-----Original Message-----
From: Julian Bradley <[log in to unmask]>
To: [log in to unmask] <[log in to unmask]>
Date: 30 August 1998 07:52
Subject: Re: monitoring in practice
>Peter Fellows typed
>
>>I will doubtless find out more at the next GPC meeting. There never has
been
>>an agreed national ie Red Book item of service fee for flu vac. We are
hence
>>entitled to charge a fee for administering the vaccine.
>
>How certain in the right to charge a fee in these circumstances?
>
>I agree we should be paid for it BUT we're giving it to NHS patients, using
>NHS drugs, for their benefit while in the UK. Can't see anything that
>allows us to charge a fee in this. It doesn't appear comparable to the
>imms for foreign travel that the government won't fund. Am I missing
>something?
>
>JB
If a FEE is specified in the Red Book for an immunisation which is a matter
of public policy, then you may not charge the patient. If a vaccine is not
centrally supplied ( an increasing trend to squeeze para 44 benefits) then
all doctors can dispense " personally" administered items with the
consequent profit involved (part of the pool of target net - superannuated
income, however!). You are entitled to charge a fee for administering flu
vaccine,since it is not part of our terms of service to immunise against
flu. The patients in the groups advised as being "at risk" in the CMOs
letter each year ( this year extending the list to all patients over 75
years), are entitled to the vaccine on the NHS, but NOT to free
administration of the vaccine, hence the unofficial item of service fees
which some sympathetic HAs had agreed as local arrangements with their
contractors. In practice few doctors charge patients in the official "at
risk" groups ( they are largely elderly or chronic sick). For those patients
not in "at risk" groups you may choose to supply the vaccine privately as
well as charging for it's administration . The basic principle is that you
cannot be paid twice for any work, but you are entitled to be paid once,
from whatever source, be it private fee, NHS item of service, or basic NHS
Terms of Service payment (as per those disgaceful BA forms, which should
never have been allowed to become a Terms of Service requirement). Many
doctors who are making heavy charges for some vaccinations eg hepatitis B,
will lose out when an official red book fee is published at long last,
because the official fee is bound to be less. There is the Catch 22
situation in the "pool". Once a Red Book fee is published, it forms part of
Target Net, and ends an avenue for private fees, thus reducing GPs overall
earning capacity, unless the pool is increased to acknowledge inclusion of
new work. Not much chance of that in present times! The Red Book section on
immunisation is a mess and long overdue for sorting out. I know the GMSC
tried hard. I was expecting a new SFA over 2 years ago, but the DoH suddenly
dragged it's feet. It doesn't seem to know which way to jump on travel
vaccines in particular, and has been reluctant to change the Regulations,
preferring a muddled series of "Executive Letters" which have little legal
standing if challenged.
Hope this makes things a little less grey!!!
Regards,
Peter Fellows, GPC
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