The amount doctors receive as part of Direct Enhanced Services (DES) payments could change following recommendations made in a new report on immunisation.

The report, produced by 2020health, calls for the introduction of a new three-tier DES system, as well as an increase for the current threshold from 70 per cent to 80 per cent. As a result, payments would be made at 80 per cent, 90 per cent and 95 per cent.

The report says much more can be done to improve the uptake of vaccinations, and to ensure the small minority who currently miss out have the opportunity to receive vaccinations if they so wish.

However, the authors were keen to stress that massive strides have been made to improve the numbers of children receiving vaccinations and that interested parties and stakeholders should not lose sight of this.

Between 2006/07 and 2012/13, national coverage of the MMR (measles, mumps and rubella) rose from 85 per cent to 92 per cent of people receiving the first vaccination (MMR1), while those receiving the diphtheria, tetanus, acellular pertussis and polio booster rose from 79 per cent to 89 per cent in the same period.

But changes within the NHS has meant people were unsure where to go for vaccination advice, with practitioners themselves also unsure of the procedure locally. The report, Protecting the Nation: Every child matters, makes a number of recommendations relating to this, as well as improved information and dissemination and access. 

Recommendations include:

  • The implementation of a national immunisation advice line
  • Ensuring immunisation is part of the Healthy Child Programme and mandatory for health visitor training. However, health visitors should be used for immunisation as a last resort
  • Ensuring immunisation data is recorded as part of the Summary Care Record
  • ‘Fit for school’ advertising campaign, particularly towards the start of school terms and in prominent places such as bus shelters and train stations
  • Improved use of text-based messaging.

A number of these strategies are currently taking place locally, but the report calls for a sharing of best practice to ensure the hard-to-reach few who would like their children vaccinated get the correct information.

Jon Paxman, co-author of the report, said: “Fewer children have fallen ill because of the immunisation programme which is an important achievement. However we can’t be complacent; it sounds great getting 92 per cent vaccination update in MMR but the Welsh experience of 2012/13 showed that anything below 95 per cent leaves children at risk. Wales had seen three consecutive years with MMR1 uptake between 92 per cent and 94 per cent at 2 years, only then to see their 1 to 4-year-olds as one of the worst affected age groups during the measles outbreak. Measles cases among the unvaccinated (all ages) outnumbered those vaccinated by more than 95:1.”

Julie Manning, CEO of 2020health, added: “Those working in immunisation have a right to be proud of their achievements over recent years. However following the reorganisation of NHS commissioning structures, introduced April 2013, some major concerns arose, particularly around provider confusion about where to go for immunisation advice, the loss of local expertise with the decommissioning of district immunisation coordinator posts, and a lack of clarity as to who was responsible for the funding of immunisation training. To a significant extent these problems remain unresolved.”

At a launch event – a round-table discussion – held in Central London, these issues and others were discussed by key stakeholders and interested parties. Although no consensus was reached, there was an appreciation that the health service could not do this alone, and would require significant help and support from other third-party agencies and organisations to treat immunisation as part of a wider, holistic solution to improving child health and wellbeing.