GPs are often requested for hepatitis B immunisation in three broad areas:
- for travel
- for occupational health
- for medical reasons (eg IV drug use for renal disease).
The responsibility to deliver hepatitis B vaccination to renal patients lies with the renal service and not with general practice.
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 are in Chapter 18 of the Green Book (see full guidance).
Model letters can be provided to patients who request a hepatitis B immunisation for occupational health purposes or to the employers. These are available in Appendix 3.
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.
One area of difficulty is if there is an occupational health risk but no employer to assess and manage this, eg 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 schools are legally responsible for providing a full occupational health service to their students. This should include appropriate training, eg 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.