in the Green Book1, and the regulations
indicating how practices are paid (the former Red Book).
The areas covered by the guidance include:
Travel vaccines
Occupational health vaccines
The childhood primary immunisation schedule, national vaccination programmes (including catch-up
programmes) and vaccination of ‘at risk’ groups as indicated by Public Health England are not
covered by this guidance.
Data from PrescQIPP2 shows that Telford & Wrekin CCG spends £8,000 per year on vaccines
potentially not suitable to be prescribed on the NHS as they are mainly used for travel.
Practice reimbursement for vaccinations
Vaccines available to be administered at NHS expense can either be:
Purchased by the practice and claimed as a personal administration expense through
FP1034PD3
Obtained by the patient on FP10 prescription. A prescription charge is payable unless the
patient is exempt. In this situation no claim for personal administration fees should be made
through FP34PD.
For travel vaccines not available on the NHS a charge may be levied for:4
The vaccine
Administration
Private prescription writing (if applicable).
The level of charges should be determined by the practice; it is advisable to develop a practice
protocol available to patients in the form of a leaflet or section of the practice leaflet or website.
Patients should be advised to compare prices as there may be variation in the amount that
individual pharmacies will charge to supply the vaccination. Alternatively, practices may choose to
buy in the vaccine directly and charge patients for the cost of the vaccine. In this situation, practices
should ensure that patients are informed of the charge they will incur before the vaccine is given.
Possible charges after vaccination:
Post-vaccination serological testing in the case of Hepatitis B administration, if performed for
travel reasons.
Provision of certification of immunisation (for example, confirmation of Meningitis ACWY135
administration).
MG/ Vaccination Guidance for Primary Care Practitioners July 2016 Review date July 2019. Adapted from PrescQIPP Bulletin 74
Travel vaccines (DROP-List) and NHS Mid Essex Locality guidance.Travel Vaccines
NHS patients are entitled to receive advice on recommended immunisations and malaria
prophylaxis free of charge5
Vaccines not allowed on the NHS should not be prescribed or supplied on the NHS for
travel purposes. Patients should be charged for these vaccinations and associated costs
Hepatitis B vaccination is not commissioned under the NHS and should be prescribed
privately
Practices who offer private services and make a charge for travel vaccines are advised
to develop a practice protocol which is available to patients for example in the form of a
leaflet or as a section on the practice website.
Patients should be advised to shop around as there will be a variation in the charges
made by different providers.
Consider the cost of the vaccine used – single vaccines are cheaper than combined in
the case of hepatitis A and typhoid (they also have different booster dosage schedules)
Vaccinations which are available on the NHS are part of additional services under GMS
and PMS. Registered patients should not be charged for the provision of these vaccines.
Practices can opt out of this provision and refer patients to a travel clinic 6
Table 1 - Travel vaccines available/not available on the NHS
Vaccine Available on Dose** Price per Potential
NHS dose* charges
BCG NO By intradermal N/A Referral to a
injection ADULT and respiratory clinic
CHILD over 1 year, is recommended
0.1 mL; NEONATE for tuberculin
and CHILD under 1 testing and follow
year, 0.05 mL up for all patients
requesting
vaccination.
CHOLERA YES ADULT and CHILD Dukoral® £23.42 None
BUT not over 6 years, 2 doses (2 dose pack)
indicated for separated by an
most travellers interval of 1–6 weeks;
CHILD 2–6 years, 3
doses each separated
by an interval of 1–6
weeks
DIPTHERIA/TETANUS/ YES The dose for children Revaxis® £6.50 None
POLIO Stock centrally from the age of six
funded by the years, adolescents
Department of and adults is 0.5 mL
Health as part of
the
Childhood
immunisation
programme
must NOT be
used for the
purposes of
travel
HEPATITIS A YES One dose followed by Havrix None
booster dose after 6- Monodose®
12 or 6-18 months £22.14
later dependent on Havrix Junior
product used. Monodose®
£16.77
MG/ Vaccination Guidance for Primary Care Practitioners July 2016 Review date July 2019. Adapted from PrescQIPP Bulletin 74
Travel vaccines (DROP-List) and NHS Mid Essex Locality guidance.Vaqta® Adult 1-
mL prefilled
syringe £18.10
Vaqta®
Paediatric
£14.74
Avaxim® £18.10
HEPATITIS YES One dose, for booster Hepatyrix® None
A/TYPHOID Hepatitis dose-see individual £32.08
A/Typhoid component. ViATIM® £29.80
available on
NHS, booster
dosage not
aligned so
consider
separate
vaccines.
