Some basic details about the vaccines, which a receptionist and other staff, should know about are given below. However, non-clinical staff should direct patients to Nurses for advice and any leaflets in display in the surgery.
There are primary, secondary and tertiary immunisations
Child immunisation will only be carried out if the following two are brought to the surgery:
- The Red Book
- A written and signed consent letter from a parent, if the child is going to be accompanied by a guardian/friend of the family.
18.104.22.168 Immunisation Schedule
At birth Hepatitis B vaccine for babies born to hepatitis B positive mothers (often detected as part of the routine Hepatitis B screening programme)
BCG mainly for babies of some immigrant families and for those in household contact with TB.
Here’s a checklist of the vaccines that are routinely offered to everyone in the UK for free on the NHS, and the age at which the baby should ideally have them.
2.5.1 Primary Immunisation
- All children should be offered immunisation even if they present outside the recommended ages
- No opportunity to offer immunisation should be missed
- There is no upper age limit for immunisation, including pertussis
- MMR can be given regardless of age
- Children attending for their school leaving immunisations should have their immunisation histories checked and offered MMR if appropriate.
- 5-in-1 (DTaP/IPV/Hib). This single jab contains vaccines to protect against five separate diseases – diphtheria, tetanus, pertussis (whooping cough), polio and Haemophilus influenza type b (Hib, a bacterial infection that can cause severe pneumonia or meningitis in young children).
- Pneumococcal infection.
Between 12 and 13 months:
- Hib/Men C booster. Given as a single jab containing meningitis C, third dose and Hib, fourth dose.
- MMR (measles, mumps and rubella), given as a single jab
- Pneumococcal infection, third dose.
3 years and 4 months, or soon after:
- MMR second jab
- 4-in-1 pre-school booster (DtaP/IPV). Given as a single jab containing vaccines against diphtheria, tetanus, pertussis and polio.
Around 12-13 years:
- HPV vaccine, which protects against cervical cancer (girls only): three jabs given within six months.
Around 13-18 years:
- 3-in-1 teenage booster (Td/IPV). Given as a single jab, which contains vaccines against diphtheria, tetanus and polio.
65 and over:
Vaccines for risk groups
People who fall into certain risk groups may be offered extra vaccines. These include vaccinations against diseases such as hepatitis B, tuberculosis (TB), flu and chickenpox. See our sections on vaccines for adults to find out whether you should have one.
All children should be offered immunisation even if they present outside the recommended ages.
No opportunity to offer immunisation should be missed
There is no upper age limit for immunisation, including pertussis.
MMR can be given regardless of age.
Children attending for their school leaving immunisations should have their immunisation histories checked and offered MMR if appropriate.
Most childhood vaccines, except the 15 year olds, are given in the Baby Clinic. When this is not possible, children are seen in Treatment Room. Nurses must be familiar with the recommendations for the giving of vaccinations together with a knowledge of individual vaccines as detailed in “Immunisation against Infectious Diseases”.
Injection Site – Nurses are aware of this.
Immunisations to be recorded, including site, in notes on yellow vaccination card and computer records.
Parents are asked to remain with the child on the premises for 15 minutes following any vaccination.
Doctor to be in Surgery or two Nurses on duty whilst vaccines being given.
Nurses to have annual update of anaphylaxis procedure and CPR.
Nurse to be familiar with the vaccine cold chain process and storage of vaccines.
Complete unscheduled immunisation form and leave for Isobel.
Prescription for Diftavax.
The DTP-Hib vaccine protects against three different diseases: Diphtheria, Tetanus and Pertussis (whooping cough) and against infection by the bacteria called Haemophilus influenza type b (Hib).
This disease begins with a sore throat and can progress rapidly to cause problems with breathing. It can damage the heart and the nervous system and in severe cases it can kill. Diphtheria has almost been wiped out in the UK, but it still exists in other parts of the world and it is on the increase in parts of Eastern Europe.
Tetanus germs are found in soil. They enter the body through a cut or burn. Tetanus is a painful disease that affects the muscles and can cause breathing problems. If it is not treated, it can kill.
Whooping cough (pertussis):
Whooping cough can be very distressing. In young children it can last for several weeks. Children become exhausted by long bouts of coughing, which often cause vomiting and choking. In severe cases pertussis can kill.
The actual whooping cough disease, but not the vaccine, can cause brain damage.
Hib is an infection that can cause a number of serious illnesses including blood poisoning, pneumonia and meningitis. All of these diseases can be dangerous if not treated quickly. The Hib vaccine protects the child against one specific type of meningitis. The Hib vaccine does not protect against any other type of meningitis.
Side effects of the DTP-Hib vaccine:
It is quite normal for the baby to be miserable within 48 hours of the injection. Some babies develop a fever.
Sometimes a small lump develops where the injection was given. This lump can last for several weeks. If the child has a worse reaction to the DTP-Hib vaccine – for example, some form of fit – your doctor may not give your child any more doses of the vaccine. If this happens, talk to the doctor, nurse or health visitor.
