Jabs can be a pain in the pocket

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IF YOUR holiday is taking you somewhere more exotic than Cornwall or the Costa del Sol this year, your first port of call should be your GP.

The rise in long-haul travel has exposed UK holidaymakers to a range of topical diseases. But the trip to the doctor for vaccinations will probably result in the first culture shock of their holiday for many British travellers: health service GPs can charge for travel vaccines.

The charges vary according to vaccine and GP. The rules are complex, and even GPs are often confused about when they can claim a fee. They have some discretion over charging and stories abound of some holidaymakers receiving vaccinations for free while a friend or relative registered with another practice was asked to pay.

In most cases, polio, typhoid, and hepatitis A vaccines are supplied free, although you may have to pay a pounds 5.50 prescription charge. Cholera and smallpox are also free, but are rarely needed. The broad principle is that travel vaccines are provided free for diseases that can be passed easily on to others and therefore pose a public health risk.

If you are travelling to low-risk countries in Europe, including Cyprus and Turkey, as well as Canada, the US, Australia and New Zealand, but nevertheless insist on having one of the above vaccines, your GP may charge.

You will usually pay for vaccination against diseases that only pose a health risk to the individual, such as yellow fever, hepatitis B, diphtheria, Japanese B encephalitis and tick-borne encephalitis, meningitis and rabies.

GPs have discretion over charges, although the British Medical Association says they should charge patients pounds 21.50 for each course of a particular vaccine. GPs may also charge a further fee of around pounds 7.50 when an international vaccine certificate is required, usually for yellow fever. A family of four could easily find the cost adding up to more than pounds 100.

Rabies is the most expensive vaccine, costing as much as pounds 28 per dose on top of the pounds 21.50 charge made by the GP for administering the course.

You will also have to pay for protection against malaria. Chloroquine and proguanil can be bought over the counter at your pharmacist, who will charge around pounds 16 for a combined course covering you for two weeks' travel. You will need a private prescription, usually pounds 7.50, from your GP for mefloquine and other anti-malarials. You also have to pay the pharmacist's charge for the drugs.

Some GPs have been mistakenly charging patients who have only requested information on travel vaccination or asked for their immunisation status to be checked. You should not pay for this.

Charging for any vaccines may seem unfair, but many question whether an overstretched NHS should vaccinate travellers able to afford expensive holidays. The Department of Health is reviewing whether all travel vaccines, which cost the NHS up to pounds 10m a year, should be paid for in full. However, charging will hit ethnic minorities who may have family obligations and could mean that many will travel without protection. The cost of treating diseases in non-vaccinated travellers could outweigh the savings.

Most GP practices offer a wide range of travel vaccines, with many setting up special clinics on a profit-making basis. Yellow fever vaccine is only available at specially-approved centres, so your GP or travel agent should direct you to the nearest centre.

Private travel vaccination clinics, such as those run by British Airways or Trailfinders, are aimed at busy people in big cities. You will have to pay a fee for any travel vaccines given at these locations, including those provided free by the NHS, and will often pay more than at your local GP practice.

British Airways Travel Clinics charge pounds 11 for standard polio and tetanus vaccines, pounds 22 for typhoid and pounds 48.50 for hepatitis A, all of which are available free, or for the cost of a pounds 5.50 prescription, on the NHS.

Many experienced travellers like to carry sterile kits containing syringes, needles and skin sutures. The NHS does not supply these but they can be bought over the counter and some GPs also sell them.

Your doctor may issue a private prescription (pounds 7.50) if you wish to carry prescription-only medicines as a precaution - for example, antibiotics or drugs to combat altitude problems. You will have to pay the pharmacist for the full cost of the drug.