ࡱ> qtnop wObjbj &hhF z z "$Po;(pWWWW>1E BQ"QQWWv6Y Y Y QXWWY QY Y bw~$WW@CdV<(fp pWpW4QQY QQQQQ|QQQ(QQQQpQQQQQQQQQz :  PRIMARY CARE DEVELOPMENT 4.4.9 ENHANCED SERVICE SPECIFICATION FOR CATCH UP MEASLES MUMPS AND RUBELLA (MMR) IMMUNISATION IN GENERAL PRACTICE SERVICE OUTLINE All practices provide essential and additional services within their contract. This enhanced service specification outlines the service to give MMR immunisation to all individuals aged 13 months to 18 years who have previously had no MMR immunisations or have received only partial (one dose) immunisation as part of a national catch up campaign to reduce the risk of a measles epidemic. The specification is designed to cover the enhanced aspects of clinical care of the patient, all of which are currently beyond the scope of presently contracted services. No part of the specification by commission, omission or implication defines or redefines essential or additional services. The Primary Care Trust reserves the right to amend or withdraw this enhanced service and this service is offered in the first instance for the remainder of the financial year 2008-09. 1.3 The previous success of the MMR vaccination programme reduced the number of measles cases to very low levels for a number of years. However, the numbers of measles cases in England are now rising, and outbreaks are occurring. 1.4 Following a decade of relatively low vaccination uptake, there are now a large number of children who are unvaccinated or partially vaccinated with MMR. The potential exposure of a large number of unprotected children to the measles virus means that there is a real risk of a large measles epidemic. Estimates suggest that an epidemic in England could result in 30,000 cases or in a worst case scenario more than 100,000 cases of measles in children and young people. These children and young people will also be susceptible to mumps and rubella. 1.5 Measles is a serious disease. It can lead to pneumonia and encephalitis and can kill. 10% of cases of measles require hospital admission, and fatality rates of one per 5000 are still seen in the UK, with recent epidemics in industrialised countries having even higher rates. Between 1992 and 2006, there were no deaths from acute measles in the UK. Between 2006 and 2008 two deaths occurred. 1.6 The primary course of MMR consists of two doses, the first routinely given at age 13 months and the second preschool at aged 3years 6 months. For children aged over 3 years 6 months a minimum of one month is recommended between the two doses. 1.7 In all cases, the final decision as to who should be offered immunisation is a matter for the clinical judgement of the GP within the scope of the national programme. 2 ELIGIBILITY 2.1 Payment arrangements under the scheme will apply to all patients aged between 13 months and 18 years not covered by existing target payments, immunised by 31 March 2009. 2.2 Patients attending at the appropriate age for immunisation (13 months or 3 years 6 months) who would have been routinely called for immunisation at this time are already covered via target payment and are expected to be immunised as part of the routine child health programme. 3 SERVICE REQUIREMENTS In addition to the MMR supplies provided for routine childhood immunisation, an additional 500,000 doses of MMR will be made available for this campaign. Vaccine will be ordered by Practices via Movianto using routine vaccine ordering and delivery systems. Practices will be able to order up to 50 doses of vaccine per week by this method. Orders should be placed a week prior to any planned clinic sessions. If more than 50 doses are required in any week Practices will be required to contact the Vaccine Supply Team at the Department of Health to advise them of their requirement before an order can be placed. The Vaccine Supply Team can be contacted via email at its mailbox at  HYPERLINK "mailto:vaccine.supply@dh.gsi.gov.uk" vaccine.supply@dh.gsi.gov.uk This address can also be used for supply queries on this campaign. All eligible patients will be notified by Patient and Practitioner Services that they are eligible, an information leaflet will also be provided. See Appendix A for a copy of the letter and information. 3.5 The Provider will undertake to: opportunistically offer and immunise any eligible patient (see 1.1) who presents to the Provider during the term of this enhanced service. Patient and Practitioner Services will notify general practitioners of all patients registered who have received the vaccine after each of the two doses. Verbal confirmation of vaccination status can be obtained via Patient and Practitioner Services. immunise all eligible patients notified of a due immunisation via Patient and Practitioner Services. to record the information that it has in the patients GP held life-long medical record using any applicable national Read codes. See section 8.2 regarding reporting arrangements; have appropriate resuscitation equipment on site in case of anaphylactic reaction, including appropriate doses of adrenaline, an algorithm for anaphylaxis (see 14.2) and a telephone in case of an emergency. Immunisation should only be undertaken where there is another health professional on the premises in case of emergency. comply with any local Patient Group Direction in place if a non-prescriber is administering the injection. HEALTH RECORD AND CONSENT 4.1 The Provider will take all reasonable steps to ensure that the lifelong medical records held by an at-risk patients general practitioner are kept up-to-date with regard to his immunisation status, and in particular include: for any refusal of an offer of vaccination: all information and advice given the patient information leaflet where an offer of vaccination was accepted: details of the consent to the vaccination or immunisation see 4.2 for more details on consent (where a person has consented on a patients behalf, that persons relationship to the at risk patient must also be recorded) the batch number, expiry date and