Updated guidance on pre-travel health services

The CQC has fully revised and reissued this information to incorporate up-to-date resources and advice – here’s what practice managers need to know

CREDIT: This is an edited version of an article that originally appeared on the CQC

Travel health services are available from a range of NHS and independent healthcare services. These include:

• NHS GP practices
• private travel clinics
• some specialist clinics providing post-tropical screening services
• occupational health settings
• military healthcare settings
• pharmacies
• independent schools and universities.

In England, a provider needs to be registered with CQC if it provides travel health services that are delivered by a doctor or a nurse. This comes under the regulated activity of treatment of disease, disorder or injury.

Travel health services are exempt from CQC registration if they are provided in:

• occupational or military settings – these work under their own standards of practice
• pharmacies – where the service is not delivered by a doctor or nurse.

NHS GP practices are required to offer certain vaccinations for the purposes of travel, free of charge. The travel vaccines available on the NHS are provided because they protect against the diseases thought to be the greatest risk to public health, if brought into this country. These are:

• polio (given as a combined diphtheria/tetanus/polio jab).
• typhoid
• hepatitis A
• cholera

Not all travel vaccines are provided on the NHS. See the BMA’s Travel medication and vaccinations guidance for further information.

A pre-travel risk assessment must be performed by the healthcare practitioner either:

• giving the travel vaccine under a Patient Group Direction (PGD) or…
• delegating the administration of the travel vaccine under a Patient Specific Direction (PSD).

For more details see:

• Royal College of Physicians and Surgeons of Glasgow Good Practice Guidance for Providing a Travel Health Service
• National Travel Health Network and Centre
• RCN Travel Health Nursing: career and competence development

GP practices that provide travel health services can also offer:

• advice, including preventing malaria. See Malaria prevention guidelines for travellers from the UK
• advice on the vaccines available on the NHS and information on where to go for those that are not.

Governance

Governance structures and individual travel medicine practitioners influence the quality and safety of services. In NHS general practice, this duty of care is often delegated to general practice nurses (GPNs), pharmacists and paramedics.

The GP delegating must be satisfied that the person providing care has:

• the appropriate qualifications, skills and experience to provide safe care for the patient
• access to appropriate training, supervision and oversight.

See the General Medical Council’s Good Medical Practice guidance.

Registered nurses delivering travel health services are professionally accountable to the Nursing and Midwifery Council (NMC). They work within the NMC Code (2015).

Training

Regardless of their profession, the minimum standard of practice for practitioners who deliver travel health services is the same. Pre-travel consultations are complex. Practitioners need a wide knowledge that covers:

• geography and epidemiology of infectious disease
• vaccine-preventable diseases
• infections transmitted by insect bites
• non-vaccine preventable risks
• the ability to risk assess and communicate this to the traveller.

Initial training for travel health should be in line with:

• Good Practice Guidance for Providing a Travel Health Service (Royal College of Physicians and Surgeons of Glasgow)
• RCN Travel Health Nursing: career and competence development. This includes using the competency assessment tools before carrying out clinical practice.

There should be evidence of formal training in immunisation and ongoing evidence of competence. Practitioners should also achieve safeguarding competence at the appropriate level. This includes awareness of female genital mutilation and forced marriage. See the RCN Travel Health Subject Guide.

Practitioners administering yellow fever vaccines must meet the standard required to register as a Yellow Fever Vaccination Centre. This is administered by the National Travel Health Network and Centre.

When the CQC inspect:

We may not look at every regulation at every assessment. Where we identify concerns regarding travel services, we assess against:

• Regulation 12 (Safe care and treatment)
• Regulation 17 (Good governance)
• Regulation 18 (Staffing) 

We will look for evidence that providers have systems to ensure that staff:

• are recruited appropriately
• operate within the limits of their capability, scope of practice and competency
• receive appropriate information, support and supervision to enable them to carry out their role.

Training and development should include, but is not limited to:

• reviewing pre-travel consultations until the practitioner has reached the minimum standard of proficiency
• communicating patient safety alerts and guidance
• opportunities for continuing professional development
• complaints and significant event arrangements.

We expect to see processes to assess, monitor and mitigate the risks relating to the health, safety and welfare of patients. Examples include:

• Using a recognised online tool to identify country-specific risks to help make recommendations. Country-specific risks include vaccine-preventable and mosquito-borne diseases. See the travelhealthpro website
• A comprehensive travel health risk assessment completed for each person using the service.                                                                                                 

Clear documentation of the risk assessment for:

• all vaccines given
• medicine prescribed or advised
• vaccines declined.

Risk assessment of the emergency equipment and medicines required. As a minimum, this must include adrenaline.

Working within the relevant legal framework for the administration of medicines. This includes:

• patient group directions (PGDs)and patient-specific directions (PSDs)
• use of unlicensed and off-label medicines.
• Safe storage of medicines, including vaccines.