GPs frequently receive requests for hepatitis B immunisation, which generally fall into three broad categories:
Travel-related immunisation
Occupational health requirements
Medical or lifestyle risk factors
Hepatitis B vaccination for travel is not included in the NHS Additional Services and, therefore, is not reimbursable under the NHS.
According to Schedule 5 of The NHS (General Medical Services Contracts) Regulations 2004, GPs may charge for travel-related immunisation:
“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 means that a GP practice can charge a private fee for hepatitis B immunisation when it is required solely for travel. However, the situation becomes more complex when Hepatitis A and B are combined into a single vaccine. Since Hepatitis A vaccination is provided free under the NHS for travel, practices must carefully consider whether it is clinically appropriate to use the combined vaccine or to offer the Hepatitis B component privately.
To ensure compliance with NHS regulations, practices must clearly define their policy regarding hepatitis B vaccination for travel. The key principles are:
If offering hepatitis B for travel, it must be done entirely as a private service.
If offering combined hepatitis A and B vaccination, it must be done entirely as an NHS service.
Patients should be clearly informed of the practice’s policy and any associated charges in advance.
Under GMS regulations, GP practices are not contractually required to provide occupational health services, including hepatitis B vaccination for work-related purposes. The responsibility for occupational health vaccination falls under employer obligations as per Health and Safety legislation.
Employers must assess and mitigate risks associated with occupational exposure to hepatitis B and provide appropriate vaccinations if necessary.
This responsibility also extends to medical and dental students, for whom Medical Schools are legally responsible for providing a full occupational health service.
GP practices cannot charge their registered NHS patients for occupational health services, including hepatitis B immunisation.
Practices may choose to enter into private contracts with employers, universities, or medical schools to provide hepatitis B immunisation. In such cases, the fee must be charged to the employer or institution, not the individual patient.
Some individuals are at increased risk of contracting hepatitis B due to their lifestyle, occupation, or medical conditions. Examples include:
Individuals with chronic renal disease or requiring regular blood transfusions
Family members of intravenous drug users
Sex workers and their close contacts
Certain occupational groups, such as tattoo artists (particularly self-employed individuals)
While hepatitis B vaccination for these groups is not explicitly covered under the GMS contract, practices should provide immunisation in clinically appropriate situations as part of good medical practice.
GPs are not contractually obligated to provide hepatitis B vaccination in lifestyle risk cases unless there is a clear clinical need.
Each case should be assessed individually to determine whether vaccination is appropriate.
If a patient is eligible for hepatitis B vaccination based on medical risk factors (e.g., renal disease), the vaccine should be provided as part of NHS care.
Practices should be cautious about charging for hepatitis B vaccinations in situations where there could be an overlap between lifestyle risk and medical need.
GP practices must be aware of their contractual obligations regarding hepatitis B vaccination and ensure that their policies align with NHS regulations.
Travel-related hepatitis B immunisation can be charged privately, but practices must be clear about when this applies.
Occupational health vaccinations are the responsibility of employers and cannot be charged to NHS-registered patients.
Medical risk-based vaccinations should be offered on a case-by-case basis under NHS care where clinically appropriate.
To maintain clarity and compliance, practices should develop a written policy outlining their approach to hepatitis B immunisation and ensure all staff members are informed of the appropriate procedures.