Travel Vaccinations

GP Practice responsibilities and guidance

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Overview

This guidance outlines the responsibilities of GP practices in the SSLMCs area regarding travel vaccinations, distinguishing between services that are part of the NHS General Medical Services (GMS) contract and those that are not. It also provides information on charging, documentation, and best practices for delivering travel health services. 

NHS-Provided Travel Vaccinations (Essential Services) 

Under the GMS contract, certain travel vaccinations are classified as essential services. Practices are required to provide these vaccinations free of charge to their registered patients when clinically indicated for travel purposes. The vaccines included are: 

  • Hepatitis A
  • Typhoid
  • Diphtheria, Tetanus, and Polio (combined booster)
  • Cholera (oral vaccine) 

These vaccinations are provided to prevent the importation of infectious diseases into the UK and are considered important public health interventions. 

Non-NHS Travel Vaccinations (Private Services) 

Vaccinations not listed above fall outside the scope of NHS-funded services and can be offered privately. These include, but are not limited to: 

  • Hepatitis B
  • Japanese Encephalitis
  • Meningitis ACWY
  • Rabies
  • Tick-borne Encephalitis
  • Tuberculosis (TB)
  • Yellow Fever (only available at designated centres) 

Practices may choose to offer these vaccinations on a private basis, charging patients accordingly. Alternatively, patients can be referred to private travel clinics. 

I am writing to advise all colleagues there has been a change in NHS Resolutions Indemnity arrangements under the Central Negligence Scheme for General Practice (CNSGP) in relation to the supply and administration of paid-for travel vaccines.

Originally, at the commencement of the CNSGP arrangements, in April, the CNSGP scheme included the supply and administration of vaccinations where patients are charged. This was an error and both DHSC and NHS England have apologised for this.

As GP practices were undertaking this work in good faith, believing it to be covered as part of CNSGP, NHS Resolution will provide assistance for any claim for clinical negligence relating to the supply and administration of privately funded travel vaccinations for the period 1 April to 31 July 2019.

This means that all practices will need to check their indemnity arrangements to ensure that all staff delivering this service have full indemnity for these services. They should check their current non-state indemnity arrangements to make sure staff are covered. Obviously also, in relation to private fee services, the cost of such services to the patient should reflect service delivery costs, including the necessary indemnity.

The CNSGP continues to provide cover for all vaccinations funded by the NHS (for which patients pay no charge); in addition, advice about travel is regarded as an essential service and is therefore covered by CNSGP.

Although it is clearly not satisfactory for there to be any change in Scheme arrangements, this change was made necessary following recent legal advice to the DHSC and given the complexity of work undertaken in General Practice, it is fair to note this is the only example of a change in cover arrangements identified from April.

Dr Julius Parker, Chief Executive

Charging for Non-NHS Travel Services 

Practices are permitted to charge for: 

  • Vaccinations not covered under essential services: As per the GMS contract clause 19.1.2(g), practices may charge for immunisations requested in connection with travel abroad for which no remuneration is payable by the Commissioner. 
  • Malaria prophylaxis: Practices can provide private prescriptions for malaria prevention medications and charge for the consultation and prescription. 
  • Important: Practices must not charge registered patients for the administration of NHS-provided travel vaccines. Additionally, charging unregistered patients for services provided on practice premises is prohibited unless those services are provided outside of core hours. 

Travel Health Consultations and Advice 

Providing travel health advice, including risk assessments and recommendations for vaccinations and malaria prophylaxis, is considered part of essential services when related to NHS-provided vaccines. However, for non-NHS services, practices can charge for the consultation, provided it leads to the administration of a private vaccine or prescription. 

It’s essential to ensure that any travel health advice given is: 

  • Evidence-based: Utilize resources like the National Travel Health Network and Centre (NaTHNaC) for up-to-date information. 
  • Documented: Maintain accurate records of consultations, risk assessments, and advice provided. 

Documentation and Governance 

When providing travel vaccinations: 

  • Patient Group Directions (PGDs): Nurses administering vaccines under PGDs must conduct the entire episode of care, including the pre-travel risk assessment, as per legal requirements.
  • Patient Specific Directions (PSDs): For vaccines not covered by PGDs, a PSD must be used, detailing the specific treatment for an individual patient. 
  • Record Keeping: Document all consultations, risk assessments, vaccines administered, and advice given in the patient’s medical record. 

Best Practices for Travel Health Services 

  • Training: Ensure that staff providing travel health services are appropriately trained and competent. 
  • Resources: Utilize reputable sources such as NaTHNaC and the Green Book for guidance on travel health. 
  • Patient Information: Provide patients with written information on recommended vaccinations, potential side effects, and preventive measures for travel-related illnesses. 
  • Referral Pathways: Establish clear referral pathways for services not provided in-house, such as Yellow Fever vaccinations. 

Conclusion 

GP practices are obligated to provide certain travel vaccinations as part of essential services. Other travel-related services can be offered privately, with appropriate charges applied. It’s crucial to adhere to legal and contractual obligations, maintain thorough documentation, and ensure that staff are adequately trained to provide safe and effective travel health services.