Taken from Financial Pulse, 8/2/97

THE PROBLEM

We recently analysed our accounts and found our earnings from vaccinations and immunisations are well below the national average. We are an urban practice of six partners with a list size of 11,800.

How can we improve in this area?

Money from vaccinations and immunisations should represent between 5 and 10% of item-of-service income, writes Dr Ian Gold. It is therefore an important source of earnings.

This practice should look at the different areas in which this income is derived so it can devise strategies to boost earnings.

Immunisations can be split into three categories:

1. childhood and pre-school

2. public policy

3. travel

CHILDHOOD IMMUNISATIONS

Childhood and pre-school immunisations contribute to target payments, of which there are two levels. You achieve the lower level if 70% of the eligible children on your practice list have received completed courses of the immunisations and the higher level if 90% have.

The maximum annual lower target payments for a GP with a national average of 22 children under two years of age and 22 children under five years of age are £745 for childhood immunisations and £220 for pre-school boosters. The maximum annual higher target payments are £2,235 for childhood immunisations and £660 for pre-school boosters.

Within these targets the actual payments depend on the proportion of the immunisations given by the GPs as part of GMS as opposed to those given at, say, health authority clinics.

This practice has not achieved any target payments. If the GPs reach the lower target for next year they could potentially receive £5,790. If they could reach the higher target this would bring them an extra £11,580. Certainly most practices would feel that improving their income by a total of £17,370 was worth a considerable amount of effort.

What can they do to improve uptake? First, the practice must calculate well in advance of the due date for claiming (the first day of each quarter) whether it is likely to achieve the targets.

There are four groups of immunisations to complete for target payments for children aged two:

diphtheria, tetanus and polio x 3

pertussis x 3

measles, mumps and rubella

hib x 3

For children aged five you need to complete reinforcing doses of diphtheria, tetanus and polio.

Currently the pre-school booster dose of MMR attracts an item-of-service payment, but it will eventually be included as part of the target payments.

Identify any children that have not been immunised so you can invite them to complete their course. This could be by letter but it is usually more effective to phone or involve the health visitor who will visit the family.

Make it easy for your patients by offering an appointment time to suit them. As a last resort it might even be worth giving the immunisation at home if it means hitting a target.

If a parent refuses immunisation, explore the reasons and determine whether the parents have all the facts needed for an informed decision. Discuss immunisations with parents at the six-week development check so the programmes are started in the right place. Use other contacts with the children to check on immunisation status and pick up defaulters.

PUBLIC POLICY IMMUNISATIONS

Most immunisations in this category attract an item-of-service fee - see schedule 1 of paragraph 27 of the Red Book.

If your immunisation income is below the national average, offer tetanus boosters for adults who have not received one in the preceding 10 years. Also pick up those who have never had a primary course. You could do this opportunistically during consultations or by recall from the computer. Check on immunisation status at new patient checks.

With tetanus (as well as typhoid and infectious hepatitis), you can generate income from reimbursement for personally administered vaccine under paragraph 44.5 of the Red Book. It is important to offer oral polio to previously unimmunised parents of children being immunised.

There is no item-of-service fee for some public policy immunisations, for example influenza, pneumococcus and hepatitis B. It is still worth generating income from these through the reimbursement scheme.

This practice could generate up to £3,700 from an effective annual influenza vaccination campaign if it immunised 10% of the practice.

Targeting patients for pneumococcal vaccination would mean immunising 5% and would bring in around £3,000.

But unlike influenza this is not repeated annually.

Influenza immunisation is strongly recommended for people of all ages, but especially the elderly, with the following:

chronic respiratory disease
chronic heart disease
chronic renal failure
diabetes mellitus, and other endocrine disorders
immunosuppression due to disease or treatment.

These are also indications for pneumococcal vaccine but splenectomised patients should be included. Influenza immunisation is also recommended for residents of nursing homes, residential homes for the elderly and other long-stay facilities. Current recommendations now include everyone over 65 years of age.

FOREIGN TRAVEL

Many practices are finding this a growth area, so it could be costly to ignore. Some attract item-of-service fees and can also be claimed for reimbursement of any personally administered drugs. Others may be a source of private income, but remember you cannot charge for the immunisation and claim an item-of-service fee or reimbursement. But you can charge for issuing an immunisation certificate.

Travel immunisations attracting item-of-service payments are:

TYPHOID - outside UK, except Canada, the US, Australia, New Zealand and Northern Europe

CHOLERA - Africa, Asia or an infected area

(Editor-In the DOH 1996 edition of Immunisation against Infectious Disease, HMSO, it states: 'No cholera vaccine is currently available in the UK. Cholera vaccine has no role in the management of contacts of any cases, or in controlling the spread of infection. Control of the disease depends on public health measures rather than immunisation Contacts should maintain high standards of personal hygiene to avoid becoming infected')

POLIO - outside Europe, except Canada, the US, Australia and New Zealand

INFECTIOUS HEPATITIS - outside Northern Europe, Australia or New Zealand.

The GPs in this practice should consider starting a travel clinic, run by the practice nurse. They should first direct this at their own patients, but there might be scope later to expand it to a private service for patients registered with other practices.

They could also consider becoming a yellow fever centre authorised by the Dept. of Health.

Good marketing is the secret of increasing uptake in this area so they should advertise the clinic via posters in the surgery and the practice leaflet. Again they should make appointments as convenient as possible.

Jan Gold is a GP in Radlett, Herts.

Editor - Another article in the same edition of Financial Pulse was entitled -"Travel vaccines - broaden your earnings. Dr Mike Townsend explains how GPs can take advantage of patients' trips to exotic destinations."

Shouldn't the priority be 'health' not 'wealth'?

Source: Informed Parent