Thursday, 1 July 2010

Q & A : Hep B vaccination for predialysis patients - who pays?

Q: Hi Donal, I am having increasing numbers of GPs who say that Hep B vaccination should be provided by renal services as part of the bundle of predialysis care. They say the PCT does not fund them for giving the vaccination, which is normally paid for privately by patients wishing to be vaccinated because of foreign travel or for employment reasons. Many patients are being left in limbo and will start dialysis without the opportunity for vaccination if we can’t sort this out. It is of course in the UK CKD guidelines, so wonder what the DH view is on it? Thanks Dr Rosie Donne, Consultant Nephrologist, Salford

A: Thank you for your email requesting the Department of Health’s (DH’s) view on who pays for Hepatitis B vaccinations in CKD .

The current DH guidance on Good practice guidelines for renal dialysis/transplantation units: prevention and control of blood-borne virus infection September 2002, (Chapter 6) makes clear that “immunisation against HBV is recommended for patients already on haemodialysis or renal transplantation programmes and for other patients with chronic renal failure as soon as it is anticipated they may require these interventions”. The need for HBV and indeed pneumococcal vaccination in CKD is now also flagged on NHS Choices.

Immunisation of patients should not be only for patients travelling abroad, as immunising all patients in a renal unit will help ensure that if an HBV outbreak occurs the minimum number of infections will result and only a few will likely progress to the chronic carrier state. The DH advice to immunise when it is clear that renal replacement therapy might be needed reflects the fact that successful immunisation is more likely the earlier in the course of CKD it is administered.

I understand that, there is no specific funding allocated through the GP contract for the provision of Hepatitis B vaccinations. It is for Primary Care Trusts (PCTs) to decide how to commission this service and to make appropriate local arrangements with GPs or other contractors who carry out the vaccinations (funding such arrangements from their general allocations). As there is, no payment specified in the GMS Statement of Financial Entitlements for providing Hepatitis B vaccination, PCTs may put in place a Local Enhanced Service (LES) agreement in relation to Hepatitis B vaccinations for predialysis patients (and/or in other circumstances, which HepB vaccination is recommended). Where GPs provide the vaccination to NHS patients it must be provided free of charge to the patient. A GP may claim from the PCT the appropriate remuneration for the procurement of the vaccine, as specified in paragraphs 17.3 and 17.4 of the Statement of Financial Entitlements and any other payment due under a LES.

We would expect that PCT and Specialised Commissioners working together with their Kidney Care Network partners should make clear who locally is responsible for provision of Hepatitis B vaccinations, how it is resourced, and to ensure this aspect of quality of care is delivered in a timely and patient centred fashion.

I hope this is helpful, Donal.