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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. 1 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 2 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 3 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] 4