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Targets for childhood immunisations are lowered and ‘clawback’ of payments scheme removed

by Rima Evans
8 March 2023

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Practices that don’t achieve QOF targets for childhood immunisations will no longer face a ‘clawback’ of item of service fees, under the new GP contract imposed by NHS England.

Target thresholds have also been revised and exception reporting for some children introduced.

The changes, which will take effect from April, have been made in response to ‘feedback’ from PCNs and the BMA’s GP Committee, NHS England said in its letter sent to practices on Monday (March 6).

Currently, practices that fall short of 80% coverage for routine childhood immunisations have to make a repayment of item of service (IoS) fees, equivalent to what they would earn for half the cohort.

This system, introduced in 2021/22, along with stricter targets, have led to serious concerns about it widening health inequalities and leading to some practices having to take a substantial financial hit.

The repayment mechanism will now be scrapped under the 2023/24 contract, so practices performing at lower levels will no longer be penalised.

The thresholds for QOF childhood vaccination and immunisation indicators will also be reduced to 89% for VI001; 86% for VI002; and 81% for VI003.  However, the upper threshold for all three will be raised from 95% to 96%.

NHS England said: ‘All the points for each indicator will be put into a sliding scale of reward between the lower and upper threshold. Reducing the lower thresholds will decrease the number of practices receiving no payment across the three indicators.’

In addition, a new personalised care adjustment – exception reporting – will be introduced for children who register at a GP practice too late (either in age, or too late in the financial year) to be vaccinated in accordance with the UK national schedule or the requirements of the relevant QOF indicator.

QOF expert GP Dr Gavin Jamie welcomed the removal of the clawback system and said the changes to targets ‘are probably sensible and avoid the cliff edges’.

However, he added, that, as ever there will be ‘winners and losers’.

‘I think that practices, overall, might have fewer points due to the removal of the lump of points at the lower threshold and the higher top threshold but that is likely to vary quite a bit between practices.

‘To balance that, children that register late in the year or outside their immunisation window will be exception reported which may have a bigger, positive effect on practices.’

Dr Jamie added: ‘If this had all come in two years ago, we would likely have had a more positive reaction.’

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

It noted that the main reasons for low performance were ‘issues outside of a practice’s control such as increased vaccine hesitancy, people either not coming forward when invited or declining, and less ability to opportunistically offer vaccination when children are present in practice for another reason.’