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Vaccination Programmes

To see the guidance and audit requirements click Here
To see the technical requirements for 2014/15 GMS contract changes click Here
To see the SFE ( Statement of Financial Entitlements) ammendments click Here
And for the PMS (Direct Enhanced Services) Directions click Here

Service Specifications - Click here

View the guidance to support the enhanced services for Patient Participation, Extended Hours, Dementia, Alcohol and Learning Disabilities

Avoiding unplanned admissions

A new unplanned admissions enhanced service is now available as part of a move to reduce unnecessary emergency admissions to secondary care.

Read codes Required

Separate guidance and templates to support implementation of the Avoiding unplanned admissions enhanced service.

Read more on the requirements

Alcohol-related risk reduction scheme

This ES will be extended for another year. Changes have been made with the aim of ensuring that patients with mental health problems receive appropriate support.

Read codes Required and Guidance

Initial screening - For this DES, screening applies to all patients registered between 1 April 2014 and 31 March 2015, who are aged 16 or over at the time the short case finding test is applied. For the purposes of this DES, the test must be applied within the financial year in which the patient registered

Full screening - If a patient is identified as positive, the remaining questions in the ten-question AUDIT questionnaire should be used to determine increasing, higher risk or likely dependent drinking.

Brief intervention - Those patients identified as drinking at increasing or higher risk levels (scores 819) should be offered brief advice. The recommended brief advice is the basic five minutes of advice used in the WHO clinical trial of brief intervention in primary care, using a programme modified for the UK context by the University of Newcastle, How much is too much? The tools from this programme have been further refined. Alcohol learning centre.

Brief lifestyle counselling - In some areas, patients drinking at higher risk levels (scores 1619) may receive brief advice or brief lifestyle counselling (2030 minutes) within the practice, or be referred to, for example, a community-based counselling service for this advice, but this distinction is not recognised for the purposes of this DES.

Referral for specialist advice - Patients identified as possibly alcohol dependent (scores of 20 or more) should be considered for referral for specialist services. Although providing brief alcohol advice is still recommended, on its own, brief advice has not been shown to be effective for this group of patients.

Assessment/screening for anxiety and/or depression - Where patients are identified as drinking at increasing or higher risk levels (score of eight or more), the practice will be required to assess/screen for anxiety and/or depression.

This is because mental health issues could be contributing to the Patient's level of Alcohol consumption. Practices will need to use an appropriate tool for the assessment / screening, for example using questionnaires such as Generalised Anxiety Disorder Scale-7 (GADS-7) and/or Patient Health Questionnaire (PHQ-9). Patients who are found to be suffering with anxiety and/or depression should, where appropriate, be provided with support and treatment

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Learning disabilities health check scheme

This ES will be extended for another year and will now allow practices to offer medicals to patients 14 years or older. There is an added requirement to produce a health action plan.

Read codes Required and Guidance.

The requirements for taking part in the DES are as follows:

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Patient Participation

Some elements of this ES are being retained but the requirement for a local practice survey is being removed. A total of 40 million of the 60 million from this enhanced service is being reinvested into core funding, with 20 million being retained.

Look at the Guidance. Page 48 onwards.

The purpose of the patient participation DES is to ensure that patients are involved in decisions about the range and quality of services provided and over time, commissioned by their practice. It aims to encourage and reward practices for routinely asking and acting on the views of their patients. This includes the patients being involved in decisions that lead to changes to the services their practice provides or commissions, either directly or in its capacity as gatekeeper to other services. The DES aims to promote the proactive engagement of patients through the use of effective Patient Reference Groups (PRGs) and to seek views from practice patients through the use of a local practice survey. The outcomes of the engagement and the views of patients are to be published on the practice's website.

One aspect that practices may wish to focus on is ensuring convenient access to the practice and also from the practice to other services in its role as coordinator of care, facilitating access to other health and social care providers.

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Extended Hours

This ES will be extended for another year. Practices will have the option to work with others to deliver extended hours across a locality if they choose to do so, appointments can now be offered with all practice staff and there is an option to provide telephone consultations and use other methods of communication.

Look at the Guidance. Page 75 onwards.

Extended opening hours should be set according to the needs and wishes expressed by patients. NHS England and practices should therefore continue to take into account results from the latest GP patient survey and PPG views, including those resulting from participating in the patient participation ES when agreeing extended opening hours.

There is no set number of appointments that should be provided within any given period of time. However, on average, practices are likely to be able to offer no fewer than two appointments for every 30 minutes of extended opening.

During core contracted hours, existing standards of access and availability should be maintained. NHS England should continue to support all practices in ensuring that they are meeting the reasonable needs of patients during core hours.

