VACCINATIONS for children could be under threat from changes to the way that family doctors are paid. A survey suggests that more than one in seven GPs is considering opting out of providing immunisations and another 10 per cent may stop chasing up children’s vaccinations because the money they are paid for doing them has dropped by more than half.

Any reduction in vaccine coverage would be “a population health disaster”, Mark Lambert, director of public health at Gateshead Primary Care Trust, told the medical newspaper Pulse, which has been conducting a campaign on the issue.

GPs complain that the changes in payments were introduced surreptitiously. Many are angry at the British Medical Association (BMA) for allowing the changes to go through.

To maximise coverage, GPs are paid extra if they achieve 90 per cent of childhood vaccines. Until April this was counted by totalling up four vaccines — MMR, DTP (diphtheria, tetanus and pertussis) polio and Hib (Haemophilus influenzae type b, a vaccine against bacterial meningitis). Doctors who achieved coverage of more than 90 per cent, with each vaccine counting for a quarter, were paid an average of £8,500 for a three-partner practice.

The rules then changed to reflect the introduction of a five-in-one vaccine, Pediacel, which covers diphtheria, tetanus, pertussis, Hib and polio. This meant that the vaccine payments were based on just two vaccines, MMR and Pediacel.

Many parents remain reluctant to have their children immunised with MMR, a hangover from the discredited claims that it is linked to autism. Since it now counts for half of the calculation rather than a quarter, the low take-up means that many GPs cannot achieve the 90 per cent target. Instead, they get a lower payment on reaching 70 per cent — a significant drop in income.

Dr Jenny Lebus, a GP in Putney, southwest London, said that her practice had been assured that there had been no change in calculating targets.

“But at the end of June we failed to achieve our targets for two-year-olds for the first time, with a huge loss of income,” she said. “With warning, we might have been able to chase up a few. We were well over 90 per cent under the old scheme.”

In Kent, the estimate is that the number of practices hitting the target has fallen from 92 per cent to 16 per cent. Dr Susan Toothill, from Sevenoaks, said that her practice was on course to lose £9,000 this year.

Pulse conducted a survey among GPs to assess the extent of the losses. The first 200 responses showed that one in seven GPs was considering not providing childhood vaccinations, and another 10 per cent said that they would not chase parents who had not actively sought vaccination.

The Department of Health said that, because only two vaccines are now administered, the workload is less and the pay cut justified. It also claimed that it offered the BMA a compromise that would have involved including meningitis C vaccinations in the target, but that this was rejected.

Dr Hamish Meldrum, chairman of the BMA GP committee (GPC), denied that this was ever offered formally. The GPC argues that the MMR target should be relaxed to allow GPs to count as vaccinated those children whose parents had been counselled but still refused MMR, but the department has declined.

So the negotiations are at a stalemate. Dr George Kassianos, spokesman on vaccination for the Royal College of General Practitioners, said: “There will be dire consequences, huge consequences. The department will have the biggest problem it has ever had on vaccination.”

THIS MIGHT HURT

• Childhood immunisation is the single most effective medical intervention
• Polio, which killed 270 people in Britain in 1955, has been eliminated here
• A practice that reaches 90 per cent of children with MMR and the five-in-one jab gets a bonus. With MMR uptake in England at 81 per cent, for a bonus the average GP must give 99 per cent the five-in-one jab
• MMR uptake in London was 71.4 per cent in 2004, making a bonus impossible for the average doctor

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