Exclusive: GPs fear public health crisis as child immunisation service axed

Plans to close immunisation clinics provided by health visitors when councils take over responsibility for the service could put children and vulnerable adults at risk and threaten practice capacity, GP leaders in London have warned.

Hackney LMC chairwoman Dr Fiona Sanders: 'The impact on health is extraordinary' (Photo: Haymarket/Pete Hill)
Hackney LMC chairwoman Dr Fiona Sanders: 'The impact on health is extraordinary' (Photo: Haymarket/Pete Hill)

A major London council has asked NHS England for assurances that its population will not be at risk when a childhood immunisation service is lost later this year. 

Local authorities across England are set to take over commissioning of child public health services, including health visiting, from NHS England on 1 October. The London Borough of Hackney council has said it has been told by NHS England that immunisations are the responsibility of GPs. The council will give 60 days notice to end immunisations for 0 to 5 years olds currently provided by health visitors when it takes over the service.

Health visitors in the east London borough currently provide immunisations for illnesses such as measles, mumps and rubella, for around a third of children, covering the shortfall of hard to reach families, and running clinics at children’s centres. 

Child immunisations will continue to be commissioned nationally from GPs by NHS England. But local GPs fear the decision to end the supplementary health visitor provision could threaten herd immunity, making the whole programme ‘useless’, and could cause a capacity crisis for practices expected to pick up the work. 

City and Hackney LMC chairwoman Dr Fiona Sanders said health officials were ‘worried’ about the effect the loss of the service will have. ‘There will be capacity problems because we are all really struggling and we have never done that level of immunisations’, she said. ‘It has massive implications for the health of children, young people, pregnant women, and all sorts of people, anybody who is vulnerable. It has devastating health consequences.'

‘The impact on health of this is extraordinary,’ she added. ‘It's short sighted because the cost of getting kids with measles, mumps, rubella: you'll lose your immunisation, your coverage will drop hugely.’

GPC deputy chairman Dr Richard Vautrey said the decision to end the service  was another sign of the withdrawal of health visitors from the routine care for young children and ‘further fragmentation of the primary healthcare team at a time when we should be rebuilding and expanding this essential community service’.

‘This has already been the experience for practices right around the country. Areas of London have historically had very low rates of immunisation and so it is vital that local authorities in the area take their public health responsibility seriously and work closely with practices to ensure the highest coverage possible’, said Dr Vautrey.

Dr Sanders said she believed no funding had been made available for Hackney Council to continue the immunisations. ‘It's just been lost’, she said.

NHS England said that councils will receive the same funding it currently receives for commissioning health visitor services and that its officials are aware of local capacity because immunisations are commissioned through the GP contract and as enhanced services. 

Immunisation services in City and Hackney are ‘adequately resourced and funded’ through the national contract agreements, an NHS England London spokeswoman said.

NHS England officials informed the council that health visitors are not required to deliver immunisations, a London Borough of Hackney spokeswoman told GPonline. The council has now asked NHS England officials to assure them the population will not be at risk and has requested that health officials meet with GPs and the local hospital to draw up an action plan.  

City and Hackney GP Confederation has been asked by NHS England whether it can support practices delivering immunisations. The federation is understood to be preparing a business case outlining the funding it would require to provide a service.

The problem may not be unique to Hackney, according to Dr Sanders. ‘It's a scandal across the country’, she said. ‘In some areas CCGs have picked [the work] up. It's been fudged in a lot of areas, but this is going to get a lot bigger.’ A national spokesman, however, said NHS England was not aware of problems elsewhere.

A spokeswoman for the London Borough of Hackney said: ‘Public health in local authorities will be taking over the responsibility for commissioning of public health services for 0-5s from 1 October 2015. This responsibility does not include childhood immunisations. The responsibility for commissioning childhood immunisations remains with NHS England.

‘NHS England have advised us that health visitors are not required to deliver immunisations, and that this is a GP responsibility. However, health visitors will be important in promoting and encouraging parents to take up immunisations offered by their local GP.

 ‘Achieving high levels of take up of childhood immunisations is a public health priority. We have requested that NHS England meet with local organisations to develop a local action plan and provide us with regular updates to assure us that our population will not be at risk.’

A spokeswoman for NHS England London said: ‘The responsibility for commissioning immunisations remains with NHS England and is done under nationally agreed terms. The childhood immunisation programme in City & Hackney is therefore adequately resourced and funded. GPs are nationally contracted to deliver this service and no practice in City & Hackney has officially opted out. 

‘Under the enhanced service GPs are responsible for delivering vaccinations to their patients, including calling and recalling them if they are overdue – this includes those that are hard to reach. NHS England has started negotiating with the GP Confederation with a view to supporting all practices to develop robust immunisation practices.’

A national spokesman for NHS England said: ‘NHS England will commission alternate provision to ensure the ‘hard to reach’ children still have access to services. Health visiting teams will continue to provide parents and young people with tailored information on the vaccination programme.’

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