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Facilitating timely diagnosis and support for people with dementia

This Enhanced Service (ES) will be extended for another year, with 50% of the ES funding available for engagement and 50% being paid on evidence of activity. A new requirement for practices to offer an advanced care planning discussion to patients diagnosed with dementia will be introduced.

Read codes Required and Guidance.

Improving diagnosis and care of patients with dementia has been prioritised by the Department of Health through the NHS Mandate and by NHS England through its planning guidance for CCGs. This enhanced service is designed to encourage practices to take a proactive approach to the timely assessment of patients who may be at risk of dementia.

For the purposes of this enhanced service, 'at-risk' patients are:

These assessments will be in addition to other opportunistic investigations carried out by practices (i.e. anyone presenting raising a memory concern).

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Vaccination and Immunisation - Full Guidance here

Rotavirus (routine childhood immunisation) (continuing April 2014)

Read codes Required

This programme is for one year from 1 April 2014 until 31 March 2015. Practices who participate in this programme will be required to sign up to the programme on CQRS no later than 30 June 2014.

Following a recommendation by the JCVI, vaccination against rotavirus was introduced to the national immunisation programme from July 2013, to protect infants.

Rotavirus can cause gastroenteritis which may lead to severe diarrhoea, vomiting, stomach cramps, dehydration and mild fever. If unvaccinated, nearly all children would have at least one episode of rotavirus gastroenteritis before reaching five years of age. The vaccine, given orally, is over 85 per cent effective at protecting against severe rotavirus gastroenteritis. An estimated 130,000 children with rotavirus gastroenteritis would have visited their practice and approximately 12,700 of these children would have been hospitalised in England and Wales each year if there was no vaccination programme. Deaths caused by rotavirus are rare and difficult to quantify accurately.

However, in England and Wales there were approximately three to four each year prior to the vaccination programme commencing. The rotavirus immunisation programme comprises two doses of rotavirus vaccine given to infants at the age of two months and three months (that is two doses four weeks apart) when they attend for their first and second routine childhood immunisations.

Vaccinations and immunisations are an additional service under the GMS contract. Changes to the GMS contract for 2014/15 include a new item of service payment of 7.64 for a completed course of rotavirus vaccination for GMS providers of the additional service.

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Shingles (routine aged 70 immunisation) vaccination programme (continuing after August 2014)

Read codes Required

This programme is for one year from 1 September 2014 until 31 August 2015. Practices participating in this programme will be required to sign up to CQRS no later than 31 August 2014.

The incidence of shingles in England and Wales is estimated to be around 790 to 880 cases per 100,000 people per year for those aged 70 to 79 years. The risk and severity of shingles increases with age and can lead to post herpetic neuralgia (PHN) and hospitalisation. It is estimated that, in people aged 70 years and over, around one in 1000 cases of shingles results in death110 111.

In March 2012, the Joint committee on Vaccinations and Immunisations (JCVI) recommended that patients aged 70 to 79 (inclusive) should be routinely offered vaccination against shingles. The roll out of this extended programme will be considered by NHS England, Public Health England (PHE) and the Department of Health (DH) and will be phased in over a period of time due to both vaccine supply and ensuring a manageable implementation process. The shingles (routine aged 70) vaccination programme was introduced from 1 September 2013, comprising a single injection, offered routinely to patients who are aged 70 as at 1 September that year.

The date of birth range for patients eligible to receive the shingles (routine aged 70) vaccination is 2 September 1943 to 1 September 1944.

Vaccinations and immunisations are an additional service under the GMS contract. The GMS Contract for 2014/15 introduced this new item of service at 7.64 payment for each dose.

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Shingles (Catch-up) vaccination programme (continuing after August 2014)

Read codes Required

This programme is for one year from 1 September 2014 to 31 August 2015. Area teams will seek to invite practices to participate in this ES before 30 June 2014. Practices wishing to participate will be required to sign up to CQRS by no later than 31 August 2014.

The shingles catch-up vaccination programme is an enhanced service (ES) commissioned by NHS England on behalf of PHE and is aimed at delivering vaccination and immunisation programmes in England. This ES is effective from 1 September 2014 to 31 August 2015124 for patients aged 78 and 79 on 1 September 2014.

Payment of 7.64 for each vaccination of shingles will be made to practices delivering this ES.

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MMR Catch-up ES (continuing April 2014)

Read codes Required

Practices who participate in this programme will be required to sign up to CQRS by no later than 30 June 2014.

Outbreaks of measles in England have been increasing in recent years. In 2012, there was a total of 1,920 confirmed cases, the highest annual figure since 1994. During 2013, 587 cases were confirmed in England.

