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Children without MMR jab struck off GPs' list
By Lorraine Fraser, Medical Correspondent
(Filed: 17/11/2002)
 

A doctor's surgery has admitted striking a number of children off its register because the practice will lose thousands of pounds a year if they do not have the controversial MMR vaccination.

The Canbury Medical Centre in Kingston, Surrey, is not meeting a government target of immunising 90 per cent of the children on its list. If this continues the doctors will each lose a "vaccination bonus" of £2,865.

The centre has informed parents that their children will be treated as "temporary residents" rather than being on National Health Service lists, and has blamed the decision on the Primary Care Agency - the NHS body that pays the vaccination bonus.

The surgery's policy came to light when Karen Kennedy-Milne, from Kingston, received a letter from the medical centre last Monday saying that her daughter Abigail, who has not had MMR, would be de-registered because she had not had all the recommended vaccinations.

The letter made clear that, if large numbers of parents refuse vaccines, such as MMR - which has been controversially linked to autism and bowel disease - doctors cannot meet their immunisation targets and will not be paid the bonuses. Single vaccinations against the three diseases are not available on the NHS.

Dr Josephine Boxer, the senior doctor at the surgery, explained to Mrs Kennedy-Milne that her practice had recently been penalised by a "large amount" of money because so many local families had decided not to have their children fully immunised. Dr Boxer said subsequently that the decision had been taken "for administrative purposes only" and was made at the suggestion of the agency.

Although the surgery insists that Abigail will still be entitled to the same level of care as previously, Mrs Kennedy-Milne said: "We have always had excellent care from the surgery but I simply can't believe that the service my daughter is now delivered is not going to be affected.

"I was absolutely livid and also quite shocked," she added. "I feel so strongly about this. Not giving Abigail MMR is my choice; it is my free choice. It is an educated decision I have made through research, deliberation and discussion - and now my child's right to a GP is being denied her.

"This goes straight to the fundamentals of why parents don't trust the doctors on MMR. How can you trust the advice of somebody who is being paid to do something? Our objection is to the possible danger around the triple vaccine and we would consider alternatives, but we haven't been offered alternatives - we have just been de-registered."

Mrs Kennedy-Milne said that her son Angus, four, had not been vaccinated with MMR either and she anticipated a letter saying that he too had been dropped from the list.

"I spoke to the Primary Care Agency and made plain that I think this is absolutely outrageous," she said. "I then received a second letter from the surgery saying that they would be continuing to offer the full range of services and emergency care to my children . . . and they would automatically be reinstated on the list at the age of six.

"It seems to me that they are fiddling the figures; they will remove as many children as they need to remove to get under this bar. When I rang the PCA I was told they would not be finding another doctor for Abigail, because as far as they are concerned it won't make any difference to the service she receives. In other words they have a legal responsibility - except where a child has not had the MMR because there is money involved."

Dr Boxer told The Telegraph that the practice had recently had a "blitz" in which about a dozen children had been dropped from the its list because they were not fully immunised.

"This is situation that we are being pushed into by a government policy that penalises us for patients having free choice," she said. "At the moment we have a problem of a large number of people refusing to have, in particular, the MMR vaccine. It is not for me to make their decisions but I don't see why we should be penalised for them."

It made "absolutely no difference" to the care the children received and a temporary resident form could be completed for them when they attended the surgery, she said.

"I don't want to be put into this situation but since we are providing full care it is the lesser of two evils," she said. "Last year as a practice we lost £10,000 compared with the year before, which is income but is also used to pay a proportion of our staff and expenses in the practice. This is quite serious finance."

The immunisation payment system should be changed to allow doctors to be paid if parents opted out of immunisations after they had been told about them, she said, adding: "It makes it seem as though we are persuading people to be immunised because we get paid, which is not the case."

Peter Holloway, the chief executive of the PCA, expressed surprise that Mrs Kennedy-Milne had been told that the practice was acting on the advice of his agency and that his staff had told her Abigail would not be allocated another doctor.

"This is not something I am aware of and I would like to look into it urgently. The aim is to ensure that the targets are a genuine reflection of the position in regard to immunisation," he said.

Jackie Fletcher of the pressure group Jabs said: "This just shows what a mess the NHS is in over vaccines. It is appalling that it should have got to the state that money has to come before a child's needs."

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