Vaccination and immunisation (V&I) FAQs

SAVE ITEM
V&I FAQs

16 / 9 / 2016 Midnight

This section includes FAQs for the following areas:

General questions

Childhood seasonal influenza

Meningococcal vaccination programme

Seasonal influenza vaccination programme

Pneumococcal polysaccharide vaccination programme

Shingles - routine aged 70 and catch-up aged 78 and 79 vaccination programme 

Hepatitis B Vaccine

General questions

A: Full details of the disease areas and their vaccines are included in the relevant chapter of the Green Book. The Green Book is available to view online.

  • Commissioners can also subscribe, free of charge, to Public Health England's 'Vaccine Update' newsletter. This is published monthly and contains useful updates on the latest developments in vaccines and vaccination policies and procedures in England.
  • When registering for the vaccine update, commissioners can also register for other updates including Green Book updates, medical device alerts etc.
To get the latest edition of the vaccine update or to sign-up visit the vaccine updates webpage.

General questions

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Q:Section 7a functions are described as ‘reserved functions’ which are not covered by the ‘enhanced services delegated to CCG’ category in the delegation agreement. Which vaccination programmes are reserved S7A functions and what is the impact for commissioners?

A: The co-commissioning delegation agreement sets out that Section 7a functions will not be delegated to CCGs. NHS England remains responsible and accountable for the discharge of all the Section 7a functions. The functions under the GMS contract that are provided in primary medical care are listed below:
  • childhood seasonal influenza
  • hepatitis B (newborn babies)
  • HPV booster
  • Meningococcal ACWY for 18 years on 31 August and freshers programme
  • meningococcal booster
  • meningococcal B (MenB)
  • MMR

pertussis pregnant women

  • rotavirus
  • seasonal flu and pneumococcal polysaccharide
  • shingles (routine and catch-up).
Other Section 7a primary medical care vaccination programmes which are not supported by NHS Employers are:
  • diphtheria, tetanus, poliomyelitis, pertussis and Hib
  • DTaP/IPV and dtaP/IPV (pre-school booster)
  • Hib/MenC infant
  • meningococcal C (MenC) infant
  • neonatal BCG
  • pneumococcal (infants)
  • respiratory syncytial virus (RSV)
  • Td/IPV (teenage booster).
It is important that public health commissioning teams can effectively discharge their responsibilities and work alongside CCGs where there is overlap within primary care contracts. Under the delegation agreement, NHS England and CCGs will need to work collaboratively to exercise these functions, including discussing with the CCGs how it proposes to address GP performance issues. CCGs will also provide administrative and management services to NHS England in relation to certain reserved functions including Section 7a functions and funds. A further guidance document on NHS Public Health Functions (s7A) and co-commissioning of primary medical care services will be published by NHS England.

General questions

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Q: Who can administer vaccines?

A: Anyone who has been trained and assessed as competent (by their employer) can administer vaccines via a parenteral (i.e. intramuscular injection) route under Patient Specific Direction (PSD) but not under Patient Group Direction (PGD). This is because only certain healthcare professionals are allowed to work under a PGD.

The preferred way for patients to receive vaccines is for trained healthcare professionals to prescribe for individual patients on a one-to-one basis. However, in some circumstances, it may be more appropriate for a patient to receive a vaccine (i.e. have it supplied and/or administered) directly from another healthcare professional. Unless covered by exemptions to the Medicines Act 1968, there are two ways of achieving this: either by a PSD or a PGD. See the Green book for further details on PSDs and PGDs.

General questions

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Q: Can vaccines be administered at the same time?

A: Some vaccines can be given at the same time as others. The relevant chapter of the Green Book should be consulted before delivering multiple vaccines to a patient as there can be directions to use different site or time between certain vaccine types.

General questions

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Q: Can the nationally defined service specifications for vaccination programmes be amended locally?

A: No. The service specification is a legal document and commissioners cannot make changes to the content. Should they wish to do additional work relating to the enhanced service locally, this would be for local discussion, agreement and payment outside of the arrangements for the nationally defined programme.

General questions

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Q:Does signing up to participate in a service on CQRS satisfy the requirement for contractual sign up?

A: No. Practices are required to agree to participate in a service with their area team based on the service specification. Sign up on CQRS is confirmation from the practice to the area team that CQRS will be used to calculate the payment.

General questions

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Q: How long are practices required to retain evidence regarding work completed which is related/attributed to V&I achievement? 


A: Practices are required to retain evidence of work completed which is attributed or related to payment, for up to six years. This evidence could reasonably be requested by any local commissioner or NHS England. Some of this evidence would be available from practices clinical systems but hard copies would need to be filed or digitised and held electronically. 

