In the current climate, avoiding home visits and non-elective admissions to hospital for a vaccine-preventable condition is particularly pertinent. Could a PCN collaborative approach help?
National Immunisation Awareness Month (NIAM) is an annual event held in August to highlight the importance of vaccination for people of all ages. While this month provides a focus, all year round General Practice and the healthcare teams across the NHS play a key role in educating the population about the importance of vaccination and the delivery of vaccination programmes.
With the introduction in 2019 of Primary Care Networks (PCN), there is now another potential approach to providing vaccination programmes; one, which SCW has supported PCNs with. The national Directed Enhanced Services (DES) for Shingles, where practices are paid £10.06 for each completed vaccination, could provide an opportunity for a motivated PCN to introduce collaborative working, resulting in an increase in uptake and an increase in income.
Shingles vaccination rates across the UK are low, often around 30%. Rather than focusing on the workload; stop and consider the outcome and you get a different perspective. Undertaking this programme prevents avoidable home visits and non-elective admissions to hospital for a vaccine-preventable condition. The patient cohort is aged between 70 and 80, which also means they are likely to have one or more Long-Term Condition, and some will have a degree of frailty. Given the challenges of delivering vaccination programmes within the Covid-19 pandemic, this programme can also be dovetailed with the winter flu vaccination programme, with both given at the same time.
This Shingles vaccination project has proven to be a way of rapidly implementing a PCN-wide project. We have seen three options for delivery:
The process is as follows:
- Practice staff run searches on GP system to identify who is eligible yet unvaccinated and flag them on the system to produce a list of patients
- Practice staff contact eligible patients and invite them for vaccination, providing assurance to individuals around the maintenance of social distancing and decontamination measures (as per Public Health England Infection Prevention and Control guidance):
- Option 1 – book patients into normal appointment slot (healthcare assistant/nurse. If Practices deliver directly and undertake the entire process, they keep the £10.06
- Option 2 – run a dedicated shingles vaccination clinic and book patients into that clinic
- Option 3 – run as a PCN within one practice and split the £10.06 between PCN and practices – the practices claim the money and then pay the PCN. For example, the money could be split £3.00 to the practice for each patient vaccinated, £4.56 to cover the costs of delivery, £2.50 to the PCN for organising and running the system, or a variation on those amounts based on the numbers vaccinated. PCN members can set the amounts paid to each by agreement locally.
- The key is that the service is funded to ensure all costs are covered and there is a small surplus e.g. if you vaccinate 8 patients an hour, you would receive a fee of £80.48. The cost of the nurse, some admin support and possibly some HCA support, leaves £30 to £40 profit, depending on the delivery option used.
You can create materials to support your approach for practices and patients. Please check with local immunisation and vaccination teams, who can support you with a variety of materials.
In terms of why do it?
- The vaccine has already been purchased by NHS England/Improvement. Significant waste within the NHS is avoided by vaccinating eligible patients
- Shingles is a vaccine-preventable condition; prevention of the condition will result in a reduction in-home visits and non-elective admissions for frail, elderly patients
- Practices/PCNs achieve service delivery with one high quality, standardised approach without unwanted variation. All from providing a straightforward shingles vaccine programme
- Fits the 2 cycle audit for CQC
This is a great opportunity for PCNs to own and drive a collaborative project. It affords the opportunity for engaging patients’ in a proactive, rather than reactive, process and allows General Practice to deliver one high quality and standardised approach without unwarranted variation across all practices.
The Primary Care Team in SCW continues to provide support and direction to practices, Primary Care Networks and federations in working to successfully implement new care models, develop connections and work collaboratively within Integrated Care Systems.
Our aim is to enable health and care systems to achieve the best possible outcomes for people, communities and populations.