GPs fear that the DoH push to cut quality points for flu will put vulnerable patients at risk.

Currently, GPs can earn up to 18 quality points for vaccinating patients with CHD, TIA or stroke, diabetes or COPD.

But the DoH wants these points dropped because it believes they are duplicated in the influenza and pneumococcal directed enhanced service (DES).

Under the DES, GPs are rewarded for giving flu vaccines to 70 per cent of patients aged 65 and over at the end of the financial year, those in nursing homes and those with chronic respiratory disease, CHD, chronic renal disease, diabetes and those being immunosuppressed.

But the GPC has argued that dropping the points will put vulnerable patients at risk. The points remain in the current DoH offer but might be dropped if the imposed deal goes ahead.

Dr George Kassianos, immunisation spokesman at the RCGP, said: 'If the flu indicators and targets were excluded from the framework, it is likely the rate of immunisation of patients with chronic disease would drop.

'We would recommend a lowering of the "at risk" age so most of the patients with chronic disease would have a good chance of receiving the flu vaccine.'

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