When can practices charge? We look at the three areas of travel, occupational health and medical/lifestyle reasons
Travel
Hepatitis B immunisation is NOT paid for by the NHS as part of additional services; however, the regulations do not say when the immunisation should be given on the NHS or as a private service. In the ‘Green Book’ (Immunisation against infectious disease), hepatitis B for travel is indicated for.
The former ‘Red Book’ (Statement of fees and allowances payable to general medical practitioners in England and Wales; not available to download online) advised what services were funded by the NHS:
as a practice, you may choose whether to give single hepatitis B immunisation for travel for free or charged;
combined hepatitis A and B immunisations must always be given for free;
the GMS regulations state that practices may charge for hepatitis B immunisations;
the Green Book advises what to give and when.
Occupational health
It is the BMA’s view that there is no obligation under the GMS regulations for a practice to provide occupational health services for patients; that responsibility rests with the employer, under health and safety legislation. In occupations where there is a risk to health, it is the employer’s duty to assess this and protect the workforce. Examples of the groups considered to require hepatitis B immunisation can be found in Chapter 18 of the Green Book (see full guidance).
Model letters
Model letters can be provided to patients who request a hepatitis B immunisation for occupational health , or to the employers. These are available in Appendix 3.
Private contract
A practice can enter into a private contract with an employer, or medical school, to provide this service, either to a group of employees or a single employee. The practice can only accept a fee from the employer, however, not from the registered patients.
Self-employed patients
One area of difficulty is if there is an occupational health risk but no employer to assess and manage this, e.g., a self-employed care worker. Practices may wish to:
refer these patients to other practices where they can be offered occupational care as a private service;
provide the immunisation as an NHS service for free and claim reimbursement of the vaccine costs.
Medical students
Medical schools are legally responsible for providing a full occupational health service to their students. This should include appropriate training, e.g., in risk-reduction and needle stick injuries.
By providing a hepatitis B immunisation a GP may be placing inexperienced students at risk by giving them a false sense of security and, potentially, exposing them to risk of contracting other blood-borne infections.
Lifestyle risk or medical conditions
Patients whose lifestyle or medical conditions put them at risk of hepatitis B, including family members of those with hepatitis B, also need immunisation.
If there is a lifestyle risk, you cannot charge.
Certain lifestyles will put some people at more risk, and practices can only rely on patients to give the correct information. Examples may include tattoo parlour workers, family members of intravenous drug users and sex workers.
Determining whether these are lifestyle risks or occupational risks (in the case of the tattoo shop owner or sex worker) is relevant to a strict interpretation of GMS obligations. However, practices are reminded of the primacy of care for the patient and good medical practice.
Giving hepatitis B immunisations to those at lifestyle or medical risk is not part of the additional service component of the global sum.
Newborn babies at risk
A newborn whose mother has hepatitis B is at an increased risk of contracting the disease. A programme ensures newborn babies receive the vaccination (first three doses) within the first three months after birth and the fourth dose at the age of one. This vaccination is incorporated into SFE for providers of the childhood immunisation additional services.
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