title of the vaccine the date of administration of the vaccine where two vaccines are administered in close succession, the route of administration and the injection site of each vaccine any contraindications to the vaccination or immunisation any adverse reactions to the vaccination or immunisation Consent forms will be sent to the individuals by Patient and Practitioner Services with the initial invite letter. Individuals being immunised in general practice are being given immunisation to protect their future health. The Fraser guidelines or competencies, relate to the childs competency that requires the individual to understand and be able to give informed consent, should be used to determine whether the persons consent is sufficient or whether parental consent is needed. The other aspect of the Fraser guidelines is whether the health professional considers it to be in the individuals best interests to have the immunisation. Where Providers are requested to immunise children under the age of 16 for whom parental consent is not available they must assess whether they consider, the individual to be Fraser competent, and obtain written consent from that individual and document this within the individual case notes. If Providers have a specific query with regard to consent further guidance can be sought from the Primary Care Trust Caldicott Guardian (Director of Nursing and Patient Safety). 4.5 Please see section 10 regarding the significant event and incident reporting requirements. TRAINING 5.1 Administration of vaccines may be undertaken by registered nurses using a patient group direction for the individual vaccine developed for this purpose. Registered nurses must be assessed as competent to use the patient group direction and have undertaken the training in section. 5.2. The Primary Care Trust has drafted a patient group direction and once this is agreed this will be available via the patient group direction section on the Trust intranet site (as below). Please note this will supersede any guidance within this specification.  HYPERLINK "http://nww.somersetpct.nhs.uk/ClinicalGovernance/PGDs/Forms/AllItems.aspx" http://nww.somersetpct.nhs.uk/ClinicalGovernance/PGDs/Forms/AllItems.aspx 5.3 The Provider must ensure that any health care professional who is involved in administering a vaccine has: any necessary experience, skills and training with regard to the administration of the vaccine as outlined in the national minimum standards published by the Health Protection Agency training with regard to the recognition and initial treatment of anaphylaxis, including immediate access to adrenaline training with regard to potential drug interactions (e.g. anti coagulant, anti epileptics and theophylline training at a minimum of annual updates and evidence of the training should be kept for each practitioner. competence in assessing the persons capacity to understand the nature and purpose of the vaccination in order to give or refuse consent access to all documents detailed in the reference section of the relevant patient group direction. 5.4 Assessment of competencies and compliance with this section will be via evidence kept by the provider with regards to training for each member of staff carrying out immunisations. STORAGE All vaccines must be stored in accordance with the manufacturers instructions and with regard to chapter 3 of the 2006 DH guidance, Immunisation against Infectious Diseases (also called the Green Book) available at HYPERLINK "http://www.dh.gov.uk/greenbook"www.dh.gov.uk/greenbook. All refrigerators in which vaccines are stored must have a maximum/minimum thermometer. Readings from the refrigerator thermometer(s) should be taken on all working days and temperature recordings should be recorded and documented. The Provider should refer to vaccine manufacturers instructions if there is variation in the temperature outside of the Green Book recommendations. Disposal should be via an approved sharps container. 7 INFECTION CONTROL 7.1 Providers must have infection control policies that are compliant with national guidelines, which include: disposal of clinical waste needle stick incidents environmental cleanliness standard precautions, including hand washing CALL RECALL 8.1 Call-Recall systems will be provided by Patient and Practitioner Services. The mechanism for this will be as follows: Letters will be sent to all eligible individuals as per 2.1. (See Appendix A.) Practices will be informed by Patient and Practitioner Services of the details and number of individuals to be invited by their Practice and will be offered 2 Call Recall Options: option 1: Patient and Practitioner Services to call named individuals to designated clinic sessions arranged by the Practice option 2: Patient and Practitioner Services to send post cards to named individuals asking them to contact their GP to make an appointment 8.4 Providers will be required to advise Patient and Practitioner Services of their preferred method of Call-recall as soon as they have contractually agreed to provide this service. AUDIT/MONITORING 9.1 The Provider must supply to the Primary Care Trust any information it may reasonably request for the purposes of monitoring the Providers performance of its obligations; and 9.2 For immunisations scheduled by Patient and Practitioner Services the individual should be detailed on the clinic listing sheet if Option 1 is used, or on the routine immunisation listing sheet if Option 2 is used. These listing sheets should be completed and promptly returned to Patient and Practitioner Services to enable rolling weekly updates to be completed. 9.3 For ad hoc attenders, the Provider will enter the individuals details on the unscheduled immunisation form routinely available within the Practice and return this to Patient and Practitioner Services. 9.4 Providers may be asked to audit the monitoring of fridge temperature. 