Post-Exposure Rabies Vaccination

Rabies post-exposure prophylaxis is now considered part of core GP services under NHS England guidance. This page explains the contractual position and what support practices can expect.

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Overview

Until recently, rabies post-exposure vaccination (PEP) was widely considered outside the scope of core general practice. This was based on a narrow reading of the SFE, practical challenges in delivery, and longstanding inconsistencies in messaging from national agencies.

Information:

However, NHS England has now confirmed that post-exposure prophylaxis (PEP) for rabies is considered an essential service, and that practices are expected to offer it when required for registered patients.

This follows clarification sought by BMA GPCE and applies from the 2021/22 contract year.

Contractual position

  • Since April 2021, vaccination and immunisation services are classified as essential services under the GMS contract.
  • This includes routine, pre-exposure, and post-exposure vaccinations, as well as NHS travel vaccinations.
  • Rabies post-exposure prophylaxis (PEP) falls within this scope, even though it is not itemised in the Statement of Financial Entitlements (SFE).
  • Rabies PEP is also deemed immediately necessary treatment, strengthening the expectation of provision.
Update to the GP Contract Agreement (March 2020)

Vaccine Supply and Reimbursement

  • UKHSA supplies the rabies vaccine free of charge to practices (usually within 24 hours) on request.
  • Practices may also claim reimbursement under Regulation 65 of the GMS contract, which allows for costs incurred in the provision of drugs and appliances for immediate treatment and personal administration.

Funding Context

  • A £30 million investment in vaccination and immunisation services was incorporated into the global sum in 2021/22.
  • This includes funding for pre/post-exposure vaccinations and NHS travel vaccinations.
  • However, significant outbreak response remains outside the scope of the global sum. In such cases, commissioners are expected to support delivery and arrange additional funding if needed.

Practical Considerations and Limitations

While the contractual expectation is now clear, the practical challenges remain:

  • Rabies PEP cases are extremely rare in general practice: most GPs will encounter one or two cases in a career.
  • Clinical familiarity is low, and support from Health Protection Teams remains important.
  • UKHSA retains responsibility for advising on risk assessment and recommending treatment.
  • If your practice is unable to provide timely administration, patients may still need to be redirected to A&E or urgent care, depending on local arrangements.

Summary

  • Practices are now expected to provide rabies PEP to registered patients, where appropriate.
  • Vaccines are provided free by UKHSA.
  • Reimbursement for administration is via the global sum and Regulation 65.
  • For significant outbreaks or complex logistics, seek support from your ICB or HPT.

If you have previously advised patients to attend A&E or declined to provide treatment, you are not alone. This clarification represents a shift in interpretation and should now guide local conversations and commissioning arrangements.

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