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Some 1,559,000 patients have been registered at some point for the minor ailment service since prescription charges were abolished in April 2011. The total number of current registrations is 956,858.

Midwives are recognised as a key group in promoting the benefits of pertussis vaccination and rubella screening.

The pertussis immunisation programme for pregnant women was introduced in October 2012 in response to a UK wide outbreak of pertussis. The programme aims to provide passive immunity to young infants in the first few weeks of life before they are old enough to start their immunisation schedule at eight weeks of age. Most pregnant women are vaccinated against pertussis in their GP practice.

Prior to the introduction of the programme, training materials were produced by NHS Education for Scotland for registered healthcare professionals and midwives and a revised version will be issued in May this year.

A leaflet explaining the benefits of vaccination is also provided to pregnant women by NHS Health Scotland.

A point of delivery audit was undertaken in the main maternity units in Scotland in January 2013, which estimated that uptake of the vaccine was high at 78.1%. HPS is currently working on a mechanism to obtain regular uptake data via general practices for the routine monitoring of this programme.

HPS monitors the incidence of pertussis and this includes collecting a dataset on all laboratory confirmed cases under one year of age, including whether the mother was vaccinated during pregnancy.

The number of laboratory confirmed cases in infants < 1 year, declined by over 85% from 140 cases in 2010 to 19 in 2013.

MMR vaccine is offered to women immediately after pregnancy if they have been identified as not immune to rubella during screening tests in pregnancy. Screening for rubella antibodies is one of the routine tests offered to all pregnant women at their first appointment with their midwife at around two to three months pregnant. Information about Rubella immunity is also included in the pregnancy screening guide which is issued to every pregnant woman in Scotland.

The MMR vaccine is the only licensed rubella vaccine in the UK. It is a live vaccine and should not be given to pregnant women. So although screening for rubella immunity happens during pregnancy, MMR vaccine can only be given after delivery and offers protection for future pregnancies.

Rubella screening services are commissioned by each NHS board and at this time there is no national system where screening and vaccination are recorded. However, a number of initiatives have been developed to monitor pregnancy and newborn screening programmes at the local (NHS board) level.

Clinical standards for pregnancy and newborn screening were developed by NHS Quality Improvement Scotland in 2005.

NHS National Services Division (who commission screening services in Scotland) developed quality indicators for pregnancy and newborn screening in 2011. These indicators included an indicator for uptake of MMR in rubella susceptible women within five days after delivery. NHS boards provided preliminary data against these indicators in 2011-2012 but the data was not robust enough to be reported.

NHS Healthcare Improvement Scotland published a series of indicators for pregnancy and newborn screening in 2013. There is no specific indicator for uptake of MMR. This can be found at:

http://www.healthcareimprovementscotland.org/our_work/reproductive,_maternal__child/programme_resources/pns_indicators.aspx

Rubella screening for pregnant women is a routine and well established part of pregnancy and newborn screening.

There are no financial incentives in addition to the present fees that optometrists may claim for carrying out free NHS eye examinations in their practices.

Free NHS eye examinations are universal and available to the whole population which is reflected in the current fee structure.

Although we don’t provide any additional incentives to optometrists in order to improve uptake of NHS eye examinations by such groups we do recognise the additional needs of some groups. For this reason optometrists can visit certain approved day centres to provide NHS eye examinations for patients who would have difficulty in obtaining services from practice premises because of their particular needs. The types of patients who could be seen include, those whose first language is not English who are new to the UK and require the service of an interpreter.

In addition, optometrists may undertake domiciliary visits to patient’s homes or residential homes in order to provide NHS eye examinations where the patient cannot leave home unaccompanied because of their particular needs, such as people with dementia or other disability. An additional fee is payable for undertaking domiciliary visits.

The eligibility criteria for the minor ailment service are the same as those which entitled people to free prescriptions before charges were abolished in April 2011.

It is for NHS boards to determine, based on local priorities and clinical need, the level of local ophthalmic service they provide in order to meet the needs of their population.

The Visual Impairment Network for Children and Young People (VINCYP) was designated a national managed clinical network on 1 April 2014. VINCYP aims to bring together health, education and social care agencies to improve the care for visually impaired children and young people. The network has been commissioned by NHS National Services Scotland and an official launch is scheduled for 30 May 2014.

The Scottish Government has invested £2 million to implement the recommendations in the ‘See Hear; A Strategic Framework for meeting the needs of people with a sensory impairment’ published on 24 April 2014 and will work with service providers, service users and relevant voluntary and statutory agencies to achieve this.

The following table sets out the number of current registrations for the Chronic Medication Service (CMS) and the Minor Ailment Service (MAS), broken down by NHS board. Eligible patients can register with the community pharmacy of their choice for each service. Registration arrangements for both services are pharmacist-based and -led.

The Scottish Government publishes leaflets giving details of both services. These leaflets are made available at GP surgeries and community pharmacies, and at Jobcentre Plus offices and Citizens Advice offices.

Published in 2011, the TB Action Plan for Scotland contains a recommendation for the Scottish Microbiology and Virology Network (SMVN, formerly the Scottish Microbiology Forum) to consider the centralisation of mycobacterial diagnostic services into a small number of laboratories with higher throughput and defined quality standards in laboratories in Scotland.

This has now been achieved. It has occurred through a natural evolution process and via facilitation by the work of the SMVN sub-group on mycobacterial services. All board TB laboratories in Scotland are accredited by Clinical Pathology Accreditation and have achieved external quality assurance results for TB culture and microscopy of 100% in 2012. In addition, Scottish TB laboratories have exceeded the European Centre for Disease Prevention and Control target for 80% of all new pulmonary TB cases to be confirmed by culture.

The Joint Committee on Vaccination and Immunisation (JCVI) undertook a review of the BCG vaccination programme in 2005 and recommended an improved targeted programme directed towards those most at risk of tuberculosis.

The Scottish Government’s TB Action Plan for Scotland, published in 2011, contains four recommendations in respect of BCG vaccination. One of these requires NHS boards to review BCG neonatal immunisation in their locality to re-examine current operational plans. In preparation for the 2013 annual report of the action plan, boards were asked to confirm their implementation status for each recommendation and thirteen reported that this had either been completed or that a review was underway. A further update on progress will be sought from boards in preparation for the 2014 annual report.

In addition, the action plan requires Health Protection Scotland to undertake a more detailed review of NHS Board BCG audit activities so that best practice can be shared across Scotland. The results of the review are awaited, but are expected to confirm that NHS boards are delivering the BCG vaccination programme in line with the recommendations set out by the JCVI and in line with the Green Book chapter publication. This can be accessed at:

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/148511/Green-Book-Chapter-32-dh_128356.pdf.

An ‘exempt visitor’ is a person who is not ordinarily resident in the UK who is exempt from NHS charges under the National Health Service (Charges to Overseas Visitors) (Scotland) Regulations 1989, as amended.

Further information on people who may not be charged for conditions (including eye conditions) that occur during a visit to the UK can be found at:

http://www.scotland.gov.uk/Topics/Health/Services/Overseas-visitors

NHS eye examinations are free to all UK residents, irrespective of the place of residence, when provided in Scotland.