The key difference in the pattern of infection in 2013 was a concentration of cases in teenagers, which had not been experienced in previous years. It is most likely that the increase in this age group was related to the adverse publicity about the MMR vaccine between 1998 and 2003 which resulted in sub-optimal vaccine coverage. Following advice from PHE, NHS England have commissioned a vaccination programme to offer Measles, Mumps and Rubella (MMR) vaccine to patients aged 16 and over who are not fully vaccinated.

This was introduced in April 2013 to run until March 2014 and has now been extended from 1 April 2014 until 31 March 2015. Vaccinations and immunisations are an additional service under the GMS contract. Changes to the GP contract for 2014/15 include a new item of service payment of 7.64 for each dose of MMR provided by GMS contractors offering this additional service.

Practices are also required to administer the vaccine to all unvaccinated eligible 'at-risk' children aged ten to 15, who present to the practice requesting vaccination or on an opportunistic basis. Payment is included in the existing global sum allocations, assuming the practice provides additional services. As such, no additional payment will be made for vaccinating these children.

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Seasonal influenza and pneumococcal polysaccharide vaccination programme (continuing after August 2014)

Additional Guidance

Read codes Required

This programme is from 1 August 2014 to 31 March 2015. Area teams will seek to invite practices to participate in this ES before 30 June. Practices will be required to confirm their participation by 31 July 2014. Practices who agree to participate will be required to sign up to CQRS by no later than 31 August 2014.

For most healthy people, influenza is an unpleasant but usually self-limiting disease. However, children, older people, pregnant women and those with underlying disease are at particular risk of severe illness if they catch it.

Pneumococcal infection is caused by Streptococcus pneumoniae a common cause of pneumonia and can also lead to invasive disease including meningitis and septicaemia. Invasive disease is common in young children, who are offered protection against 13 serotypes of S, pneumoniae through the pneumococcal conjugate vaccination (PCV13) programme. Children aged under two years are covered under the Statement of Financial Entitlements (SFE). In older children and adults, severe pneumococcal infection predominantly affects those with underlying conditions and the elderly.

The aim of the seasonal influenza and pneumococcal polysaccharide vaccination programmes is to protect those who are most at risk of serious illness or death should they develop influenza or pneumococcal disease, by offering protection against the most prevalent strains of influenza virus and against 23 serotypes of S. pneumoniae.

Payment of 7.64 for each dose of the appropriate seasonal influenza or PPV23 vaccine will be made to practices delivering this ES in accordance with the service specification.Where two doses of vaccine are to be administered, this must be done at least four weeks apart. Payment under this ES will be on a monthly basis, based on an item of service payment of 7.64 per dose (either one or two doses as clinically appropriate) per eligible patient vaccinated.

Vaccination must be delivered during the period of this ES, namely between 1 August 2014 and 31 March 2015, with vaccinations concentrated between 1 September 2014 and 31 January 2015 for seasonal influenza.

Seasonal influenza and PPV23 are set up as separate services on CQRS and GPES. As practices who agree to participate in this ES will be expected to deliver vaccinations to eligible patients for both the seasonal influenza and pneumococcal vaccination programmes, practices would be expected to sign up to both services on CQRS.

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Childhood Seasonal Influenza ES (continuing after August 2014)

Read codes Required

This programme is from 1 September 2014 to 31 March 2015. Area teams will seek to invite practices to participate in this ES before 30 June 2014. Practices who agree to participate will be required to sign up to CQRS by no later than 31 July 2014.

In 2012 the Joint Committee on Vaccination and Immunisation (JCVI) recommended that the seasonal influenza programme be extended to all children aged two to under 17. The roll-out of this extended programme will be phased in over a period of time ensuring a manageable and successful implementations process. The first cohort of patients to be vaccinated from 1 September 2013 to 31 March 2014 was children aged two and three years.

This Enhanced Service (ES) further extends the patient cohort to include all children aged two, three and four years old (but not aged less than two or aged five or over) from 1 September 2014 to 31 March 2015. Further phasing and consideration of how the programme will be extended to school age children will be informed by pilots and through collaboration between Public Health England (PHE), NHS England and the Department of Health (DH).

The childhood seasonal influenza ES is in addition to the seasonal influenza ES which vaccinates children aged six months and over who have clinical conditions which put them at risk of the effects of influenza. Children aged two, three and four but not aged less than two or aged five or over (including those defined as at-risk) are excluded from the seasonal influenza ES to avoid duplication as this cohort is eligible under this extended childhood seasonal influenza ES.

his ES is effective from 1 September 2014 to 31 March 2014 for patients aged two, three and four (but not aged less than two or aged five or over) on 1 September 2014. In the interests of maintaining the highest level of safety and in order to set a clear and manageable limit, healthy children that turn two after 1 September 2014 should not be offered the vaccine.

