BCG patient pathway flowchart: text alternative
Updated 20 November 2025
Applies to England
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Eligible babies should be offered the BCG vaccine at 28 days or soon after.
Step 1
Bacillus Calmette–Guérin vaccine (BCG) eligibility[footnote 1] identified at booking appointment and recorded in maternal notes.
Step 2
Baby born in hospital in community or home birth.
Step 3
Midwife, neonatal nurse or paediatrician assesses and records BCG eligibility on:
- NIPE S4N
- local maternity IT system
- discharge summary to GP or Health visitor
Step 4
Offer BCG vaccination and obtain consent
If declined:
Notify GP or health visitor (HV) via discharge summary or suitable local alternative, inform Childhood Information System (CHIS).
Discharge – follow local discharge policies.
If accepted – go to step 5.
Step 5
Referral via local systems (includes mother’s medical history, checklist, translation needs).
Go to step 6.
Step 6
Healthcare practitioner assesses eligibility or contraindications (CI) from referral or list.
Go to step 7.
Step 7
Prior to clinic, provider checks SCID screening status of neonate (NBSFS/CHIS):
If SCID suspected go to step 8.
If SCID Screen not offered or SCID not suspected or SCID declined go to step 12.
If SCID Screen offered and result unavailable – reschedule BCG appointment.
Step 8
Provider checks with GP whether Immunology discharge letter received.
Go to step 9.
Step 9
Provider checks with GP whether Immunology discharge letter received
Step 10
GP confirms baby can receive BCG.
If no go to step 11.
If yes go to step 13.
Step 11
Cancel BCG appointment.
Go to step 12.
Step 12
Record in PCHR red book, local database and inform GP, HV or CHIS.
Discharge – follow local discharge policies.
Step 13
Offer BCG appointment:
If declined go to step 14.
If accepted go to step 16.
Step 14
Provider contacts to discuss decision.
Re-offer BCG appointment.
If declined go to step 15.
If accepted go to step 16.
Step 15
Appointment declined.
Record in PCHR red book, local database and inform GP, HV or CHIS.
Discharge – follow local discharge policies.
Step 16
Attendance:
If not attended – reoffer appointment as per WNB policy.
Go to step 17.
If attended go to step 18.
Step 17
Attendance:
If not attended – follow WNB policy.
Record in PCHR red book, local database and inform GP, HV or CHIS.
Discharge – follow local discharge policies.
If attended go to step 18.
Step 18
BCG vaccination appointment: given or not given or declined.
Record in PCHR red book, local database and inform GP, HV or CHIS.
Discharge – follow local discharge policies.
Glossary
CHIS: Child Health Information System
IT: Information technology
NBSFS: Newborn Blood Spot Failsafe Solution
NEMS: National Events Messaging System
SCID: Severe Combined Immunodeficient Syndrome
NIPE S4N: National IT system for the Newborn and Physical Examination screening programme
PCHR: Personal Child Health Record aka ‘Red Book’
BCG: Bacillus Calmette–Guérin vaccine
PMH: Past medical history
WNB: Was not brought
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BCG eligibility is described in chapter 32 of the Green Book ↩