10 SIGNIFICANT/ADVERSE EVENTS 10.1 The Department of Health emphasizes the importance of collected incidents nationally to ensure that lessons are learned across the NHS. A proactive approach to the prevention of recurrence is fundamental to making improvements in patient safety. 10.2 The Provider should be aware of the various reporting systems such as: the National Patient Safety Agency National Learning and Reporting System the Medicines and Healthcare products Regulatory Agency reporting systems for adverse reactions to medication (yellow card system), and accidents involving medical devices and be aware of the relevance of the Black Triangle Status the legal obligation to report certain incidents to the Health and Safety Executive under the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations (RIDDOR) 10.3 In addition to any regulatory requirements the Primary Care Trust wishes the Provider to use the local Significant Event Audit system in place to facilitate the dissemination of learning, minimising risk and improving patient care and safety. 10.4 In addition to their statutory obligations, the Provider will give notification, within 72 hours of the information becoming known to him/her, of all emergency admissions or deaths of any patient treated by the Provider under this enhanced service, where such admission or death is or may be due to the Providers intervention as covered by this specification. Notifications are to be sent to the Director of Nursing and Patient Safety with a copy to the Senior Primary Care Commissioning Manager for the specific locality and to the PCT Immunisation Co-ordinator. 11 PRICING 11.1 Payment will be at the rate of 7.51 per immunisation. 11.2 The Provider is not eligible for the Personal Administration fee if the patient receives a prescription but the vaccine is not supplied and administered. This vaccination cannot be provided as a private treatment to any of the Providers registered patients. Providers can refer patients to another provider for a private vaccination, but no financial adjustments between Providers should be made. Where a patient is not in the nominated catch up group, the decision to immunise is based on the GPs clinical judgement. There would be no item of service fee on this basis, but if the Provider supplies and administers the vaccine the Personal Administration fee would apply. 12 PAYMENTS 12.1 Payments will be made at the end of the financial year based on the information held by Patient and Practitioner Services Child Health team. 13 PATIENT AND PUBLIC INVOLVEMENT 13.1 The service will conform to professional and legal requirements especially clinical guidelines and standards of good practice issued by NICE and professional regulatory bodies, and legislation prohibiting discrimination. It is anticipated that for the majority of enhanced services translated information will be available via the Department of Health. If a patient wishes to communicate via a language that is not covered via these leaflets please let the Primary Care Trust Equality and Diversity Lead know and use the commissioned interpretation and translation service (Applied Language Solutions*) to facilitate the consultation and provision of information to the patient. Use of the interpretation/translation service should be recorded in the patients lifelong medical record including confirmation of the first language of the patient. 13.2 Providers should encourage and consider any patient feedback (positive and negative) on the service that they provide and use it to improve the care provided to patients, particularly if there are plans to alter the way a service is delivered or accessed. *Orange book with regard to these services is available at  HYPERLINK "http://www.somersetpct.nhs.uk/how%20we%20do%20things" www.somersetpct.nhs.uk/how we do things PINs for accessing this service have been given to each provider. REFERENCES 14.1 GREAT BRITAIN. 2008. CMO Letter 5 August The MMR Catch-up Programme. Gateway no. 10192 For example from the National Resuscitation Council:  HYPERLINK "http://www.resus.org.uk/pages/anaalgo.pdf" http://www.resus.org.uk/pages/anaalgo.pdf  HYPERLINK "http://nww.somersetpct.nhs.uk/ClinicalGovernance/PGDs/Forms/AllItems.aspx" http://nww.somersetpct.nhs.uk/ClinicalGovernance/PGDs/Forms/AllItems.aspx HEALTH PROTECTION AGENCY. June 2005. Standard number: Standard year National Minimum Standards for Immunisation Training. The Health Act 2006: Code of Practice for the Prevention and Control of Healthcare Associated Infections, The Stationary Office, updated 2008. APPENDIX A Suggested template letter of appointment / invitation to be sent via Practitioner Services PRACTICE NAME ADDRESS [Date] [Recipients Address] Dear Parent Our records have indicated that your child has not received a complete course of MMR vaccine (two doses). If your child has not had two doses of MMR vaccine they are at risk of catching measles. Measles can be serious, leading to pneumonia and even death. The Department of Health has therefore recommended that your child needs a catch-up dose of MMR vaccine. We are writing to invite you to bring your child for this vaccination on: [date and time] [venue] This catch-up dose is important for your child because there has been a recent rise in cases of measles. Measles is one of the most infectious diseases known, and MMR vaccine will protect your child from measles, mumps and rubella. For more information on measles and the MMR vaccine, please read the leaflet (enclosed). If you have any further questions, please get in touch with your health visitor, practice nurse or GP or see www.immunisation.nhs.uk. . As an NHS provider, we recommend the MMR vaccine for your child and hope that you will be able to bring your child for this appointment. If the above time and date are not suitable for you, please contact the [surgery name and contact no.] to arrange another appointment. Yours sincerely Registered GP  See reference one  See references.  See references.  National Minimum Standards for Immunisation Training, Health Protection Agency, June 2005.  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