NHS England has clarified that exception reporting in specific circumstances for childhood immunisations QOF targets are included in the 2023/24 contract, despite fears there had been a U-turn.
A spokesman confirmed that details and coding on personal care adjustments (PCA) – also known as exception reporting – for indicators VI001, VI002 and VI003 are set out in the QOF business rules document, which he said ‘should be read’ alongside QOF guidance.
It now allows exception reporting, for example, where a child with an incomplete vaccination status registers at a practice too late in the financial year for it to be completed, or is too old for the programme.
Concessions to the controversial childhood immunisations programme were welcomed when they were announced as part of the letter announcing the GP contract imposition last month.
However, there were worries these changes had been dropped or forgotten when the Government’s Statement of Financial Entitlements (SFE) and 2023/24 QOF guidance were later published by NHS England. These stated that the only form of exception reporting allowed for the three childhood immunisations indicators was related to clinical contraindications, with no changes to the previous years’ contracts.
An NHS England spokesman has now said: ‘The PCA referred to is included in the 2023/24 contract and there has been no U-turn.’
He explained that it falls under the criterion in the QOF guidance, ‘The intervention described in the indicator is clinically unsuitable for the patient.’
Dr Clare Bannon, BMA GP Committee England deputy chair, had said they had fought hard for this change to childhood immunisations targets during negotiations, ‘so that practices do not miss out on vital funding through no fault of their own.’
Meanwhile, the latest Primary Care Bulletin from NHS England also said an update has been made to the SFE from 1 April 2013, to clarify that practices are eligible for the £10.06 item of service fee ‘for additional vaccines administered to eligible individuals where clinically indicated for medical reasons, including post-transplant, in line with the Green Book’.
Details of the vaccinations this applies to can be found in Section 19, paragraphs 4 and 5 of the SFE.
Changes to childhood immunisations exception reporting
Other than contraindications, the QOF business rules 2024 sets out that exception reporting is allowed for:
Indicator VI001: The percentage of babies who reached 8 months old in the preceding 12 months, who have received at least 3 doses of a diphtheria, tetanus and pertussis containing vaccine before the age of 8 months.
Patients… who have registered in the practice with an incomplete vaccination status where the practice does not have sufficient time to complete the vaccination doses prior to the patient reaching 8 months i.e. patients who meet any of the following criteria:
- Patient was registered on or after the date they reached 8 months of age (248 days old).
- Patient was registered on or after the date they reached 7 months of age (217 days old) and had received only two, or fewer, doses of a diphtheria, tetanus and pertussis containing vaccine prior to registering.
- Patient was registered on or after the date they reached 6 months of age (186 days old) and had received only one dose, or no doses, of a diphtheria, tetanus and pertussis containing vaccine prior to registering.
- Patient was registered on or after the date they reached 5 months of age (155 days old) and had received no doses of a diphtheria, tetanus and pertussis containing vaccine prior to registering.
Indicator VI002: The percentage of children who reached 18 months old in the preceding 12 months, who have received at least 1 dose of MMR between the ages of 12 and 18 months.
Patients..who have registered in the practice with an incomplete vaccination status where the practice does not have sufficient time to complete the vaccination doses prior to the patient reaching 18 months i.e. patients who meet any of the following criteria:
- Patient was registered after they reached 18 months of age (558 days old).
- Patient was registered after they reached 17 months of age (527 days old) and had not received their first MMR vaccine prior to registering.
Indicator VI003: The percentage of children who reached 5 years old in the preceding 12 months, who have received a reinforcing dose of DTaP/IPV and at least 2 doses of MMR between the ages of 1 and 5 years.
Patients…who have registered in the practice with an incomplete vaccination status where the practice does not have sufficient time to complete the vaccination doses prior to the patient reaching 5 years i.e. patients who meet any of the following criteria:
- Patient was registered after they reached 5 years of age.
- Patient was registered after they reached 4 years 9 months of age and had not received an MMR vaccine or a reinforcing dose of DTaP/IPV prior to registering.
- Patient was registered after they reached 4 years and 10 months of age and received only one dose of an MMR vaccine and no DTaP/IPV vaccine prior to registering.
- Patient was registered after they reached 4 years and 10 months of age and received only the booster dose of DTaP/IPV vaccine and no MMR vaccine prior to registering.
- Patient was registered after they reached 4 years and 11 months of age and received only two doses of an MMR vaccine and no booster dose of DTaP/IPV vaccine prior to registering.
- Patient was registered after they reached 4 years and 11 months of age and received only one dose of the MMR vaccine and the booster dose of DTaP/IPV vaccine prior to registering.
