Vaccination and immunisations (VI) - QOF indicator

Vaccination and immunisation in QOF

The vaccination and immunisation indicators cover early childhood vaccinations and shingles vaccination in older adults. For 2026/27, notable features include equal recognition of MMR and MMRV for QOF achievement, following the MMRV rollout from 1 January 2026, and an additional route to childhood vaccination points through improvement thresholds.

Indicators, points and thresholds

MMR and MMRV have the same status when assessing QOF achievement.

Why vaccination is included

• Among public health measures for preventing disease, vaccination is surpassed only by clean water. Childhood vaccination prevents between 3.5 and 5 million deaths worldwide each year. Healthcare workers, particularly those working in communities, are the most trusted sources of advice influencing vaccination decisions, making their role in communicating dependable vaccine information especially important.

Recording vaccinations given overseas

• A vaccination administered abroad can contribute to QOF achievement when the overseas schedule matches the UK National Vaccination Schedule. With appropriate evidence, practices should enter the vaccination in their clinical system and count it as achievement of the relevant indicator, rather than simply applying a personalised care adjustment (PCA).

• Clinicians must use their judgement when a patient or representative says that vaccination took place abroad or in another setting. Under the Green Book approach, children and adults arriving in the UK without either documentation or a reliable verbal immunisation history should be treated as unimmunised, with a full course of the required vaccines planned. Conversely, documentation or a reliable verbal account can support recording them as immunised. A verbal history may not establish the batch number or precise vaccination date.

• To include a qualifying overseas vaccination in QOF without generating an item of service payment, record it as follows:

1. Enter the vaccination procedure SNOMED code with a backdated event date that accurately represents when the vaccine was administered.

2. For Optum and INPS practices, select ‘No’ for the GMS flag; for TPP practices, select ‘No’ for the ‘Event done’ flag.

3. Attach free text to the vaccination SNOMED code recording the administration date and location.

Automated personalised care adjustment

• VI001, VI002 and VI003 have an automated PCA for children whose registration leaves too little time for vaccination. This may reflect their age at registration or the point in the financial year when they join the practice. The relevant requirements are those of the UK national schedule, or the QOF indicator where these differ.

• The QOF V&I GPES extraction business rules incorporate this adjustment. It applies after registration when either:

1. Outstanding vaccinations cannot be completed within the indicator’s permitted timeframes; or

2. Vaccination is incomplete and the child is already beyond the indicator’s age limit.

• Practices cannot enter this PCA manually. The extraction logic applies it once registration and the necessary criteria are satisfied, but recorded achievement takes precedence if the required vaccines were administered before the age limit. An adjusted child is excluded from both numerator and denominator, so does not affect the practice’s achievement.

• Children registering with incomplete vaccinations after reaching the relevant age limit receive the automatic adjustment because the practice was not responsible for the missed vaccination. Those limits are 8 months for VI001, 18 months for VI002 and 5 years for VI003.

• For children joining before the age limit, the rules consider both the remaining time and the number of doses still needed. The allowance is 31 days per outstanding dose between registration and the indicator’s age limit. The business rules provide the fuller detail.

• Before the financial year ends, practices may wish to check that the adjustment is operating in their system, using reporting tools such as ‘How am I driving?’.

• The examples below illustrate how this works for each childhood indicator.

VI001: examples of automated PCA

These examples concern doses of a diphtheria, tetanus and pertussis containing vaccine received before registration.

• Registration on or after 7 months of age: a child with two or fewer doses receives an automatic PCA because the available time is insufficient to offer and administer the remaining vaccinations.

• Registration on or after 6 months of age: the adjustment applies if the child has received one or no doses. However, a child registering at 6 months of age with two doses already recorded leaves enough time for the remaining dose. If the practice does not administer it before the child turns 8 months, that child does not meet the indicator.

• Registration on or after 5 months of age: no previous doses means the automatic adjustment applies. A child registering at 5 months of age with one or two doses already given has enough time to complete the course. If the outstanding one or two doses are not administered before the child turns 8 months, the practice does not achieve the indicator for that child.

• Registration between 1-4 months of age: where there are no previous doses, the practice must administer all three before the child turns 8 months old to achieve the indicator for that child. Failure to do so does not qualify for the automated PCA.

VI002: examples of automated PCA

• A child registering at 17 or 18 months of age without an MMR or MMRV vaccination receives the automatic adjustment. In contrast, if registration occurs at 16 months or younger and one dose of MMRV has not been administered before the child turns 18 months, the indicator is not achieved for that child.

VI003: examples of automated PCA

• Registration on or after 4 years and 11 months of age: insufficient time triggers the automatic adjustment where the child has either two vaccinations comprising MMR or MMRV but no booster diphtheria, tetanus, acellular pertussis and inactivated poliomyelitis vaccine (DTap/IPV), or only one MMR or MMRV vaccination together with the booster DTap/IPV.

• Registration on or after 4 years and 10 months of age: the adjustment applies where the child has either only one MMR or MMRV vaccination and no booster DTap/IPV, or no MMR or MMRV vaccination but has received the booster DTap/IPV.

