Between May and June 2024 Londonwide LMCs collected evidence from London practices to quantify the financial impact that the omission of exception reporting based on patient choice for vaccination and immunisation indicators in the 23/24 QOF contract had, despite practices’ best efforts to increase patient uptake.
As part of the QOF contract for 23/24, practices were eligible for up to 64 points for vaccination and immunisations under the Public Health domain, 54 of which related to childhood vaccinations and immunisations. We have received widespread feedback that achieving these targets has been particularly difficult for practices in London where vaccination uptake is amongst the lowest levels in the county, for reasons outside of practices’ control.
While there is a Personalised Care Adjustment to allow for exception reporting where individuals have registered at the practice later in the contract year, NHS England does not allow for exception reporting where families are making an informed decision to decline the vaccination for their child despite multiple contacts or discussions with a health provider. This has had a significant impact on practice achievement, with many practices reporting that they have achieved 0 points for indicators VI001-003, resulting in a loss of thousands of pounds for the average practice.
| Indicator | Points | Thresholds |
| VI001. The percentage of babies who reached 8 months old in the preceding 12 months, who have received at least 3 doses of a diphtheria, tetanus and pertussis containing vaccine before the age of 8 months | 18 | 89-96% |
| VI002. The percentage of children who reached 18 months old in the preceding 12 months, who have received at least 1 dose of MMR between the ages of 12 and 18 months | 18 | 86-96% |
| VI003. The percentage of children who reached 5 years old in the preceding 12 months, who have received a reinforcing dose of DTaP/IPV and at least 2 doses of MMR between the ages of 1 and 5 years | 18 | 81-96% |