Personalised Care Adjustment (PCA) VI001, VI002 and VI003 (2024/25)
Dear Colleagues,
I have been asked for clarification regarding the application of Personalised Care Adjustments (PCA) for Childhood Immunisations apply for VI001, VI002 and VI003.
My understanding is this exemption applies for childhood immunisations VI001, VI002, and VI003. It is based on the child registering at the practice too late (either in age, or within the QOF year) to receive a UK scheduled vaccination. However, this cannot be manually coded, hence you won’t be able to identify any codes. The process is described within the 2024/25 QOF guidance.
The relevant section is within 4.4 [Vaccinations and Immunisations (VI)] and I have cut and pasted the guidance.
Note on automated Personalised Care Adjustment (PCA) introduced in 2023/24
As part of the changes to the GP Contract 2023/24 published on 6 March 2023, a new PCA was introduced for VI001, VI002 and VI003 to take into account patients who registered at the practice too late (either too late in age, or too late in the financial year) to be vaccinated in accordance with the UK national schedule (or, where they differ, the requirements of the relevant QOF indicator).
From April 2023, this new automated PCA has been built into the business rule logic underpinning the QOF V&I GPES extracts and applies in circumstances where a child is registered with a practice and:
1. there is insufficient time to provide any incomplete vaccinations either within the required timeframes to meet the indicator requirements, or
2. where a child has an incomplete vaccination status and is now older than the cut-off age required by the indicator.
The PCA cannot be applied manually and will be automatically applied by the indicator logic. The PCA will be superseded in the extract logic by success (i.e. the relevant vaccinations being given before the relevant cut-off age required by the indicators). The PCA applies once the individuals are registered with the practice and the relevant logic parameters are met. Where the PCA is applied, it will remove the child from both the denominator and numerator thus not impacting on achievement of the relevant indicator. In the event a child is registered with a practice and has already reached the relevant indicator’s cut off age - where the cut off age is 8 months for VI001, 18 months for VI002 and 5 years for VI003 - and had incomplete vaccinations, then the automatic PCA will be applied. This is because it is by no fault of the practice that this child was not vaccinated.
However, for a child that is registered with a practice at an age younger than the cut off age for the relevant indicator, then the PCA is flexibly applied depending on both the time remaining prior to the child reaching the cut off age and the number of outstanding doses. A timeframe of 31 days per outstanding dose from registration date to meeting the cut off age for the indicator is applied. Further information can be found in the business rules. Practices may want to check whether this PCA is active on the system by using the various system reporting tools such as ‘How am I driving?’ before the end of the financial year.
Some examples of how the new PCA applies to the three V&I indicators are provided below:
For VI001.
i. If a child is registered with a practice on or after 7 months of age and has two or fewer doses of diphtheria, tetanus and pertussis containing vaccine prior to registering then the PCA would automatically be applied as there would be insufficient time to offer and administer the required doses.
ii. If a child is registered with a practice on or after 6 months of age and has one or no doses of diphtheria, tetanus and pertussis containing vaccine prior to registering then the PCA would automatically be applied as there would be insufficient time. However, if a child registered with the practice at 6 months of age and had already had two doses of diphtheria, tetanus and pertussis containing vaccine prior to registering and the third dose was not given by the practice before the child turns 8 months, then the practice would not achieve the indicator for this specific child – this is because the practice would have had sufficient time to give the remaining dose.
iii. If a child registered with a practice on or after 5 months of age and had no doses of diphtheria, tetanus and pertussis containing vaccine prior to registering then the PCA would automatically be applied as there would be insufficient time. However, if a child registered with the practice at 5 months of age and had already had one or two doses of diphtheria, tetanus and pertussis containing vaccine prior to registering and the third dose was, or second and third doses were, not given by the practice before the child turns 8 months, then the practice would not achieve the indicator for this specific child – this is because the practice would have had sufficient time to give the remaining one or two dose(s). If a child registered with a practice between 1-4 months of age and had no doses of diphtheria, tetanus and pertussis containing vaccine prior to registering and the practice does not give all three doses before the child turns 8 months old, then the practice would not achieve the indicator for this specific child. The automated PCA would not apply.
For VI002.
i. If a child has reached 17 or 18 months of age when registering with the practice and had not had an MMR vaccination, then the automatic PCA will be applied. However, if the child is 16 months or younger and does not receive one dose of MMR vaccination before they turn 18 months, then the practice would not achieve this indicator for the specific child.
For VI003.
i. If a child registered with a practice on or after 4 years and 11 months of age and had either (1) two MMR vaccinations but no booster DTap/IPV or only one MMR and the booster DTap/IPV, then the automatic PCA will be applied as there is insufficient time.
ii. If a child registered with a practice on or after 4 years and 10 months of age and had either (1) only had one MMR and no booster DTap/IPV or (2) no MMR but had the booster DTap/IPV, then the automatic PCA will be applied as there is insufficient time.
iii. If a child registered with a practice on or after 4 years and 9 months of age and had no MMR vaccinations and no booster DTap/IPV, then the automatic PCA will be applied as there is insufficient time.
iv. If a child registered with a practice younger than 4 years and 9 months of age and does not receive both MMR vaccinations and the booster DTap/IPV then the practice would not achieve the indicator for this specific child.
This exemption is automatically applied, triggered by the date the child registers, which may be a relevant consideration for practices.
I hope this background is helpful.
Dr Julius Parker
Chief Executive
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Updated on Wednesday, 10 April 2024
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