Travel Health information

The BMA have produced guidance regarding Travel Vaccinations and what general practice should offer, the full guidance can be found here.

Are we contracted to provide Travel vaccination?

The provision of vaccination and immunisation services is an additional service and funding remains within the global sum.

NHS patients are entitled to receive advice on recommended immunisations and malaria prophylaxis free of charge.

Vaccinations which are available on the NHS are part of additional services under GMS and PMS, registered patients should not be charged for the provision of these vaccines.

All practices are expected to offer all NHS travel vaccinations and advice services to their registered eligible population unless they have opted out.

Can I ask the patient to visit travel clinic or websites for assessment & advice and just give vaccines?

See page 19 of RCN Competencies: Travel health nursing: career and competence development (2018) which states:

“Recent concerns have been raised of a growing trend of reports (in England) that some travel health providers are not performing a risk assessment, but instead sending the traveller to a private service or instructing the traveller to identify their vaccine needs online. Following this, the original provider then administers the vaccines identified as being “recommended”. This practice is considered unsafe. Those who ‘just give vaccines’ according to information the traveller has obtained or identified, puts the individual health care practitioner at significant risk. Moreover, as a GP surgery who makes such a request is already paid for providing travel and risk assessment services, advice is an integral part of this service. Nurses practising in the UK are reminded of their personal accountability and compliance with The Code when advising travellers.”

Competencies: Travel health nursing: career and competence development

The RCN have published 2018 updated guidance on “the current guidelines and standard of care of travellers”.

Access to the RCN web page and their document, “Competencies: Travel health nursing: career and competence development” can be found on the following link: https://www.rcn.org.uk/professional-development/publications/pdf-006506

Resources & Websites

Jane Chiodini – Travel Health Specialist nurse

Jane Chiodini is a well-respected Travel Health Specialist nurse and provides free to download resources including Travel risk assessment forms, Travel risk management forms, A guide for travel vaccines, Malaria prophylaxis & a variety of patient advice leaflets. Theses resources can be accessed here.

The website also offers a useful “Help” section on different topics such as Rabies, Malaria, diabetes & travel etc. These can be accessed via the following link https://www.janechiodini.co.uk/help/

World Health Organisation (WHO)

WHO‘s primary role is to direct international health within the United Nations’ system and to lead partners in global health responses.

Travel Health Pro (NaTHNaC)

The National Travel Health Network and Centre  (NaTHNaC) The national centre providing travel health resources funded by the Department of Health for England.

Other useful websites

• Foreign, Commonwealth and Development Office (FCDO) The FCDO has a worldwide network of embassies and consulates, their website includes information about services that are available for UK citizens while they are overseas.
• Information on UK Vaccinations Information on UK National Schedule vaccinations aimed at the public.

• Altitude.org A High Altitude Resource. This website is written by UK doctors and aims to provide information about high altitude and its effects on the body. It contains several useful interactive altitude calculators and detailed tutorials about altitude sickness and also allows individuals who may have had HAPE to register on a HAPE database.
• Age UK  Useful advice for the elderly traveller.
• Australian Venom Research Unit  Advice, resources and research on spider, snake and jellyfish envenomation.
• British Airways Medical Service Provides advice on fitness to travel and specific contraindications.
• British Heart Foundation Information for travellers with people with a heart or circulatory condition.
• British Mountaineering Council  Provides information to Doctors/Climbers/Trekkers on climbing at altitude.
• Coeliac Travel  Advice for travellers with coeliac disease.
• Crohn’s and Colitis UK Information for people travelling with Crohn’s Disease or Ulcerative Colitis.
• Diabetes UK Information for travellers with Type 1 and Type 2 diabetes.
• Diving Medicine Scotland Official NHS Scotland point of information for the public and other healthcare professionals on Diving Medicine.
• Himalayan Rescue Association Nepal  The Himalayan Rescue Association (HRA) is a voluntary non-profit organization formed in 1973 with an objective to reduce casualties in the Nepal Himalayas, especially keeping in view the increasing number of Nepalese and foreigners who trek up into the remote wilderness.
• International Society of Travel Medicine  The ISTM, with more than 4,000 members in 100 countries, is the largest organisation of professionals dedicated to the advancement of the specialty of travel medicine. Members include physicians, nurses and other health professionals from academia, government and the private sector. Services for members include a newsletter, a well established Journal, a conference in alternate years and research awards.
• International Association for the Medical Assistance of Travellers (IAMAT)  Lists of clinics for travellers requiring heath services abroad. Various leaflets and a medical directory of participating doctors are available. Membership is free of charge.
• International Travel and Parkinson’s  Information for travellers with Parkinson’s.
• Marie Stopes UK Contraception and Sexual Health Advice for Women Travellers. Includes helplines within collaborating countries.
• Mobility International  Mobility International USA (MIUSA) is a disability-led non-profit organisation aiming to rights through international exchange and international development.
• National Asthma Campaign  Information for travellers that have severe asthma.
• SOS International  A private company offering comprehensive high quality medical services to travellers at many centres around the world.
• Wilderness Medicine Society  The mission of the Wilderness Medical Society is to encourage, foster, support, or conduct activities to improve the scientific knowledge of the membership and general public in human health activities in a wilderness environment.
  An expert organisation with long and varied experience in health issues related to exploration and travelling to remote areas.
• World Tourism Organisation  Provides a wide range of articles and statistics on tourism and links to groups concerned with ecotourism.