• Registration on or after 4 years and 9 months of age: a child with neither MMR or MMRV vaccinations nor a booster DTap/IPV receives the automatic adjustment because there is insufficient time to complete vaccination.

• Registration younger than 4 years and 9 months of age: if both MMRV vaccinations and the booster DTap/IPV are not administered, the indicator is not achieved for that child.

VI001: based on NICE IND215

Clinical rationale

• Diphtheria, tetanus and pertussis (whooping cough) are acute infections with potentially serious complications. The routine schedule places the hexavalent (6-in-1) vaccine at 8, 12 and 16 weeks old. Alongside diphtheria, tetanus and pertussis (DTaP), it provides immunisation against poliomyelitis (IPV), haemophilus influenzae type B (Hib) and hepatitis B.

• VI001 encourages vaccination early in life in line with that schedule. Using 8 months old as the assessment point accommodates postponement because of febrile illness while retaining the aim of protecting children against these infections as soon as possible.

Reporting and verification

• The indicator definition in the table sets out the qualifying requirements.

• The indicator-specific guidance permits a personalised care adjustment only when the specified intervention is contraindicated for the patient.

VI002: based on NICE IND216

Clinical rationale

• MMR provides combined protection against measles, mumps and rubella. From 1 January 2026, MMRV was introduced into the routine childhood 2-dose schedule; the Green Book contains further details. Either vaccine is accepted equally for QOF. Measles, mumps and rubella spread readily and may lead to serious complications, including meningitis and encephalitis. Varicella (chickenpox) is also an acute, highly transmissible infection with potentially severe complications.

• In England’s routine schedule, the first MMRV dose (MMRV1) is due within a month of the child’s first birthday.

• VI002 promotes prompt vaccination. Assessment at 18 months old leaves room for delay caused by febrile illness, without changing the intention to vaccinate as early as possible.

Reporting and verification

• Use the table’s indicator definition to establish whether the requirements have been met.

• For this indicator, the specific reporting guidance restricts personalised care adjustment to patients for whom the stated intervention is contraindicated.

VI003: based on NICE IND217

Clinical rationale

• VI003 encourages completion of immunisation in accordance with the routine schedule. The 5 years old assessment point is intended to ensure that children have full protection against the relevant infections before starting school.

Reporting and verification

• Eligibility for achievement is determined by the indicator wording shown in the table.

• The indicator-specific reporting rules allow a personalised care adjustment only for a contraindication to the intervention described.

VI004: based on NICE IND219

Clinical rationale

• Shingles develops when a latent varicella zoster infection becomes active again. Both its frequency and severity rise with age. Since 1 September 2023, the routine schedule has recommended offering shingles vaccination to people turning 65 years of age and those aged 70 to 79. Eligibility continues until their 80th birthday.

• VI004 encourages shingles vaccination among patients 70 years old and over. As vaccine effectiveness falls with age, vaccinating earlier is encouraged to obtain the best protection.

Reporting and verification

• Apply the criteria in the indicator definition. Only patients who have completed the vaccination course belong in the numerator. A personalised care adjustment is available where vaccination is contraindicated or the patient has declined it.

Improvement thresholds for VI001, VI002 and VI003

Why an improvement route is included

• Childhood vaccination uptake differs markedly between geographical areas. Practices’ Indices of Multiple Deprivation (IMD) decile is strongly associated with their QOF childhood vaccination achievement: those serving deprived areas are less likely to meet the lower achievement threshold. This reflects established evidence linking deprivation with vaccine uptake. A Royal College of Paediatrics and Child Health policy report identified interacting influences, including difficulties accessing services, socioeconomic circumstances, health literacy, confidence in authorities and beliefs about health.

• These differences can weaken QOF’s ability to encourage childhood vaccination in some areas. The additional points route is intended to recognise practices’ efforts to raise uptake even when achievement remains below the lower thresholds. Improvement-based calculations provide a further attainable incentive to increase vaccination among registered patients.

• The improvement thresholds are designed to help practices raise uptake despite difficult circumstances, while preserving World Health Organisation (WHO) herd immunity targets. They also aim to avoid penalising practices already meeting the existing achievement thresholds or weakening their incentive to do so.

Reporting and verification

• Each of the three indicators retains the same maximum points allocation, irrespective of whether points are earned through standard QOF achievement thresholds or the new improvement thresholds.

VI004: repeated guidance based on NICE IND219

Clinical rationale

• Reactivation of dormant varicella zoster virus causes shingles, with older age associated with more frequent and more severe disease. The routine vaccination offer introduced in September 2023 covers people turning 65 years of age and those aged 70 to 79; patients remain eligible until their 80th birthday.

• The indicator promotes vaccination for people 70 years old and over. Earlier administration is encouraged because the vaccine provides less effective protection as age increases.

Reporting and verification

• The table gives the indicator’s requirements, and numerator inclusion requires completion of the vaccination course. Practices can apply a personalised care adjustment when the vaccine is contraindicated or vaccination has been declined.