Childhood seasonal influenza vaccination programme

Q: Do children who are defined as ‘at-risk’ fall under the childhood influenza programme or the routine seasonal influenza programme?

A: All children who meet the age criteria as specified in the service specification are included in the childhood programme regardless of their risk status.

Childhood seasonal influenza questions

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Meningococcal vaccination programmes

Q: As part of the 2016/17 agreement, the third dose of MenC was removed from the targeted childhood vaccination programme. When is that change effective from?

A: This change is effective from 1 July 2016.

Meningococal questions 

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Q: What about young adults who are going to university in autumn 2015 but are below the current age criteria for the meningococcal freshers programme? 

A: Young adults who started at university for the first time in August 2015, but are younger than the normal age and are therefore outside the cohort defined in the specification are expected to be at a similar level of risk as their peers. As these patients fall outside of the eligible cohort defined by the NHS England service specification, they would not covered by the automated data collections. Where these young adults self-present for vaccination, practices should discuss the vaccination of these patients with their commissioner on a case-by-case basis. In line with established procedures, where the practice and commissioner agree to the amendment the commissioner will adjust the practice achievement. 


In the spirit of the agreement, we would expect these practices to be remunerated for vaccinating these patients.

Meningococal questions

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Q. Why is the routine MenB programme only being offered to infants aged 2 months or over?
A. Meningococcal disease can affect all age groups, but the rates of disease are highest in the first two years of life. Cases increase from birth and peak around five months before declining. In considering the epidemiological and economic evidence as well as vaccine safety and efficacy, the Joint Committee on Vaccination and Immunisation (JCVI) prioritised young infants with the aim of providing optimal protection as early as possible. For further information see the PHE immunisations for healthcare professionals document.

Meningococal questions

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Q: Are infants born before 1 May 2015 going to be offered the MenB vaccine?

A. There are currently no plans to extend the MenB vaccination programme beyond the current infant arrangements. The JCVI did not recommend a catch-up programme for infants born before the 1 May 2015. As meningococcal disease peaks around five months of age before declining, the priority of the MenB programme is to ensure the vaccine is offered routinely to infants who are due to receive their routine primary immunisations on or after the 1 September (those born on or after 1 July 2015) with a limited catch-up for those infants born from 1 May to 30 June 2015 which will provide protection to this most vulnerable group prior to the peak in incidence of disease. The JCVI keeps the eligibility criteria for all vaccination programmes under review.

Meningococal questions

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Q. Can parents or guardians whose children don’t fall into the eligible age groups get their child vaccinated against MenB? If so, how?

A. Children can be vaccinated through a private clinic that is able to obtain the vaccine from the manufacturer. However, parents or guardians should be aware that they will be responsible for the full cost of the vaccine. Under the current contract for general practice, practices are restricted from providing private services to their own NHS patients except in very specific areas, such as travel advice.

Meningococal questions

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Q. Is a list of private providers of vaccination programmes available and is there any guidance on how much a private course of MenB vaccination would be?

A. No list of private providers is available. Parents or guardians would be responsible for finding a private provider, this may be possible by contacting pharmacies that hold private clinics.

The price for private vaccinations are at the discretion of the provider. As private vaccinations are not part of the GMS contract, we are unable to provide advice around pricing.

Meningococal questions

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Seasonal influenza vaccination programmes

A: No. Although the services are separate on CQRS and GPES, they have one service specification and therefore are mutually dependent.

Seasonal influenza questions

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Q:Where can I find the Read codes for defining a patient as at-risk for the seasonal influenza and pneumococcal vaccination programmes?

A: The Read codes for these programmes are detailed in spreadsheets which are available to download from our main vaccination and immunisations page.

Seasonal influenza questions

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Q: Where can I find list of eligible patients and the Read codes for the seasonal influenza and pneumococcal polysaccharide vaccination programme?

A: The list of conditions for which practices may receive payment for the administration of the seasonal influenza and pneumococcal vaccine can be found in the service specification. The decision to administer the seasonal influenza and pneumococcal vaccine is clinical, based upon the patients underlying disorder and a clinical judgement which is not always possible to accurately reflect in a simple list of Read codes.
The list of Read Codes in the workbook should only be used to support external assessors to validate the practice return for payment. These Read codes must not be used to conduct clinical audit or call and recall of eligible patients.
Where a clinician has made a clinical judgement that a patient requires the seasonal influenza vaccination but believes that they may not fall within the list of acceptable conditions for the purposes of this enhanced service, the clinician should record ‘9OX4. Needs influenza immunisation’. Where the assessor identifies patients with this code the practice may be asked to provide evidence as to why they felt the patient was eligible.

