QOF expert Dr Gavin Jamie explains how the vaccination and immunisation indicators work and offers tips on how to ensure maximum coverage and points
The vaccination and immunisation domain contains four indicators.
Three are for childhood vaccinations and worth a total of 54 points. This is potentially a lot of points for a relatively small population and, as we will see, they are concentrated on quite a small number of children.
The other indicator rewards uptake of the shingles vaccination in the elderly, worth a total of 10 points.
The QOF payments related to target coverage are in addition to the £10.06 item of service (IoS) payments which now apply to all vaccinations (except Covid).
The full UK routine immunisations schedule is available here.
Practices will receive £10.06 for each dose administered. Since this work moved into QOF, the thresholds are now be measured at the end of the year, rather than quarterly as they were previously.
Each of the three QOF indicator payments will work as follows.
Indicator VI001: completion of DTP vaccination at eight months (18 points)
This is a large number of points, but given over a very small range of uptake, from 89% to 96%. In a typical practice that whole range is likely to be fewer than 10 patients.
That is equivalent to 2.5 QOF points for each 1% added, and a typical practice will have around 90 births a year. This will make immunisations for each additional patient in this small range very well paid – around £500 per course.
The timescales are tighter than in previous vaccination incentives, however, this indicator measures uptake in infants at eight months. Although the schedule for DTP should be completed at 16 weeks, there is a small allowance for delay due to febrile illness or other problems. Where the vaccine has to be delayed, it could be worth making an alternative future appointment in the same phone call. Confirmation with a SMS, or other written message, could also increase the chance of attendance.
After eight months, infants will no longer be eligible for the QOF indicator, but will still attract the IoS payments.
There is no exception reporting available for parental choice in the childhood vaccination indicators. However there is some automatic exception reporting where a patient registers with the practice without a history of vaccinations and where it would be impossible for the practice to complete the course within the required timescale. Practices will still be expected to ‘catch up’ and the £10.06 item of service payments will still apply.
Exception reporting is available where there are contraindications to the vaccine, but these will be rare and are likely to be mostly allergies.
VI002: receipt of at least one MMR vaccination at 18 months (18 points)
This is a similar indicator, but for the single MMR vaccination. Again, there is little allowance for delay to the vaccination.
Points are awarded from 86% with the 18 points gradually awarded as you get to 96%.
An appointment should be scheduled as soon as possible after the child’s first birthday. If it needs to be postponed due to a febrile illness then it there is still time to do so but it is important that happens promptly.
If patients have travelled away for more than three months, it would be sensible to make sure that they are removed from the practice list but can be re-registered on their return. So be mindful to take note when parents inform you that they are travelling.
When patients do register it is essential that their previous vaccination details are recorded. This should be done as soon as possible and definitely before the end of the QOF year.
Exception reporting for parental preference is not permitted, but contraindications may be a little more frequent as this is a live vaccination.
Patients who are registered after 18 months old or after 17 months without an MMR vaccination will be automatically exception reported. Again practices should offer a catch-up vaccination and will receive the item of service fee.
Because of the way that the timescales work a patient will be counted if they turn 18 months old at the start of the QOF year, meaning that they could be nearly two and a half years old when QOF data is collected. The actual vaccination would have taken place in the previous QOF year. All of these patients will need accurate and up to date information.
VI003: completion of both MMR doses and DTP booster at five years (18 points)
There are three vaccinations required for this indicator – both doses of MMR and the booster DTP. This is in addition to MMR in the previous indicator. The threshold is slightly more forgiving, with points awarded from 81% achievement, increasing to the full 18 at 96%.
The timescale is more generous as well. The schedule suggests that these should be done at three years and four months – a full 20 months before the QOF measurement is taken. A child turning five years old in April of 2021 may have had the vaccinations in September 2019 with the payment not due until April 2022.
These long time periods make record keeping and transfer even more important. Where patients are coming from outside England the vaccination history will be on paper and often in patient held record. This should be obtained at the time of registration – a photograph from a phone is often sufficient and can be sent in using services such as Mjog or Accurx. These details can then be coded in the practice.
There is exception reporting where completion of immunisations would be impossible. However all patients registered after 4 years and 9 months would be expected to have had two doses of MMR and DTaP/IPV before their fifth birthday.
Shingles vaccinations in the elderly
VI004: uptake of shingles vaccination between 70 and 79 years in 80 year olds (10 points)
It is worth noting that although the shingles vaccination programme has changed quite a lot, the QOF indicator remains intact.
Compared with the other indicators in this area, the indicator for shingles vaccination is a little different. Much of the work for it is likely to have happened already. Currently it will be looking at patients who have been part of the catch-up vaccination programme for shingles. These patients may have had the vaccination up to eight years ago and, in future years, it could be a long time between vaccination and payment.
The vaccinations themselves will continue to be paid at £10.06 by the IoS payment. QOF points will be in addition to this.
All of the QOF points are available where 60% of 80-year-old patients have had the vaccination at the end of the year. Either a single dose of the live vaccination or two doses of the inactivated vaccine will count for this indicator. In the case of the two dose vaccine the first dose must be given before their 80th birthday but the second can be given up to their 81st birthday.
National figures suggest that most practices are well on the way to achieving this already, but it would be worth looking at your 79-year olds and inviting them as soon as possible. If vaccine supply is limited then concentrate on those closest to their 80th birthday as after that day there will be no way to make them achieve this indicator.
Unlike the childhood vaccinations, exception reporting if patients do not want the vaccination will apply – although the timescale for this to be entered is still uncertain.
Dr Gavin Jamie is a GP partner in Swindon and runs the QOF Database website