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NHS Borders Enhanced Service Programme for Primary and Community Care
Pneumococcal Vaccination under 65 years of age
Local Enhanced Service 2016/2017
Introduction
The purpose of the local enhanced service is to cover the provision of pneumococcal
immunisation for those aged less than 65 years of age and in at-risk groups.
Payment for pneumococcal vaccination for those aged 65 or over is incorporated in
the Influenza DES.
Background
Pneumococcal vaccination can reduce the serious morbidity and mortality from
pneumonia by immunising those most likely to have a serious or complicated illness. This
can avert the need for the patient to be hospitalised.
No uptake target has been set for immunizing those in the non-age-related at-risk
groups as reliable statistics on the size of this group are not available. For all at-risk
groups, GPs should aim to maximize uptake in the interests of patients. In all cases, the
final decision as to who should be offered immunisation is a matter for the clinical
judgment of the GP, although we would expect GPs to focus on the at-risk groups.
This enhanced service gives incentives to GPs to provide a proactive and preventative
approach by adopting robust call and reminder systems for the patients on their list in
the at-risk groups to receive immunisation.
Target Population
Eligible at-risk groups are those defined in the current version of Immunisation against
Infectious Diseases - The Green Book. Table 25.1 in this chapter details the clinical at-risk
groups; occupational at risk groups are in a separate section in the chapter.
Practices are encouraged to access the appropriate chapter of this resource on a
regular basis to ensure up to date working and for further detail, which is available
online:
https://www.gov.uk/government/publications/pneumococcal-the-green-bookchapter-25.
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Children and Adult Clinical risk groups
Examples (decision based on clinical
judgement)
Asplenia or dysfunction of the spleen
This also includes conditions such as
homozygous sickle cell disease and coeliac
syndrome that may lead to splenic
dysfunction.
This includes chronic obstructive pulmonary
disease (COPD), including chronic bronchitis
and emphysema; and such conditions as
bronchiectasis, cystic fibrosis, interstitial lung
fibrosis, pneumoconiosis and
bronchopulmonary dysplasia (BPD).
Children with respiratory conditions caused
by aspiration, or a neurological disease (e.g.
cerebral palsy) with a risk of aspiration.
Asthma is not an indication, unless so severe
as to require continuous or frequently
repeated use of systemic steroids (as
defined in Immunosuppression below).
This includes those requiring regular
medication and/or follow-up for ischaemic
heart disease, congenital heart disease,
hypertension with cardiac complications,
and chronic heart failure.
Nephrotic syndrome, chronic kidney disease
at stages 4 and 5 and those on kidney
dialysis or with kidney transplantation.
This includes cirrhosis, biliary atresia and
chronic hepatitis.
Diabetes mellitus requiring insulin or oral
hypoglycaemic drugs. This does not include
diabetes that is diet controlled.
Due to disease or treatment, including
patients undergoing chemotherapy leading
to immunosuppression, bone marrow
transplant, asplenia or splenic dysfunction,
HIV infection at all stages, multiple myeloma
or genetic disorders affecting the immune
system (e.g. IRAK-4, NEMO, complement
deficiency) Individuals on or likely to be on
systemic steroids for more than a month at a
dose equivalent to prednisolone at 20mg or
more per day (any age), or for children
under 20kg, a dose of 1mg or more per kg
per day.
It is important that immunisation does not
delay the cochlear implantation.
This includes leakage of cerebrospinal fluid
such as following trauma or major skull
surgery
Chronic respiratory disease
Chronic heart disease
Chronic kidney disease
Chronic liver disease
Diabetes
Immunosuppression
Individuals with cochlear implants
Individuals with cerebrospinal fluid leaks
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Reinforcing immunisation
Antibody levels are likely to decline rapidly in individuals with no spleen, splenic
dysfunction (including coeliac disease) or chronic renal disease1 and therefore reimmunisation with PPV23 is recommended every five years in these groups.
Revaccination is well tolerated2.
Testing of antibody levels prior to vaccination is not required.
Although there is evidence of a decline in protection with time3, there are no studies
showing additional protection from boosting individuals with other indications, including
age, and therefore routine revaccination is not currently recommended.
Practice Requirements


Practices are asked to look at ways in which they can identify those patients
who require pneumococcal vaccination and address call and recall for this
cohort.
Use national read codes as noted below; the current codes are:
(i)
(ii)
(iii)
(iv)
9021.
6572.00
8I2E.00
8I3Q.00
letter invite to screening
pneumococcal vaccine given
pneumococcal vaccine contraindicated
pneumococcal vaccine declined
(Note that the dots after the codes are important)
Payment Arrangements
Practices will be paid an engagement fee of £1000 in Year 1 of the LES to resource time
taken to review +/- design systems for identifying those patients suitable for
pneumococcal vaccination (e.g. using list of patients undergoing DMARDs monitoring
to help identify those who may be immunosuppressed) and to reflect the work required
to implement such processes.
Payment arrangements under the scheme will apply to all at-risk patients who are
immunised by 31st March in the relevant financial year. For payment purposes, the
immunisation programme will operate from 1 April to 31 March in each year.
A fee of £7.67 will be paid for each vaccination administered
A claim form will be issued by P&CS in due course for return to Louise PattersonColtman, P&CS Admin by 31 March 2017.
[email protected]
1
Giebink et al., 1981; Rytel et al., 1986
2 Jackson et al., 1999
3 Shapiro et al., 1991
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Please sign and return this completed form only to confirm your participation.
NHS Borders Enhanced Service Programme for
Primary & Community Services
Pneumococcal Vaccination under 65 years of age
Local Enhanced Service 2016/17
Practice Name: ____________________________________
Practice No: ______________________________________________
Signed for and on behalf of the Practice _____________________________
Please print name and designation __________________________________
Date _______________________________________________________________
Notice Period
In the event of a practice being unable to maintain the service for the duration of the
contract or wishing to opt out, an appropriate period of notice will be agreed with NHS
Borders (normally 3 months).
The payments will be subject to the normal payment verification processes.
Forms should be returned to Louise Patterson-Coltman in P&CS:
[email protected]
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