Vaccination plans raise 'grave concerns' from experts

Immunisation experts are 'gravely concerned' that vaccination services will be undermined by changes to the way national schemes are managed.

Flu jab: experts fear NHS reform could undermine vaccination systems
Flu jab: experts fear NHS reform could undermine vaccination systems

NHS Commissioning Board medical director Bruce Keogh has written to SHA and PCT cluster leads to explain how screening and immunisation will fit into the reformed NHS.

Vaccination will be co-ordinated at a national level across England, with responsibility shared by the DH, Public Health England and the NHS Commissioning Board (see details below).

Dr John Middleton, vice president for policy at the Faculty of Public Health, said the new structures offered ‘many opportunities but also substantial challenges’.

‘The success of screening and immunisation programmes depends on excellent communication and very close collaboration between GPs and their teams, public health staff and hospital services,’ he said.

The new system ‘is untried and untested and will disrupt many well established working relationships’ and responsibilities at local levels remained unclear, he said. ‘We are gravely concerned about risks posed by these unanswered questions and how the complex new arrangements will be made safe and effective.’

RCGP immunisation spokesman Dr George Kassianos said the changes were ‘no longer under discussion’ and GPs must work to support the new system.

‘Our aim is to see a seamless transition that will not have a negative effect on our immunisation rates or the quality of our work,’ he said.

Hertfordshire GP Dr Mike Ingram, who has an interest in immunisation, said it was important for public health and preventive medicine to be managed at a national level. ‘One of the most important things is an accurate, consistent and scientific message going out across all levels, from the CMO, through ministers, to GPs and practice nurses,’ he said.

Dr Peter English, a consultant in communicable disease and a former GP, said national consistency was necessary for immunisation programmes to work effectively. ‘Everybody needs to be working towards the same standards,’ he said.

DH responsibilities

  • Overall responsibility for the strategic oversight and direction of the national screening and immunisation programmes.
  • Setting screening and immunisation policy based on expert advice from the NSC and the Joint Committee on Vaccination and Immunisation (JCVI) respectively.
  • Securing the necessary funding, delegating further responsibilities to its agency Public Health England.
  • Holding Public Health England and the NHS CB to account for their roles in ensuring delivery of the programmes through respective framework agreements.

Public Health England responsibilities

  • Responsible for delivery of those functions within the national screening and immunisation programmes best carried out previously at national level.
  • Advising DH on the development of national service specifications.
  • Setting quality assurance standards and providing independent quality assurance of the provision of screening and immunisation programmes.
  • Funding and managing the piloting and rolling out of new screening programmes and extending current ones.
  • Procuring, storing and distributing vaccines and immunoglobulins.
  • Gathering and analysing coverage and surveillance data.
  • Developing and providing national communication strategies for immunisation.
  • Providing expert public health analysis and advice to the NHS CB, and to DH.
  • Supporting the independent expert advisory committees (UK NSC Cancer Screening Advisory Committees and JCVI).

NHS Commissioning Board responsibilities

  • Responsible for the commissioning of screening and immunisation services on behalf of Secretary of State through a section 7A agreement which will be supported by funding from the public health ring-fenced budget.
  • Supported in its commissioning responsibilities through detailed service specifications for each of the programmes.
  • Accountable to DH.

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