Jenny Greenfield gives advice on setting up a travel health clinic, and explains how these clinics can benefit both patients and GP practices.

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Read this article to learn more about:

  • important considerations in setting up a travel health clinic
  • how a travel health clinic can benefit your GP practice
  • useful resources for staff running a travel health clinic

M any people enjoy travelling: in the 3 months to December 2015, UK residents made 13.4 million trips abroad (a 10% increase compared with the same time period in the previous year).1 The high number of people travelling abroad and their increased awareness of travel-related illness means that there is a demand not just for immunisations, but also for comprehensive pre-travel health advice.

Pre-travel advice is available from a number of sources, including the internet, but the information may not be reliable. Most patients who visit their GP surgery for advice are seen ad hoc, but giving comprehensive travel advice takes time and is therefore costly to the practice. Many nurses and GPs are now trained in travel medicine, so one way to meet the increased demand for travel advice could be to set up a primary care travel clinic. All surgery staff involved in providing this service need an understanding of the complexity of travel health to ensure safe and best practice, the Royal College of Nursing (RCN) Competences document on Travel health nursing: career and competence development provides useful guidance.2 These clinics benefit both the traveller, by providing a comprehensive service, and the practice, by freeing up consultation time and decreasing the number of appointments made by patients for travel-related illnesses on their return to the UK (see Box 1). In a study investigating travel-related infection in European travellers a burden of infectious disease in ill returned travellers was demonstrated, which was potentially preventable, emphasising the value of pre-travel consultations that are relevant to destination.3

Setting up a travel clinic: initial considerations

Several questions should be considered before setting up a travel clinic:4

  • how much will it cost to set up and run a clinic? Potential costs include: staff, occupying the clinic or treatment room, office supplies, and purchase and maintenance of equipment
  • is the expense of setting up the travel clinic justified by the number of potential patients? This could be assessed by auditing the number of patients asking for travel advice in the last 6 months
  • is an appropriate space available that can accommodate a vaccine fridge, couch, and resuscitation equipment?
  • are any of the practice staff trained in giving travel advice and immunisations? Do the staff have access to up-to-date information, for example, via a specialist online advice service such as NaTHNaC or TRAVAX (see Box 2)?

Ordering and storing travel vaccines

In 2013, Sanofi Pasteur and GlaxoSmithKline were the leaders in the global travel vaccine market.5 In the UK, both of these companies have online ordering systems (similar to other companies providing vaccines), allowing you to place orders and track the status of these, making it straightforward to maintain your stocks of necessary travel vaccines.6,7 Travel vaccines are not supplied through ImmForm, the system used by the Department of Health, the NHS, and Public Health England (PHE) to provide vaccine ordering facilities.8

When storing vaccines, it is important that the 'cold chain' is not broken: the temperature of the vaccine fridge should be 2–8° C, and this should be checked and recorded daily.9

Vaccines to supply

Information on the vaccines required, depending on which global area is being visited, is provided by the National Travel Health Network and Centre (NaTHNaC). Commissioned by PHE, NaTHNaC provides health information ahead of travel to healthcare professionals and travellers.10

NHS Prescription Services, a service provided by the NHS Business Services Authority, calculates the remuneration and reimbursement due to dispensing pharmacist contractors, including GP surgeries, across England.11 Its website-www.nhsbsa.nhs.uk/PrescriptionServices.aspx—provides information explaining which travel vaccinations remuneration can be claimed for.

Vaccines provided free of charge

In England, the NHS normally provides the vaccines listed below free of charge to patients, as the diseases they protect against are considered to pose the greatest risk to public health if they were brought into the country:12

  • diphtheria, polio, and tetanus (combined booster)
  • typhoid
  • hepatitis A (also when combined with typhoid or hepatitis B)
  • cholera.

Vaccines—charged to patients

Patients will usually be charged in England for the below travel vaccines:12

  • hepatitis B (when not combined with hepatitis A)
  • Japanese encephalitis
  • tick-borne encephalitis
  • meningitis C (and other meningitis vaccines)
  • rabies
  • tuberculosis
  • yellow fever.

