Non-Standard Childhood Immunisation Requests

Guidance for practices

Date published:
Date last updated:
Next review date:

Summary 

GP practices are increasingly encountering parental requests for childhood vaccination schedules that deviate from the nationally recommended programme. These often involve spacing out vaccines, omitting certain components, or following a bespoke schedule obtained from private providers. 

While practices should support informed decision-making, they are not contractually obliged to deliver off-schedule or incomplete immunisations. This guidance sets out the clinical, contractual, and operational considerations when responding to such requests. 

Core Contractual Position 

Under the General Medical Services (GMS) contract, practices are required to deliver childhood immunisations in accordance with the national immunisation programme. This is defined in: 

The schedule itself is based on guidance from the UK Health Security Agency (UKHSA) and the Joint Committee on Vaccination and Immunisation (JCVI). 

Requests for alternative schedules, including delayed, spaced, or selective vaccinations, fall outside this contractual requirement. Practices are not required to accommodate such requests and would not be reimbursed for delivering vaccinations that do not align with the national schedule. 

PGD and PSD Considerations 

The majority of routine childhood vaccines are delivered under Patient Group Directions (PGDs). PGDs are strictly limited to vaccines given in accordance with the national schedule. 

Off-schedule vaccination would instead require a Patient Specific Direction (PSD). While this is legally permissible, it raises important issues: 

  • The prescriber assumes full clinical responsibility for the decision;
  • A bespoke PSD must be issued for each vaccine episode; 
  • The workload for clinical and administrative staff increases significantly. 

For non-standard schedules that remain incomplete or diverge from evidence-based practice, the medicolegal risk rises accordingly. 

Clinical and Operational Risks 

Departing from the national schedule may: 

  • Delay effective protection for the child;
  • Require additional appointments and injections, increasing distress and workload;
  • Create fragmentation of care, particularly if partial NHS vaccination is supplemented privately;
  • Generate disputes or complaints if outcomes differ from expectations. 

If a family insists on an alternative schedule, and the request does not meet clinical or contractual requirements, practices are within their rights to decline to offer this on the NHS. 

Funding and Charges 

Staff time spent arranging bespoke immunisation schedules is not funded separately, as it falls outside the GMS contract and national immunisation programme. 

However, practices cannot levy a private fee for delivering NHS-provided vaccines under a non-standard schedule, even where it increases workload. If parents wish to pursue a different regime, they should do so entirely through a private provider. 

Private Provision 

Families may choose to follow a bespoke vaccination schedule privately, via a provider willing to deliver unlicensed or off-schedule regimes. In such cases: 

  • Ensure clear documentation of the decision and rationale;
  • Offer NHS vaccination where accepted (e.g. rotavirus, if in line with national schedule);
  • Provide evidence-based information to support informed choice. 

It may be appropriate to refer families to NHS information on routine childhood vaccinations or the UKHSA immunisation schedule. 

Recommendations for Practice 

  • Clarify contractual obligations: Practices must only deliver the nationally approved schedule. 
  • Do not use PGDs for off-schedule vaccines: Consider PSDs only where clinically justified and safe. 
  • Decline non-standard schedules on NHS grounds if incomplete, unlicensed or unsupported. 
  • Document discussions carefully, particularly where vaccines are declined or partially accepted. 
  • Offer rotavirus or other components if within the programme and acceptable to parents. 

If in doubt, contact your LMC for advice or support with drafting clear patient communications. 

Related Content