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New vaccination strategy signals end to GP practice incentives

by Anna Colivicchi and Rima Evans
14 December 2023

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Vaccinations will become part of a ‘one-stop shop’ with NHS staff set to expand the offer of blood pressure tests and other health checks and advice alongside routine vaccinations, NHS England has announced.

The long-awaited national vaccination strategy document, published yesterday, may also see the end of the current GP practice vaccination enhanced services and QOF targets, with ICBs set to take over population-level management.

The strategy does not suggest taking vaccinations away from practices but indicates programmes should be led from PCN rather than practice level.

And while NHS England (NHSE) will maintain overall accountability for vaccination services, it will delegate commissioning responsibility to ICBs, with the intention that all ICBs take this on by April 2025.

The plan said it is looking at the funding arrangements for vaccination adding that a ‘consistent national financial framework is valued’.

‘We…heard that the way current primary care incentive schemes for vaccination are structured may not maximise our opportunities to address disparity in uptake’ it stated.

‘During 2023/24 we are… considering how we can maintain a consistent national financial framework and national item of service fee, while giving systems greater flexibility over how they direct their resources. This is in line with the Fuller Stocktake recommendation to amalgamate existing primary care funding where possible and maximise system decision-making on discretionary investment. The aim is to rebalance funding to increase uptake in underserved populations and tackle wider health inequalities.’

Meanwhile, the vaccination plan also said that local health teams ‘will have more flexibility’ to locate vaccine services in convenient local places such as community centres, sport facilities and places of worship.

Infants and pre-school children vaccinations will ‘likely’ continue to be delivered within general practice, while adult vaccinations will be at ‘a range of locations depending on circumstances’, NHS England has said.

Routine and seasonal vaccinations delivered to for school-aged children are likely to be at primary and secondary schools.

Making vaccination a central role of integrated neighbourhood teams could support ‘a more joined-up offer to the public’, the strategy added, by aligning it with, for example, delivery of other preventative services.  This would maximise vaccination uptake as well as uptake of other health services such as smoking cessation or asthma checks.

In 2025/26, people will be able to access their own vaccination record through the NHS App and book vaccinations.

And NHS England will make changes to GP IT systems in 2024/25 that will ‘improve the visibility of vaccinations’ delivered by GPs and other providers and help ‘ensure a consistent view’ of a patient’s vaccination status.

‘Within our digital changes, a key target will be to ensure timely and accurate data is available from GPs and other providers, to ensure a consistent view of uptake across all vaccination services,’ the document said.

‘Visibility of this data at national, regional and local level will support planning of targeted outreach services, building on the approach for COVID-19 and flu.’

The strategy has also said it will look at the option of centralising procurement and supply of the adult flu vaccine in an effort to eradicate problems with procurement experienced at local level.

It explained: ‘We will undertake cost–benefit analysis, in partnership with the Department of Health and Social Care (DHSC), UK Health Security Agency (UKHSA) and NHS Supply Chain, to explore whether centralising the procurement and supply of adult flu vaccine could deliver better outcomes and address the existing clinical, operational and financial challenges associated with local procurement.’

However, it confirmed the procurement and supply of COVID-19 vaccines, like most vaccines for the NHS programme will remain centralised.

In addition it is proposed that a vaccination workforce be developed that has ‘a skill mix that makes best use of trained, unregistered staff where clinically appropriate and subject to the appropriate legislation, and focuses registered staff on activities where they can bring most benefits including delivering other health and wellbeing interventions alongside vaccination’.

Some of the actions included in the strategy will begin to be implemented in 2023/24, with ‘as many changes as possible’ to be brought in from 2024/25 and most of the proposals set to be delivered by 2026 (see also box below).

Health minister Maria Caulfield said: ‘To ensure as many people get vaccinated as possible, we need to make sure the programme fits around people’s lives.

‘The Vaccine Strategy will build on the brilliant work already underway to make it easier than ever to get vaccinated and to reach people who would not typically come forward for their jabs.

‘Whether it’s booking via the app or stopping in while at parents evening with your children – we are unveiling new, innovative ways of getting these lifesaving jabs and easing pressure on the NHS.’

Implementation timescale

In 2023/24, start to implement some of the actions in this strategy. These include:

  • developing the roadmap to delegation of commissioning responsibility
  • drafting new service specifications and developing commissioning, contracting and procurement options
  • building digital services capability.

In 2024/25, the aim is to implement as many changes as possible, which may include:

  • moving towards shadow population-based ICS-level budgets for vaccination, using 2023/24 to explore the benefits and risks of this approach with systems
  • some commissioning and contracting changes
  • more formal joint working between regional commissioning teams and ICBs as a step towards full delegation
  • delivering some changes to digital services.

NHSE said it expects most of the proposals in this strategy will be delivered by 2025/26.

Source: NHS England vaccination strategy

A version of this article was first published on our sister publication Pulse