Dr Nabi’s practice in Slough had been facing challenges with its preschool booster immunisation uptake rates for almost two years. Our Improving Immunisation Uptake Team (IIUT) worked in collaboration with staff at the practice to review their approach to childhood immunisations, providing long-term support, which resulted in a substantial increase in pre-school booster uptake by February 2022.
Context
The NHS Long Term Plan focuses on ensuring a strong start in life for children by transforming services to reduce health inequalities. The IIUT work directly with primary care colleagues across the communities we serve, to reduce variation in immunisation uptake, by improving access to vaccinations for all children. The IIUT are a specialist team that works in collaboration with GP practices, to identify and address key challenges and boost childhood immunisation uptake rates.
Challenge
Many practices, such as Dr Nabi’s practice in Slough, face various challenges in immunising children against preventable diseases in line with the UK immunisation schedule. When working with transient populations, immunisation histories from overseas can be hard to translate and patients can move away without notifying their GP. Practices sometimes have difficulty coding immunisations onto their system correctly which leads to scheduling errors and missed immunisations. Staff capacity and high workloads can also hinder efforts to address challenges, as was identified in Dr Nabi’s practice. The practice was keen to engage with the IIUT but staffing challenges made this very difficult.
Approach
The IIUT review 0-5 immunisation uptake data monthly for all practices across the Thames Valley.
In early 2020, the data for Dr Nabi’s practice in Slough highlighted where improvements to their uptake rates could be made. The IIUT approached Dr Nabi’s practice, offering a package of intensive and bespoke support to address the challenges.
Several key challenges were identified, and the following approaches were adopted in collaboration with Dr Nabi’s practice to address and resolve them, including:
- A ‘whole practice approach’ to childhood immunisations was adopted and discussed during weekly meetings with the IIUT. The key to success in this practice was the manager allocating protected time to all practice staff to refine and apply new administrative and clinical immunisation processes.
- Staffing changes led to a renewed focus on childhood immunisations which presented the opportunity for increased engagement with the IIUT, which had been a challenge for almost two years.
- In weekly meetings, the IIUT provided training to practice staff on various topics, including talking to families about immunisations, which boosted their confidence. Both administrative and clinical staff adopted a warm approach and began making calls to families to understand their individual needs.
- One member of staff, who has a background as a health and wellbeing coach, was particularly persistent in following up on every child and dedicated himself to understanding the needs of families. This resulted in great success booking children in for missing immunisations.
- The IIUT provided training to practice staff on deciphering overseas immunisation histories, data cleansing and utilising reports from Child Health Information Services (CHIS). The IIUT also promoted ‘catch-up clinics’, to ensure every child was given the opportunity to receive immunisations, to bring them in line with the UK schedule.
Impact
In early 2022, and within one month of the IIUT providing an intensive period of support, Dr Nabi’s practice saw its preschool booster immunisation uptake rates rise from 74.6% to 81.3%. Alongside the improved uptake rates, the practice has seen several additional benefits:
- Taking the time to call and understand each family’s needs resulted in this practice successfully immunising children who had previously been disengaged with the immunisation programme
- This helped to keep every child in focus, ensuring as many children are immunised as possible
- Boosting immunisation uptake results in increased health protection and prevention against potentially deadly infectious diseases
- Practice immunisation processes were reviewed/refreshed, and staff felt more confident registering/ deregistering patients and knowing how to log refusals
- Staff reported that the practice now has a better working relationship with CHIS, allowing data to be better synchronised
- This partnership working between the IIU Team and Dr Nabi’s practice, led to a greater focus on a strong start in life for children, a key aim of the NHS Long Term Plan
It was thought that because of the demographic of the surgery there were many families reluctant to take up vaccines but by being proactive and persistent this has allowed some children to be offered immunisations who would otherwise have been overlooked.
The approach was warm and welcoming. During the meetings, Carly and Katherine (IIU Team) gave me small sections of the report to focus on first to build my confidence. This boosted my morale and then gave me the motivation to learn more. I never felt that I was asking a silly question. Almost anyone with the IIU team’s support could do this and make a difference - Shakib Hussein, Practice Administrator
Feedback from the Practice Manager highlighted:
The support provided by the IIUT was very much appreciated, it is a wonderful service.
The personal approach and MS Teams meetings provided very helpful support. The building of relationships during meetings particularly helped the staff involved. This was much more helpful than just email support.
The virtual approach was very suitable for the practice, especially when some staff were working from home.
The support has really improved our immunisation uptake rates and this has been very much appreciated by the Head GP.
For more information on the Improving Immunisation Uptake Service,
Find out more about the work we do to support improving immunisation uptake.
