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Setting up a travel clinic in primary care

Carolyn Driver
MSc RN RM RHV FPcert
Travel Health Specialist Nurse

Organising travel health consultations into a specific clinic is a good way of improving the standard of service on offer

Travel health is a time-consuming and complex activity, so health professionals offering this service should ensure they have adequate levels of knowledge, experience and resources, as well as sufficient time to deliver a high standard
of care.1

Organising a travel clinic
Staff involved with nurse-led clinics must be sure they have the competence to offer the service (see Box 1).2
Register as a Yellow Fever Centre. Information from the National Travel Health Network and Centre (NaTHNaC) for England, Wales and Northern Ireland or Travax for Scotland
(see Resources).

[[Box 1 vaccines]]

If nursing staff are not independent medical prescribers, patient group directions (PGDs) can be used in an NHS setting for NHS-funded vaccines. However, vaccines privately supplied will need to be prescribed or administered under a patient specific direction. Nurses working in wholly private settings that were approved by the Care Quality Commission before September 2010 can administer all vaccines under PGDs. Information on all aspects of PGDs or non-medical prescribing can be found at the National Electronic Library for Medicines or the National Prescribing Centre websites (see Resources).
Stock vaccines rather than issuing prescriptions - this ensures that the cold chain is maintained and courses of vaccination can be commenced immediately.

Appointments    
Most travellers are usually fit and in full-time work or education, so early morning or late afternoon clinics work well.
Appointments should be a minimum of 20 minutes and patients should be made aware of the length of appointment - families or groups will need longer.1,2

Use a questionnaire and give the patient access to this before their appointment, enabling all relevant information to be available, facilitating a thorough risk assessment. It can be downloaded from the practice website or posted if time permits. Alternatively, the patient needs to be asked to bring all relevant information and arrive early so that that they can complete it. Examples of questionnaires can be found in the Yellow Book and Royal College of Nursing competency document.1,2

Vaccines
GP practices can claim reimbursement for NHS-funded vaccines and receive a profit through the Prescription Pricing Authority (PPA). These include hepatitis A, typhoid and diphtheria, tetanus and polio (2% of the global sum covers administration of these vaccines).

A profit can be made on any privately provided vaccines.
Vaccine manufacturers fulfill orders quickly and will supply small quantities so there is no need to carry a large stock.

Retail items and charging
In a general practice setting you cannot charge your patient any fee for a vaccine that is reimbursable through the PPA.3
You can charge for the cost of a privately supplied vaccine and for administering it.
You can charge for a private prescription for malaria prophylaxis.3
You cannot charge your own listed patients a consultation fee.
Consider stocking items such as insect repellents, mosquito nets, impregnation kits, first aid and medical kits, and water-purifying tablets. This enables the patient to get everything they need in one place and improves the profitability of the clinic.

Documentation
Develop a travel clinic protocol that outlines the process for your travel clinic, eg, method of risk assessment, resources used, and documents such as the questionnaire and patient information leaflets provided. Summarise routine insect bite avoidance and food and water precaution advice.
Basic risk assessment can then be recorded in the patient notes as 'carried out as per practice protocol' and the risk assessment form can be scanned in to patient records.
Vaccine name, batch number, expiry date and site of administration, malaria prophylaxis recommended or prescribed and any other advice specific to the individual patient should be recorded in the patient's notes.
Give the patient a record of their vaccines and encourage them to keep it with their passport and bring it to any future visits to a travel clinic.
Ensure there is an efficient process for reimbursable vaccine claims.

References

  1. Field VK, Ford L, Hill DR (eds). Health information for Overseas Travel: the Yellow Book. National Travel Health Network and Centre: London; 2010.
  2. Chiodini J, Boyne L, Grieve S, Jordan A. Competencies: an integrated career and competency framework for nurses in travel health medicine. London: RCN; 2007.
  3. General Practitioners Committee. The new GMS contract explained: Focus on...Vaccinations and Immunisations. London: BMA; 2004.

Resources
National Travel Health Network and Centre (NaTHNaC)
W: www.nathnac.org

TRAVAX
Only available on subscription to those in England but is free to practices in Scotland, Wales and Northern Ireland
W: www.travax.nhs.uk (provided by Health Protection Scotland)

The Green Book
The paper copy of the Green Book is no longer appropriate as there have been so many revisions
W: www.dh.gov.uk/greenbook

Malaria References
Various important sources of information on malaria prevention, diagnosis and treatment
W: www.malaria-reference.co.uk

Google Maps
W: http://maps.google.com
National Electronic Library for Medicines
Patient Group Directions
W: www.pgd.nhs.uk