Guidance

Annexe C: information and resources to support implementation

Published 30 April 2025

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This publication is available at https://www.gov.uk/government/publications/changes-to-the-routine-childhood-schedule-letter/annexe-c-information-and-resources-to-support-implementation

1. The Joint Committee on Vaccination and Immunisation (JCVI)

A combined Hib/MenC vaccine was introduced into the routine childhood immunisation programme in 2006. In November 2022, the Joint Committee on Vaccination and Immunisation (JCVI) issued a statement on its advice in relation to changes to the routine childhood schedule due to the discontinuation of the Menitorix (Hib/MenC) vaccine manufactured by GSK currently offered at 12 months of age.

Following the discontinuation of Menitorix the JCVI advised that the following changes should come into effect nationally:

  • the cessation of the Menitorix (Hib/MenC) offer once the current supply of Menitorix (Hib/MenC) vaccine has been depleted
  • an additional dose of Hib-containing multivalent vaccine (such as the DTaP/IPV/Hib/HepB vaccine which is also offered earlier in infancy) offered at 18 months which requires the creation of a new 18-month routine immunisation appointment
  • the second dose of MMR vaccine should be brought forward from 3 years 4 months to 18 months of age to improve uptake
  • due to the success of the adolescent MenACWY programme in controlling meningococcal C (MenC) disease across the population a dose of MenC-containing vaccine is no longer recommended at 12 months

Furthermore, JCVI agreed at its October 2024 meeting to the following selective neonatal HepB immunisation schedule changes due to the introduction of an additional hexavalent dose at 18 months as a result of the childhood schedule changes:

  • the current monovalent dose offered at 12 months will be removed from the selective schedule (these children will instead wait until 18 months of age to be offered their 6th HepB dose as part of the hexavalent vaccine)

  • JCVI have recognised that the blood test (usually performed as a dried blood test) remains an important part of the HepB care pathway for infants on the selective programme. The test should continue to be performed and can be undertaken at any time between 12 and 18 months, for example at an opportunistic healthcare attendance or at a routine appointment

At its February 2025 main committee meeting, the JCVI discussed the possible changes to the PCV13 and MenB (4CMenB) vaccination times within the childhood schedule.

Data from LIONMENB indicated that vaccinating infants with 4CMenB at 8 and 12 weeks of age (compared to at 8 and 16 weeks of age) and a single dose of PCV13 at 16 weeks (compared to at 12 weeks) provides earlier immunological protection against invasive meningococcal diseases (IMD) due to vaccine-preventable serogroup B infection, without compromising longer term immunological protection against invasive meningococcal diseases (IMD) or invasive pneumococcal disease (IPD). The 8 and 12 week 4CMenB and 16 week PCV13 schedule was also associated with an improved safety profile compared to the current schedule.

Members were in agreement with the proposal to give the 4CMenB vaccine at 8 and 12 weeks of age and move the first PCV dose from 12 weeks to 16 weeks.

2. Funding and service arrangements

Routine NHS-funded vaccinations and immunisations are delivered as essential services under the GP Contract and have been agreed via consultation with GPC England in the 2025/26 GP contract. The changes to the routine childhood programme, described in this letter, will be reflected in the Green Book .

Practices should continue to offer these services in line with vaccination and immunisation standards and core contractual requirements, including undertaking call/recall for patients as they become eligible. Regional commissioners will need to ensure all commissioned services including but not limited to SAIS teams, CHIS providers and 0-19 vaccination services, are informed of these changes.

Funding arrangements are outlined in the General Medical Services Statement of Financial Entitlements Directions and covered under the Public Health Allocation to regional commissioners.

3. Vaccine coverage data collection

Coverage of both doses of MMR vaccine and the 4th dose of the hexavalent vaccine will be collected. GP practice-level MMR and hexavalent vaccine coverage will be based on data automatically uploaded via participating CHIS and GP IT suppliers to the ImmForm website (a website used by UKHSA and NHS to collect data on vaccine coverage and provide vaccine ordering facilities for the NHS).

From 1 January 2026, an additional data collection will be instituted to monitor coverage of the second dose of MMR and the 4th dose of the hexavalent vaccine at age 18 months as follows:

  • denominator: the number of patients in the relevant age bands registered with a participating GP on the data extraction date

  • numerator: the number of patients in the denominator that have received either the MMR vaccine or 4th dose of hexavalent vaccine between 1 January 2026 and the data extraction date

The data will be validated and analysed by UKHSA to check data completeness, identify and query any anomalous results and describe epidemiological trends. Reports will be available on GOV.UK.

4. Centrally supplied vaccines

The vaccines for the universal programmes will be available to order in the usual way online via the ImmForm website. See the ImmForm help sheet for information on registering for an ImmForm account. Providers should ensure that local stocks of vaccine are rotated in fridges so that wastage is minimised. It is recommended that practices hold no more than 2 weeks’ worth of stock.

Monovalent HepB vaccine is not supplied centrally by UKHSA.

5. Patient Group Directions (PGDs)

Updated PGD templates will be produced by UKHSA for NHS England areas to authorise for their commissioned services. These will be available from the PGD collection on GOV.UK.

6. Immunisation Against Infectious Disease (the Green Book)

The following Green Book chapters will be updated and published on GOV.UK ahead of the programme changes taking effect:

For the hexavalent (DTaP/IPV/Hib/HepB) vaccine:

In addition, the following chapters will also be updated to align with the changes:

7. Training and information resources for healthcare practitioners

Training and information resources for Healthcare Practitioners will be made available on the GOV.UK website:

8. Patient information materials

All patient facing resources can be ordered free of charge via:

The following publications are new to the collection:

All users need to register to receive deliveries. If you register as a health professional, you can order 500-1000 copies on the website. For larger quantities, please call 0300 123 1002. Or email dhextracopies@prolog.co.uk.

Guidance on informed consent can be found in chapter 2 of the Green Book.

10. Reporting suspected adverse reactions

Healthcare professionals and members of public are asked to report suspected adverse reactions through the online Yellow Card website, by calling 0800 731 6789 (9am to 5pm, Monday to Friday) or by downloading the Yellow Card app.

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