GPs opting out of childhood jabs

Childhood immunisation protects against many infectious diseases

Children in the most deprived areas of the country are being put at risk because GPs are not providing vaccinations, figures suggest.

One in eight practices in deprived areas are not giving immunisations, because they cannot hit government targets, the Liberal Democrats said.

Poor uptake in these areas could lead to major disease outbreak, they warned.

The British Medical Association said it would be very unusual for GPs to opt out of giving vaccinations.

The Department of Health said that if GPs opted out, primary care trusts were responsible for providing vaccination.

Childhood immunisation for diseases such as whooping cough, diphtheria, polio, meningitis C, measles, mumps and rubella is an "additional service" under the GP contract, which means practices can choose not to provide the service.

Individual GPs who carry out vaccinations are paid for the proportion of children they manage to immunise each year - £995 for 70%, £2,865 for 90%.

Practices in deprived areas have always struggled to achieve high uptake because of poverty, ethnic diversity and high levels of mobility.

An investigation of NHS data by Lib Dem MP Steve Webb has shown that, although 94% of practices are still providing immunisation services, those that have opted out are concentrated in deprived areas.

Overall, in the 61 most deprived PCTs, 12.5% of practices have chosen not to carry out childhood immunisations compared with 0.2% in the 61 least deprived PCTs.

It is believed that practices are choosing to opt out because they have little chance of hitting the higher payment target.

Outbreaks

Recently published figures show that measles outbreaks are on the rise in areas where uptake of MMR is lower - with 449 cases so far this year compared with 77 cases last year.

Mr Webb, MP for Northavon and health spokesperson for the Lib Dems, said the opt-out could lead to an epidemic.

"They have set up a system where doctors in deprived areas who are nowhere near meeting the target have no incentive to continue doing immunisation.

"They should have never been allowed to opt out, I can't understand why they agreed it, instead the practices should have been offered more support to improve uptake."

He added: "But the real worry is that if you go below these critical uptake thresholds in localised areas you will get outbreaks."

"The best way to deliver vaccination is through GPs - PCTs don't have access to the network, they are starting with a handicap."

Dr George Kassianos, immunisation spokesperson for the Royal College of General Practitioners, said: "There are some practices working in deprived parts of the country and really struggling in many clinical areas, not just immunisation.

"I think the Department of Health really needs to single-out these practices and give them much more support in providing these services to their patients."

Dr Laurence Buckman, deputy chairman of the British Medical Association's GPs committee said he had never met a doctor who had opted out of childhood immunisations.

He added: "I'm sure there are some who have, but it would be very unusual for them to do so."

Dr Buckman said some PCTs did provide a central immunisation service, but most did not have the resources to do this.

A spokesperson for the Department of Health said: "Under the current vaccine payment system, GPs are financially rewarded and therefore incentivised to ensure every child get the vaccinations they need.

"PCTs are responsible for maintaining provision of the service in their area if a GP practice opts out and should take an innovative approach to improving immunisation uptake among deprived and at risk communities.

"This includes using home visits and other opportunities to boost uptake."