Overview
Rabies vaccination is included in the Statement of Financial Entitlements (SFE) only for pre-exposure prophylaxis, and only for high-risk occupational groups or in the event of a localised outbreak.
Post-exposure prophylaxis (PEP) for rabies is not a core responsibility for general practice.
Commissioning Responsibility
Provision of post-exposure rabies vaccination falls to Integrated Care Boards (ICBs). If no commissioned service is in place, patients will default to A&E. Practices are not obliged to provide this care, and may not be indemnified to do so.
Out-of-hours services may have local arrangements, depending on whether the ICB has commissioned them accordingly. Historically, some Local Commissioned Services (e.g. Brighton) provided for this, but have since been decommissioned due to lack of use.
National Position and UKHSA
UKHSA communications have at times suggested that general practice is responsible for providing post-exposure rabies vaccination. These messages often arrive via generic templates but are not aligned with contractual responsibilities or indemnity cover for GPs. UKHSA is aware of this but continues to default to suggesting GP delivery where no commissioned service exists. This must be challenged robustly.
Practices should not be expected to deliver unfunded services simply because a commissioning gap exists.
UKHSA ensures that each A&E department holds stock of rabies PEP, and that is the most appropriate and safe setting for administration of the full vaccination course.
Routine vs Non-Routine Vaccination
Rabies prophylaxis does not fall within the scope of routine vaccination and immunisation services defined in the GP core contract.
The key reference is Section 1.1, which confirms that only routine V&I services are essential under GMS. Rabies is not one of these.
Some communications may cite older NHSE guidance such as: Update to the GP Contract Agreement (March 2020)
Which contains the line:
“All practices will be expected to offer all routine, pre and post-exposure vaccination and NHS travel vaccinations to their registered eligible population.”
However, this is guidance, not a contractual requirement. It is not consistent with the SFE or core contract, and therefore cannot override them.
Summary
| Not core: Post-exposure rabies vaccination is not part of GMS core services. |
| Not routine: It is not covered under routine vaccination and immunisation responsibilities. |
| Not commissioned: If no ICB service exists, responsibility lies with the commissioner – not defaulting to general practice. |
| Not safe: Clinical and indemnity concerns mean A&E is the safer setting for treatment. |
Practices may wish to check whether their local out-of-hours service has been commissioned for this. Otherwise, patients should be directed to A&E.