It is only possible for patients to obtain yellow fever vaccines from designated centres.12 NaTHNaC offers information, including training dates and frequently asked questions, on how to become a Yellow Fever Vaccination Centre (YFVC).13

Fees for non-NHS services

In England, under the NHS (General Medical Services Contracts) Regulations 2004 (Schedule 5—Regulation 24) it is possible to accept a fee from patients for the sale of travel kits, made up of drugs, medicines, or appliances, which patients can have in their possession when travelling outside of the UK. Similarly, the practice may accept a fee for a medical examination that provides an opinion on whether the patient is fit to travel.14

Box 1: Benefits of running a travel health clinic

  • Delivery of accurate and focused advice to the traveller
  • Frees up consultation time for other patients
  • Decreases the number of appointments made by patients for travel-related illnesses on their return to the UK
  • Opportunity to update patient records—travellers tend to be ‘well’ patients who do not attend surgery regularly
  • Job satisfaction for the staff running the clinic.

Box 2: Sources of further information

Immunisation against Infectious Diseases (The Green Book)

International travel and health

  • Published by the World Health Organization, this book provides the latest, evidence-based travel health guidance for healthcare professionals, travellers, and Member States

Patient group directions

Recommendations for the practice of travel medicine

RCN Competences—Travel health nursing: career and competence development

TRAVAX

  • Maintained and continually updated by the Travel and International Health Team of Health Protection Scotland. TRAVAX is an interactive website providing up-to-the-minute travel information for healthcare professionals

TravelHealthPro

  • A website comprising the travel health resources of the National Travel Health Network Centre (NaTHNaC)

TravelHealthPro telephone advice line

  • An advice line for health professionals. Providing guidance to healthcare professionals advising travellers with complex travel itineraries and/or special health requirements
    • Telephone: 0845 602 6712 (local call rate)
      • Monday–Friday, 09.00–11.45 and 13.00–15.45
      • closed Wednesday afternoons and bank holidays

Malaria prevention guidelines for travellers from the UK

 

View related immunisation content

 

References

  1. Office for National Statistics. Overseas travel and tourism: provisional results for December 2015. Available at: www.ons.gov.uk (accessed 28 February 2016)
  2. Royal College of Nursing. Travel health nursing: career and competence development. London: RCN, 2012. Available at: www2.rcn.org.uk/__data/assets/pdf_file/0006/78747/003146.pdf
  3. Warne B, Weld L, Cramer J et al. Travel-related infection in European travelers, EuroTravNet 2011. Journal of Travel Medicine; 21 (4): 248–254. Available at: jtm.oxfordjournals.org/content/jtm/21/4/248.full.pdf
  4. Skeet J. Running a specialised GP travel health clinic. Management in Practice. 2009; 17. Available at: www.managementinpractice.com/featured-articles/running-specialised-gp-travel-health-clinic (accessed 26 April 2016)
  5. Reuters. Research and Markets: The Global Travel Vaccine Market is Forecast to Show Growth. Available at: www.reuters.com/article/research-and-markets-idUSnBw275532a+100+BSW20130627 (accessed 26 April 2016)
  6. Sanofi Pasteur MSD. V@xishop: now there's a hero at hand! Available at: www.spmsd.co.uk/vaxishop/ (accessed 26 April 2016)
  7. GlaxoSmithKline. Vaccines: frequently asked questions. Available at: hcp.gsk.co.uk/therapy-areas/vaccines/vaccines-faq.html (accessed 26 April 2016)
  8. ImmForm. ImmForm helpsheet 13—vaccines available via ImmForm. Available at: www.gov.uk/government/uploads/system/uploads/attachment_data/file/338040/ImmForm_Helpsheet13_VaccinesOnImmForm_acc.pdf
  9. Public Health England. Protocol for ordering, storing and handling vaccines. London: PHE, 2010 (updated 2014). Available at: www.gov.uk/government/uploads/system/uploads/attachment_data/file/300304/Protocol_for_ordering__storing_and_handling_vaccines_March_2014.pdf
  10. National Travel Health Network and Centre (NaTHNaC). NaTHNaC: about us. Available at: nathnac.net/about-us/ (accessed 26 April 2016)
  11. NHS Business Services Authority. NHS Prescription Services Authority: about Prescription Services. Available at: www.nhsbsa.nhs.uk/PrescriptionServices/809.aspx (accessed 27 April 2016)
  12. NHS Choices. Travel vaccinations. Available at: www.nhs.uk/conditions/Travel-immunisation/Pages/Introduction.aspx (accessed 26 April 2016)
  13. National Travel Health Network and Centre (NaTHNaC). NaTHNaC: Health professionals—resources for Yellow Fever Vaccination Centres. Available at: www.nathnac.org/yf_centres/Yellow_Fever_Vaccination_Centre_Information.htm (accessed 26 April 2016)
  14. British Medical Association. GP practices: focus on private practice. Available at: www.bma.org.uk/support-at-work/gp-practices/focus-on-private-practice (accessed 27 April 2016) G