HEPATITIS B NO See Individual Engerix B® Private
(Except for product. £12.99 (prefilled prescription
travellers to syringe) Cost of vaccine
areas of high (under 16 years Administration
prevalence who £9.67)
intend to seek Fendrix® £38.10
employment as HBvaxPRO®
healthcare £12.20
workers or stay (under 16 years
for long periods £8.95)
(3 months or
longer) and for
travellers with
pre-existing
medical
conditions who
may be at higher
risk of requiring
medical
procedures
abroad.
JAPANESE NO Dose by intramuscular Ixiaro® Private
ENCHEPHALITIS injection in deltoid £59.50 prescription
region, ADULT over Cost of vaccine
18 years, 2 doses of Administration
0.5 mL separated by
interval of 28 days;
booster dose 1–2
years after completing
primary course, but for
those at continued risk
the booster dose
should be given 1 year
after completing the
primary course;
CHILD 2 months–3
years, 2 doses of 0.25
mL separated by
interval of 28 days;
CHILD 3–18 years, 2
doses of 0.5 mL
separated by interval
of 28 days
MG/ Vaccination Guidance for Primary Care Practitioners July 2016 Review date July 2019. Adapted from PrescQIPP Bulletin 74
Travel vaccines (DROP-List) and NHS Mid Essex Locality guidance.MENINGOCOCCAL - NO Single dose Menveo® £30 Private
MENINGITIS ACWY Nimenrix® £30 prescription
Cost of vaccine
Administration
Certification
RABIES NO 1 mL on days 0, 7, Rabipur® £28.80 Private
and 28 (3rd dose can prescription
be given from day 21 if Cost of vaccine
insufficient time before Administration
travel)
TICK-BORNE NO ADULT and CHILD TivoVac® £32.00 Private
ENCHEPHALITIS over 16 years, 3 doses TivoVac Junior® prescription
each of 0.5 mL, £28.00 Cost of vaccine
second dose after 1–3 Administration
months and third dose
after further 5–12
months; CHILD 1–16
years 3 doses of 0.25
mL, second dose after
1–3 months and third
dose after further 5–12
months; ELDERLY
over 60 years and
immunocompromised
(including those
receiving
immunosuppressants),
antibody concentration
may be measured 4
weeks after second
dose and dose
repeated if protective
levels not achieved
TYPHOID YES 0.5 mL at least 2 Typhim Vi® None
weeks before potential £9.30
exposure to typhoid Typherix® £9.93
infection
YELLOW FEVER NO ADULT and CHILD N/A SPECIALIST
Only available at over 9 months, 0.5 mL CENTRES ONLY
designated
Yellow
Fever
Vaccination
Centre
* Based on BNF 68 September 2014-March 2015
** For full dosage information, check the BNF and the individual vaccine Summary of Product
Characteristics.