Payment of 7.64 for each dose of influenza vaccination will be made to practices delivering this ES in accordance with the service specification.

Payment will be made based on the monthly count multiplied by 7.64. Only one payment will be made per dose delivered. Where two doses have been delivered, practices may be required to provide evidence as to why the second dose was indicated. Where evidence does not support delivery of a second dose, the practice will not be paid for the second dose.

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Hepatitis B (new born babies) vaccination programme (commencing April 2014)

Read codes Required

Practices participating in this programme will be required to sign up to CQRS by no later than 30 June 2014.

PHE identified the need to introduce a consistent approach across England for the vaccination to protect against hepatitis B in newborn babies. As a result, vaccination against hepatitis B was introduced for newborn babies into the national immunisation programme from 1 April 2014.

The UK is a very low-prevalence country, for hepatitis B. Prevalence is higher in adults born in high-endemicity countries, many of whom will have acquired infection at birth or in early childhood. Prevalence rates found in antenatal women, vary from 0.05 to 0.08 per cent in some rural areas to one per cent or more in certain inner city areas.

All newborn babies born to mothers with hepatitis B should receive a complete course of hepatitis B vaccination. The benefit of vaccination is high in this group of infants and vaccination should not be withheld or delayed.

The hepatitis B immunisation programme comprises four doses of hepatitis B vaccine given to infants at birth (routinely in hospital), aged one month, aged two months (four weeks after dose one) and at aged 12 months.

Vaccinations and immunisations are an additional service under the GMS contract. The GMS Contract for 2014/15 introduced this new item of service at 7.64 payment for each dose.

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Meningococcal C (MenC) freshers vaccination programme (commencing April 2014)

View the Guidance for this enhanced Service

Read codes Required

Area teams will seek to invite practices to participate in this ES before 30 April 2014. Practices who agree to participate will be required to sign up by no later than 30 June 2014.

Meningococcal disease is a life-threatening infection. It is a term used to describe two major illnesses meningitis and septicaemia. These can occur on their own or more commonly both together. Most people will make a good recovery but at worst meningococcal disease causes very severe illness that can rapidly result in death.

The MenC routine vaccination programme was introduced in 1999 for children and adolescents under the age of 18. In 2002, the catch-up campaign was extended to include adults under 25 years. In 2006, the course was changed to two doses (at three and four months) and a booster dose at 12 months of age. In 2013, following recommendations by JCVI, further changes were made and an adolescent booster was introduced. JCVI noted that older adolescents (who will be beyond the age of the routine booster introduced in 2013/14 academic year), may have only received a single dose of MenC vaccine at a young age. This group is at increased risk of contracting MenC disease if they enter into a further education setting for the first time because the disease can spread quickly in areas where people live closely to each other, e.g. in university halls of residence or shared accommodation.

Following recommendation by JCVI, a vaccination programme against MenC for freshers (first time university/further education students who have received notification via UCAS to obtain MenC vaccination) is being introduced and anticipated to last until the first cohort of the school year nine vaccination programme reaches university age (2018). An estimated 400,000 students in England, aged between 17 and 25 inclusive in the financial year 2014/15 and attending university/further education for the first time, will be advised to contact their general practice to obtain the MenC vaccination. This is a new enhanced service (ES) commissioned by NHS England on behalf of Public Health England (PHE) and is aimed at practices delivering vaccination and immunisation programmes in England. This ES is effective from 1 April 2014 until 31 October 2014.

Payment of 7.64 for each dose of MenC vaccination will be made to practices delivering this ES.

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Pertussis (pregnant women) vaccination programme (continuing April 2014) - Supplementary guidance

This ES will apply for the period from 1 April 2014 until 31 March 2015. NHS England area teams will seek to invite and sign up GP practices to participate in this ES by no later than 30 June 2014.

The Chief Medical Officer (CMO), on the advice of the Joint Committee on Vaccination and Immunisation (JCVI), asked that the temporary programme of pertussis (pregnant women) vaccination be extended to respond to the ongoing outbreak of infection that led to a number of infant deaths across the country.

Vaccination of pregnant women in the third trimester (recommended between 28 and 38 weeks of pregnancy) offers protection to newborns during the early weeks after birth when the risk of complications from pertussis are greatest.

The aim of this ES is to support NHS England area teams in establishing pertussis vaccination within GP practices, in order to prevent cases of the disease and deaths in infants. Pertussis vaccination will boost immunity in women in late pregnancy so that pertussis antibodies are passed from mother to baby to passively protect infants in the first months of life (before they receive their routine childhood immunisations from aged two months). It is important for all women to be offered the pertussis vaccine during each pregnancy.

Payment available to participating GP practices under this ES in 2014/15 is priced as follows:

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Prepared By Jean Keenan