The following immunisations for travel are part of additional services under General Medical Services (GMS) and Personal Medical Services (PMS). Patients should not be charged a fee for these specified travel immunisations if the service is provided to registered patients. Practices can opt out of this provision. Where vaccines are required for occupational health reasons, these should not be provided on FP10.

• Hepatitis A
• Typhoid
• Combined hepatitis A and typhoid
• Tetanus, diphtheria and polio combined vaccine
• Cholera

The vaccines stated above are available at NHS expense in one of two ways:

• Purchased by the practice and personally administered payment claimed through FP34PD.
• Obtained by the patient on FP10 prescription. A prescription charge is payable to the pharmacy unless the patient is exempt. In this situation no claim for personal administration fees should be made through FP34PD.

Travel vaccines that cannot by given as an NHS service

The following vaccines are not remunerated by the NHS when used for travel purposes:

• Hepatitis B
• Meningitis ACWY
• Yellow Fever
• Japanese B encephalitis
• Tick borne encephalitis
• Rabies

The practice may therefore charge a registered patient for the vaccination if requested for travel. The patient may either be given a private prescription to obtain the vaccines, or they may be charged for stock purchased and held by the practice. The process of administration of the vaccine is also chargeable. An FP10 must not be used to provide these vaccines.

The combined hepatitis A/ hepatitis B vaccine should NOT be prescribed on the NHS. The hepatitis B element of the combined vaccine is not commissioned by the NHS as a travel vaccine and hence (although the combined vaccine is available on the NHS) providing the hepatitis B element in this way on the NHS is an inappropriate use of NHS resources.  Please do not permit the prescribing of this item free at the point of delivery when it is not funded for the travel indication. Patients requiring both vaccines for travel purposes should receive hepatitis B privately or obtain the combined vaccine privately.

BMA advice regarding Hep B vaccines for student health professionals and volunteer travellers

It is GPC's view that there is no obligation under the GMS regulations for a practice to provide occupational health services for patients. That responsibility rests with the employer under Health and Safety Legislation, and in occupations where there is a risk to health from any form of work related infection it is the employer’s duty to assess that risk and, if present, to protect the workforce. Examples of the groups that are considered at occupational health risk and require hepatitis B immunisation is set out in Chapter 18 of the Green Book.

The same applies for healthcare students who often request a hepatitis B immunisation prior to, or on entering, a course. Medical Schools are legally responsible for providing a full occupational health service to their students and applicants. This should include appropriate training for example in risk reduction and coping with needle stick injuries. By providing a hepatitis B immunisation, a GP could place inexperienced healthcare students at risk by providing a false sense of security and potentially exposing them to clinical risk of other blood borne infections, including HIV and hepatitis C, before they have received appropriate training.

https://www.bma.org.uk/advice/employment/gp-practices/service-provision/hepatitis-b-immunisations

Private Prescribing

For travel vaccines not available on the NHS, a charge may be levied for:

• The vaccine
• Administration
• Private prescription writing.

The level of charges should be determined by the practice; it is advisable to develop a practice protocol available to patients in the form of a leaflet or section of the practice leaflet or website. Patients should be advised to compare prices as there may be variation in the amount that individual pharmacies will charge to supply the vaccination. Alternatively, practices may choose to buy in the vaccine directly and charge patients for the cost of the vaccine.

There may be further charges incurred after vaccination depending on where the patient is travelling. Practices should note that these charges should be arranged privately and funded by patients and not the NHS:

• Post-vaccination serological testing in the case of Hepatitis B administration, if performed for travel reasons.
• Provision of certification of immunisation (for example, confirmation of Meningitis ACWY135 administration).

Should you have any queries please contact the Medicines Management Team

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