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NHS England wrote off £4.2m ‘overpayment’ to practices for childhood immunisations

by Emma Wilkinson
8 February 2023

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NHS England has said it will not claw back £4.2 million ‘overpayment’ from GP practices that did not meet childhood vaccination targets last year.

In its annual report, NHS England listed the overpayment figure in a section on cash losses after a review found that practices were struggling to hit targets for reasons outside their control.

After a review of a ‘large number of commissioner and practice queries’ it became apparent that ‘practices were struggling to meet the performance threshold’, the report said.

It confirmed that ‘some contractors could not meet the vaccination targets that were set in relation to routine childhood vaccination and immunisation’, which resulted in an overpayment.

Analysis in October suggested that only 8.1% of practices were able to achieve the maximum vaccination and immunisation QOF score of 64 points in 2021/22.

The annual report went to say that the vaccinations and immunisations repayment mechanism ‘is intended to limit financial gain by practices with lower levels of performance’.

But it noted: ‘The main reasons for this are issues outside of a practice’s control such as increased vaccine hesitancy, people either not coming forward when invited or declining, less ability to opportunistically offer vaccination when children are present in practice for another reason.’

The review also found that the Covid-19 pandemic has impacted on practice capacity, NHS England said.

A new QOF system for vaccinations and immunisation was also introduced in 2021/22, where an item of service payment of £10.06 now applies to each vaccine dose administered and if fewer than 80% of children have the jab then practices may face a clawback equivalent to half the cohort. 

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Concerns had been raised that the new system was overly complex and had the potential to increase inequalities affecting deprived practices more.

It is not clear from the NHS England report if overpayment was decided on a case-by-case basis and how many practices were affected.

Professor Azeem Majeed, professor of primary care and public health at Imperial College London, said: ‘I don’t think my practice was allowed to retain QOF payments for childhood vaccination.

‘Like many practices in inner city areas, we have high levels of deprivation and challenges in addressing vaccine hesitancy amongst parents.

‘Population mobility is a major challenge as we can vaccinate children but then they leave the practice before the QOF target is calculated.’

He added: ‘We do eventually get vaccination rates up to a high level but this takes a lot of work in contacting families and addressing data issues because vaccine data is often missing from medical records when patient register with the practice.

‘This work often goes unfunded because we can’t meet the target in time for the QOF payments.’

‘I hope these challenges for practices in areas where vaccination targets are hard to achieve can be recognised by NHS England. The current system is very rigid and is very demoralising for practices in areas with high levels of vaccine hesitancy.’

A version of this story was first published on our sister title Pulse.