What vaccines are provided as an NHS service?

The following travel immunisations must be given as part of NHS provision through GMS & PMS Regulations; therefore practices cannot charge for the following vaccinations.

• Hepatitis A (infectious Hepatitis) ­ first and second/booster doses
• Combined Hepatitis A & B ­ two doses with a third for over 16s
• Typhoid ­ first and second/booster doses
• Combined Hepatitis A and Typhoid ­ first and second/booster doses
• Tetanus, Diphtheria & Polio ­ as given in the combined Td/IPV vaccine
• Cholera

What vaccines are not provided as an NHS service?

Travel immunisations that cannot be given as an NHS service

• Yellow Fever
• Japanese B encephalitis
• Tick borne encephalitis
• Rabies
• Men ACWY (unless eligible as routine immunisation)
• Hep B (unless eligible as routine immunisation or patient is at risk due to reasons other than travel see green book )

The contractor may therefore charge a patient registered for GMS/PMS/APMS services for the immunisation if requested for travel.

The patient may either be given a private prescription to obtain the vaccines, or they may be charged for stock purchased and held by the practice. The process of administration of the immunisation is chargeable as well. Practices should also give the patient written information on the immunisation schedule proposed and the charges involved at the outset of the process.

An FP10 (or equivalent NHS prescription) must not be used to provide these vaccines.

Travel immunisations that can be given as either NHS or as a private service

The following immunisations for travel are not remunerated by the NHS as part of additional services and are in this category:

• Hepatitis B (single agent) any dose
• Meningitis ACWY (quadrivalent meningococcal meningitis vaccine; A, C, Y and W135)

This category is the one that causes most confusion. The ambiguity in this section stems from the regulations regarding the charging of patients that are registered with the practice. Schedule 5 of the NHS regulations 4 states that:

“The contractor may demand or accept a fee or other remuneration…. for treatment consisting of an immunisation for which no remuneration is payable by the Primary Care Trust and which is requested in connection with travel abroad”

This wording leaves the decision as to whether the practice levies a charge or not to the discretion of the practice. The regulations do not impose any circumstances or conditions as to when these immunisations should be given on the NHS or as a private service nor do they allow any outside organisation to decide which option should be chosen.

Practices therefore need to be clear about their policy to avoid falling foul of regulations that prohibit charging NHS registered patients. The service must be provided either entirely as an NHS process or entirely as a private service, and the following paragraphs illustrate that difference.

To provide this as an NHS service, the practice would either prescribe the immunisation on an FP10 (or national equivalent) or (in England and Wales) provide the vaccine from purchased stock and claim reimbursement through the normal channels (in the same way as immunisations provided under additional services). The practice must not charge the patient for the administration of the vaccine.

If a confirmatory certificate is requested by the patient, then the practice may charge for this, but cannot charge just for recording immunisation details for the patient’s personal record.

Alternatively, the practice may decide that providing this is as a private service and charge a patient registered for GMS services for the immunisation. In this situation this can either be provided on a private prescription or the patient charged for the supply from practice stock. In this situation a charge may be made for the administration of the vaccine.

It is important to avoid mixing these two scenarios. If these immunisations are provided as an NHS service, then no charge can be made to the patient other than for certification if requested by patient (which is not compulsory).

Practices also must ensure that their policy is non-discriminatory and that this is not done contrary to the Equality Act 2010 (formerly the Disability Discrimination Act).