If a baby has a fit in the first 48 hours after being given the DTP-Hib vaccine at 2, 3 and 4 months, it is no more common than at any other time for young babies. But if you delay the immunisation, it increases the chances of fits after DTP-Hib.
So, it’s important to make sure the child gets vaccinated on time.
Polio vaccine protects against the disease poliomyelitis.
Polio is a virus that attacks the nervous system and can cause permanent muscle paralysis. If it affects the chest muscles it can kill. The virus is passed in the faeces (poo) of infected people or those who have just been immunised against polio. Routine immunisation has meant that the natural virus no longer causes cases of polio in the UK. But polio is still around in other parts of the world, especially in India.
Unlike other immunisations, you take the polio vaccine by swallowing it. The doctor or nurse drops the liquid into child’s mouth.
The polio vaccine is passed into child’s nappies for up to six weeks after the vaccine is given. If someone who has not been immunised against polio changes your child’s nappy, it is possible for him or her to be affected by the virus. There is about one case each year. This works out at about one case for every 1.5 million doses used. You must wash your hands thoroughly to prevent this happening.
If you think you have not had the polio immunisation, contact your doctor. You can arrange to have it at the same time as your child. This also goes for anyone else in the family who looks after your child.
The MMR vaccine protects your child against Measles, Mumps and Rubella (German measles).
The measles virus is very infectious. It causes a high fever and a rash. About one in 15 children who gets measles is at risk of complications, which may include chest infections, fits and brain damage. In severe cases measles can kill.
The mumps virus causes swollen glands in the face. Before immunisation was introduced, mumps was the commonest cause of viral meningitis in children under 15. It can also cause deafness, and swelling of the testicles in boys and ovaries in girls.
Rubella, German measles, is usually very mild and isn’t likely to cause the child any problems. However, if a pregnant woman catches it in her early pregnancy, it can harm the unborn baby.
In some children the illness may pass almost unnoticed, but others can be very ill. The most dangerous thing about these illnesses is that they can cause complications. Before the vaccine was introduced, about 90 children a year in the UK died from measles. Because of immunisation, children no longer die of measles.
The child will receive two doses because measles, mumps and rubella vaccines don’t always work well enough on the first go. The second MMR immunisation makes sure that your child gets the best protection against these three diseases. This also gives a second chance for those children who missed out the first time around. So, you can be sure your child is well protected before they start school.
The MMR vaccine is prepared in egg but it can be given to children who are allergic to eggs. If your child has had a serious reaction to eating eggs, or food containing egg, then talk to your doctor. The usual signs of a serious allergic reaction are a rash that covers the face and body, a swollen mouth and throat, breathing difficulties and shock. In these cases your doctor can make special arrangements for the immunisation to be given safely.
About a week to 10 days after the MMR immunisation some children become feverish, develop a measles-like rash and go off their food for two or three days. Very rarely, a child will get a mild form of mumps about three weeks after the injection. Your child will not be infectious at this time, so they can mix with other people as normal. Occasionally, children do have a bad reaction to the MMR vaccine. About one child in a thousand will have a fit. A child who actually has measles is 10 times more likely to have a fit as a result of the illness.
This is given when a child is between 10 and 14 years. It is sometimes given to babies shortly after they are born. The BCG vaccine gives protection against TB (tuberculosis).
TB is an infection that usually affects the lungs. It can also affect other parts of the body such as the brain and bones.
Although TB is no longer common in this country, there are between 5,000 and 6,000 cases a year. TB is on the increase in Asia, Africa and some Eastern European countries.
Most children have the BCG injection when they are between 10 and 14. The child will have a skin test to see if they already have immunity to TB. If not, the immunisation is given. Babies under three months who are having the immunisation don’t need to have the skin test.
A small blister or sore appears where the injection is given. This is quite normal. It gradually heals leaving a small scar.
Hepatitis B vaccine
This vaccine gives protection against hepatitis B.
There are several different types of hepatitis and they all cause inflammation of the liver. The hepatitis B virus is passed through infected blood and may also be sexually transmitted. Some people carry the virus in their blood without actually having the disease itself. If a pregnant woman is a hepatitis B carrier, or gets the disease during pregnancy, she can pass it on to her child. The child may not be ill but has a high chance of becoming a carrier and developing liver disease later in life.
Pregnant women are offered a test for hepatitis B during their antenatal care. Babies born to infected mothers should receive a course of vaccine to prevent them getting hepatitis B and becoming a carrier. The first dose should be given within two days of birth, and two more doses should be given before the child is six months.
Side effects of the vaccine tend to be quite mild. The injection site is often red and can be sore for a few days afterwards.
A mother having hepatitis B can still safely breastfeed.
all people aged 65 years and over
all those with a long-term health condition
People of all ages who are in the following Clinical risk groups:
- Chronic respiratory disease and asthma that requires continuous or repeated use of inhaled or systemic steroids or with previous exacerbations requiring hospital admission
- Chronic heart disease
- Chronic renal disease
- Chronic liver disease
- Chronic neurological disease
all pregnant women at any stage of pregnancy
Given: every year starting in October/November.
Patients who want to have a Flu Vaccine but do not qualify under the criteria above, can obtain vaccination from Chemist or other outside agencies.