MG/ Vaccination Guidance for Primary Care Practitioners July 2016 Review date July 2019. Adapted from PrescQIPP Bulletin 74
Travel vaccines (DROP-List) and NHS Mid Essex Locality guidance.Table 2 - Occupational Health
Under the Health and Safety at Work Act7, employers must pay for protective measures
such as immunisation. In occupations where there is a risk to health from any form of work
related infection it is the employer’s duty to assess that risk and, if present, to protect the
workforce.8
Vaccine Indication Available on NHS Advice
HEPATITIS A Vaccination is NO Workers should be
recommended for certain advised to contact their
at-risk occupational occupational health
groups (laboratory department for advice &
workers, some staff of vaccination. If no
large institutions, sewage occupational health
workers and staff who service exists, the
work with primates), and employer should be
should be considered in advised to make private
certain circumstances for arrangements with
others (food handlers, another practice or
day care workers, occupational health
healthcare workers). service provider
HEPATITIS B Healthcare workers in the NO A GP need not provide
UK and overseas Hepatitis B immunisation
including students and for occupational reasons
trainees for a registered patient
under essential or
Laboratory staff additional services. It is
the employer’s duty
Staff of residential and rather than the GP’s
other accommodation for responsibility to ensure
those with learning that an ‘at risk’ employee
difficulties does not work until they
have been appropriately
Other occupational risk vaccinated and a full risk
groups such as assessment has been
morticians & embalmers, performed.
prison service staff who
are in regular contact The GPC view is ‘there is
with prisoners, police and no obligation under the
fire and rescue services. regulations governing GP
contracts to administer
such vaccinations for
occupational reasons.
Patient should be
referred to the
employer’s occupational
health department’.
Template letters for
dealing with requests for
Occupational Health
cover can be obtained
from the GPC document
‘Hepatitis B immunisation
for employees at risk’8
MG/ Vaccination Guidance for Primary Care Practitioners July 2016 Review date July 2019. Adapted from PrescQIPP Bulletin 74
Travel vaccines (DROP-List) and NHS Mid Essex Locality guidance.Resources for further information Further information on which vaccinations are necessary or recommended for the areas your patients will be visiting are available on these two websites: • Fit for Travel9 • National Travel Health Network and Centre (NaTHNaC)10. NHS patients are entitled to receive advice on recommended immunisations and malaria prophylaxis free of charge11. Further information on individual vaccines is available from the Summary of Product Characteristics (SPC) available at www.medicines.org.uk. Some countries require an International Certificate of Vaccination or Prophylaxis (ICVP) before you enter12 (e.g.many tropical countries in Africa and South America will not accept travellers from an area where there is yellow fever unless they can prove that they have been vaccinated against it. Saudi Arabia requires proof of vaccination against certain types of meningitis for visitors arriving for the Hajj and Umrah pilgrimages. Providing a certificate of vaccination in such cases can be charged for. Local yellow fever centres can be found at https://www.nathnac.org/yellowfevercentres.aspx?comingfrom=travel 1 Dept of Health “Immunisation against Infectious Disease” (Green Book) available at https://www.gov.uk/government/collections/immunisation-against-infectious-disease-the-green-book 2 PrescQIPP Bulletin 74 Travel Vaccines DROP List 3 http://www.nhsbsa.nhs.uk/PrescriptionServices/933.aspx 4 GMS Regulations (Schedule 2, paragraph 4 and Schedule 5, paragraph 1 (g)) 1st March 2004 http://www.legislation.gov.uk/uksi/2004/291/schedule/2/made 5 http://www.legislation.gov.uk/uksi/2004/291/schedule/2/made 6 Focus on Hepatitis B Immunisations General Practitioners Committee August 2012 7 Health and Safety Executive Regulations 2002(as amended) http://www.hse.gov.uk/biosafety/blood-borne- viruses/immunisation.htm 8 BMA, Focus on hepatitis B vaccines, August 2012 http://bma.org.uk/practical-support-at-work/gp-practices/focus-hepatitis-b-immunisations 9 Fit for Travel. http://www.fitfortravel.nhs.uk/advice.aspx 10 National Travel Health Network and Centre (NaTHNaC) http://www.nathnac.org/travel/index.htm 11 Focus on travel immunisation, BMA. November 2012. http://bma.org.uk/practicalsupport-at-work/gp- practices/focus-travel-immunisation 12 World Health Organisation, International health regulations 2005 http://www.who.int/ihr/ports_airports/icvp/en/ MG/ Vaccination Guidance for Primary Care Practitioners July 2016 Review date July 2019. Adapted from PrescQIPP Bulletin 74 Travel vaccines (DROP-List) and NHS Mid Essex Locality guidance.
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