Seasonal influenza questions

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Q: What are the requirements around call and recall of patients under the childhood and routine seasonal flu vaccination programmes?

A: For the childhood programme, all patients are vaccinated on a call and recall basis regardless of risk status.

For seasonal influenza the service specification states that:

Patients should be vaccinated on either: 

a.            a proactive call basis, if not considered at-risk, or

b.            a proactive call and recall basis, if considered at-risk with the aim of maximising uptake in at-risk patients.

For information, section 7 of the Directions state that practices must have robust call and reminder systems to contact at-risk patients with the aim of maximising uptake in the interest of at-risk patients and meeting any public health targets. The targets are set out in the annual flu plan. 

Practices should be aware that where they do not comply with the requirements as set out in the specification and the Directions, funds can be withdrawn.

Seasonal influenza questions

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Pneumococcal polysaccharide vaccination programme

Q: Can practices sign up to deliver just the seasonal influenza programme and not pneumococcal?

No. Although the services are separate on CQRS and GPES, they have one service specification and therefore are mutually dependent.

Pneumococcal polysaccharide questions

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Q:Where can I find the Read codes for defining a patient as at-risk for the seasonal influenza and pneumococcal vaccination programmes?

A: The Read codes for these programmes are detailed in spreadsheets which are available to download from our main vaccination and immunisations page.

Pneumococcal polysaccharide questions

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Q:Where can I find a list of eligible patients and the Read codes for the seasonal influenza and pneumococcal polysaccharide vaccination programme?

A: The list of conditions for which practices may receive payment for the administration of the seasonal influenza and pneumococcal vaccine can be found in the service specification. The decision to administer the seasonal influenza and pneumococcal vaccine is clinical, based upon the patients underlying disorder and a clinical judgement which is not always possible to accurately reflect in a simple list of Read codes. The list of Read Codes in the workbook should only be used to support external assessors to validate the practice return for payment. These Read codes must not be used to conduct clinical audit or call and recall of eligible patients. Where a clinician has made a clinical judgement that a patient requires the seasonal influenza vaccination but believes that they may not fall within the list of acceptable conditions for the purposes of this enhanced service, the clinician should record ‘Needs influenza immunisation’. Where the assessor identifies patients with this code the practice may be asked to provide evidence as to why they felt the patient was eligible.

Pneumococcal polysaccharide questions

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Shingles - routine aged 70 and catch-up aged 78 vaccination programmes

Q:If a patient requests a shingles vaccination but they do not meet the age range criteria for these enhanced services, can they still be vaccinated?

A: Patients who are not included in either patient cohort for the shingles or shingles catch-up programmes who request vaccination may be vaccinated, at the practice's discretion. However, practices are advised that this should only occur where eligible patients have already been vaccinated or offered the vaccination and the practice is using up their left over stocks. If a practice chooses to vaccinate patients not included in the eligible patient cohort, then these patients would not be eligible for payment under the enhanced service specification.
Shingles questions

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Q: Why is the timeframe on CQRS different to the timeframes in the specification and guidance?
NHS England applied the increase in the IoS fee for shingles from 1 April 2016 rather than from 1 September 2016 as this is how it is outlined in the SFE which is effective from April. To be equitable to practices, this increase was also applied to the catch-up programme which has a specification rather than being included in the SFE.


Breakdown of shingles programmes:

  • 2015/16 shingles programmes - 1 September 2015 – 31 August 2016
    • 1 September 2015 – 31 March 2016 – IoS fee £7.64
    • 1 April 2016 – 31 August 2016 – IoS fee £9.80
  • 2016/17 shingles programmes - 1 September 2016 – 31 March 2017 – IoS fee £9.80


NHS England have confirmed that there will not be a change to the 2016/17 SFE or the service specification to reflect this change.
Due to the timeframes for the shingles programmes being out of line with the SFE and annual cycle of negotiations, NHS England and GPC agreed that the two vaccination programmes would end on 31 March 2017 and fall in with the annual cycle from this point. Any changes to the programme from 1 April 2017 would therefore be picked up as part of the wider GMS negotiations and as such will be communicated formally at that point.
There is no impact on the eligibility of the patients for the two programmes.

Shingles questions

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Hepatitis B Vaccine 

Q. The hepB vaccination programme requires a heel prick test as part of the payment criteria for the fourth dose, where can I find further information on the heel prick test?

A. The heel prick testing is not commissioned as part of this vaccination programme, however PHE has developed a dried blood spot (DBS) test that has been validated for detecting hepatitis B surface antigen. Local screening and immunisation leads, who feel that this service could help increase the uptake of hepB vaccinations at 12 months, are advised to express their interest in this service. See the hepB DBS testing for infants webpage for further details. 

Hep B questions

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