Nursery ban called for in MMR row

GPs plan new moves to enforce vaccination
By Sarah-Kate Templeton Health Editor

Pressure on doctors to meet immunisation targets for the MMR vaccine amid parents' fears that the jab is linked to autism is forcing increasing numbers of GPs to consider drastic action including dropping families from their NHS lists and excluding unvaccinated children from nursery schools.

The Sunday Herald has learned that several Scottish practices are actively planning to remove families who refuse vaccination from their NHS lists.

It has also emerged that refusing unvaccinated children admission to nursery school has been discussed by GPs as a way of achieving herd- immunity -- the point at which an outbreak can be prevented.

GP practices are paid to reach immunisation targets of 70 and 90%. If they fail to meet these targets because parents do not want to have their children vaccinated, the practices can lose thousands of pounds.

Dr Eric Holliday, who practices in Wiltshire, has removed one family from his NHS list because the parents refuse to have their children vaccinated.

He has agreed to treat the family, although they are not on his list and he is not paid to care for them, because this way he loses a fraction of the cash which would be withheld if the practice failed to meet its immunisation targets.

He said: 'This family is not registered with us and we are not contracted to see them but we have elected to see them for nothing.

'This is possible with one family but if this involved several dozen families in a large urban setting it would be problematic.'

London GP Dr Margaret Safranek told the GP magazine Pulse that many GPs are finding ways of refusing to register families who don't want the MMR vaccine.

She said: 'I think there is an enormous number of patients swimming around out there who are not taken on. The fact we could be penalised because people refuse the vaccine leads to a lot of minor 'cheating'. Who can blame us?'

Several Scottish practices are now discussing how they can manage the system in order not to lose out on payments.

And doctors are so concerned about the falling immunisation rates that they have proposed banning children from nursery school if they have not received the MMR.

Dr Mustafa Kapasi, chair of Inverclyde Local Health Care Co-operative and a Greenock GP who supports the proposal, said GPs had discussed it at a national meeting.

He said: 'This has happened elsewhere, including the USA, and so why should it not happen here? At the end of the day, we have got to make sure that there is immunity.

'I am sure it would be unpopular, however. People would say we were acting like Big Brother and that it was against their human rights.'

Dr Syed Ahmed, public health consultant with Greater Glasgow Health Board, rejects such a drastic measure but argues that parents do have a responsibility to vaccinate their children to protect at-risk groups.

He said: 'I do not think we can say that unless a child is vaccinated he or she cannot go to school. But there are children who do not have any choice and cannot be vaccinated, such those who are immuno compromised or have leukaemia. Parents have got a choice but they also have a responsibility to protect these children from disease.'

Bill Welsh, chairman of Action Against Autism, said: 'The current structure where doctors receive targeted payments for vaccine administration is exacerbating an already fraught area in doctor/patient relationships. In parents' minds it brings into question a doctor's impartiality when advising on immunisation matters.

'To suggest any form of compulsory vaccination reveals a disregard for the concerns of parents.'

www.doh.gov.uk/mmrvac.htm

www.autismuk.com