The pneumococcal vaccination (the pneumo jab) protects against pneumococcal infections.
Pneumococcal infections are caused by the bacterium Streptococcus pneumonia, which is sometimes referred to as the pneumococcus bacterium.
The bacterium can cause several conditions including:
- pneumonia: inflammation (infection) of the lungs
- septicaemia: a form of blood poisoning from an infection in the blood
- meningitis: an infection of the membranes that surround the brain and spinal cord
A pneumococcal infection can affect anyone. However, some groups of people need the vaccination because they have a higher risk of an infection developing into a serious health condition.
- children under the age of two (as part of the childhood vaccination programme)
- adults aged 65 or over
- children and adults with certain chronic (long-term) health conditions, such as a serious heart or kidney condition.
Types of pneumococcal vaccine
There are two different types of pneumococcal vaccine:
- Pneumococcal conjugate vaccine (PCV): this is given to all children under two years old as part of the childhood vaccination programme.
- Pneumococcal polysaccharide vaccine (PPV): this is given to people aged 65 or over, and to people at high risk due to chronic health conditions.
Things to consider before vaccination
In rare cases the vaccination may need to be delayed, or may not be safe to have. The reasons are listed below.
Allergic reactions. Tell your GP if you’ve had a bad reaction to any vaccination in the past. If you have had a confirmed anaphylactic reaction (a severe allergic reaction) to the vaccine, or any ingredient in the vaccine, you should not have it. However, if it was only a mild reaction, such as a rash, it is probably safe for you to have the vaccine.
Being unwell. If you’re mildly unwell at the time of the vaccination, it is still safe to have the vaccine. However, if you are “actively unwell”, for example, if you have a high temperature (fever), it is likely that the vaccination will be delayed. This is because it will be difficult to tell the difference between the symptoms of your condition and a bad reaction to the vaccine.
Pregnancy and breastfeeding. The pneumococcal vaccine is thought to be safe to receive during pregnancy and breastfeeding. As a precaution, if you are pregnant, you may be advised to wait until you have had your baby (unless the benefits of having the vaccine outweigh the risks to your child).
Suppressed immune system. If you have a suppressed immune system, for example, because you have HIV or AIDS, you may need to have extra doses of the pneumococcal vaccination. This is because you may not produce enough antibodies (proteins that destroy disease-carrying organisms) to provide immunity after the standard dose of the vaccine. Ask your GP for more information.
Although the pneumococcal vaccinations are considered safe and rarely cause problems, both the PCV and PPV vaccines can cause mild side effects including:
- a slightly raised temperature (mild fever)
- redness at the site of the injection
- hardness or swelling at the site of the injection
In rare cases, some people react badly to the vaccine and develop serious side effects. If you develop any unusual symptoms after having the vaccination, call your GP or NHS Direct on 0845 46 47 (check current number).
Children may need extra immunisations depending on their age, which country you are visiting and how long you plan to stay. You should contact your doctor or a travel clinic for up-to-date information on the immunisations your child may need. If you are travelling to an area where there is malaria, your child will need protection. This is one of the most serious health problems in tropical countries. There isn’t an immunisation against malaria, but some anti-malarial drugs can be given to children. It is essential to do all you can to avoid getting bitten by mosquitoes. Insect repellent, mosquito nets soaked in repellent and making sure arms and legs are covered between dusk and dawn will all help. Be careful not to use too much repellent on your child’s skin.
Travel and other vaccines
If you’re not sure whether you or your child have had all your vaccinations, ask your GP or practice nurse.
For information on vaccination for travelling abroad refer to:
Health advice for travellers (T5), an information leaflet produced by the Department of Health, from the post office.
Stay Healthy Abroad, a Health Education Authority publication, gives advice and information for each country.
Health Information for Overseas Travel, produced by the Department of Health and published by HMSO, contains advice and information for each country.
“The Guide to Childhood Immunisations” (HEA).
The National Health Service provides most health care to most people free of charge, but there are exceptions: prescription charges have existed since 1951 and there are a number of other services for which fees are charged.
Sometimes the charge is made to cover some of the cost of treatment, for example, dental fees; in other cases, it is because the service is not covered by the NHS, for example, providing copies of health records or producing medical reports for insurance companies.
Certificates and extracts from records
Certificates without examination
Straight forward certificates of fact £16.50
Patient or company requesting more complex certificates£28.00 to £58.50
Work in surgery
- a) extract from records 62.50
- b) report on a pro forma, no examination (e.g. 20 minutes)£83.50
- c) written report without exam, with detailed opinion and statement on condition of patient (e.g. 30 minutes)£124.50
Some services provided do not come within the treatment available under the NHS. These services are subject to a charge dependent on the time required. Examples include:
Private medical examinations.
Doctor’s certificates for less than 7 days.
Please Note: As a matter of policy, the practice should not provide signatures on shotgun certificate and passport applications.
Health Checks for patients over 75: Annual health checks for patients of 75 and over. These are carried out by a practice nurse or by a doctor. A district nurse can also perform these health checks for those who are unable to attend surgery.