Our IMS Regional Improving Immunisation Uptake Support Team helped Greater Manchester Partnership identify housebound individuals who required delivery of the COVID-19 vaccination at home, helping them achieve an overall uptake percentage of greater than 90% in age groups 70+.
The NHS Immunisation Management Service (IMS) supports the enhanced winter flu programme and the national COVID-19 vaccination programme by optimising uptake of these vaccinations amongst eligible individuals, particularly amongst those in the most vulnerable groups. The regional Improving Immunisation Uptake Team is a dedicated team provided as part of the service and reflects the seven NHS regions.
The team uses operational data to provide regular and constantly updated analysis of vaccination uptake by variables such as age, deprivation, ethnicity, postcode and to identify significant uptake outliers both in terms of good and poor uptake performance. This analysis supports the regions in their operational planning.
The challenge and our solution came at a time when England was in lockdown, but with a clear roadmap outlined as to when the easing of restrictions would commence. As such, there was a real need to try and ensure as many vulnerable individuals as possible were vaccinated and thereby protected.
One element of our IMS is the outbound Recall Centre. This call centre contacts unvaccinated individuals from priority groups to encourage uptake of the vaccine. During these calls, our team can capture some useful insights as to how the public feels about the vaccines and some of the reasoning behind vaccine hesitancy. This can help identify some of the barriers to achieving high vaccination uptake levels.
A significant barrier that emerged early on was of some individuals ‘waiting to have the vaccination at home’ or reporting being ‘physically unable to leave the property’ to attend a vaccination centre.
Most people giving these responses were in the elderly age groups of 70 upwards. Our IMS Recall Centre had been targeting the elderly population first, in line with the schedule of priority groups for COVID-19 vaccination, which enabled SCW to further identify these housebound citizens.
Our IMS Regional Improving Immunisation Uptake Support Team were approached by the Greater Manchester COVID-19 vaccination programme lead to ask if the IMS Recall centre data could be used to improve uptake in cohorts 1 to 5 who may need extra support in having their COVID-19 jab.
The official request was to provide Patient Identifiable Data (PID) for those unvaccinated individuals who had given the verbal response of ‘waiting to have the vaccination at home’. Greater Manchester ICS would then potentially be able to deliver the required home vaccinations.
The ambition was to help achieve the 85% national uptake target in each priority group. The individuals identified by our IMS Recall Centre would help the region achieve an overall uptake percentage of greater than 90% in age groups 70 plus.
What we delivered
The request was considered and approved by the national programme board and IMS programme management team. There were two key requisites to this approval:
1. Each identified individual had to have their GP practice record checked by their GP practice to ensure contact was appropriate before any contact to offer the COVID-19 vaccination was made.
2. The PID had to be sent safely and securely to agreed recipients. Each of the 10 CCGs involved had to identify a dedicated individual as the designated recipient of PID who would then receive a list of citizens registered at GP practices within their CCG only.
The IMS system support team ran analysis identifying a total of 813 eligible individuals across Greater Manchester with no recorded COVID-19 vaccination, who had verbally identified themselves to the IMS Recall Centre as waiting to be home vaccinated.
Each CCG had at least 50 such individuals and 94% of the individuals were aged 65 or over. Reports were produced that included patient demographics, GP practice information and contact details ensuring a smooth process of confirmation. The CCGs validated the information and liaised with local services to ensure delivery of the vaccine.
The IMS Improving Immunisation Uptake Team requested that the reports were returned with a vaccination status of either delivered or undelivered with the latter outcome accompanied by a reason.
Of the 813 individuals identified, 394 (48%) of individuals across all 10 CCGs received a COVID-19 vaccination first dose within two weeks of the reports being sent. As a result, four of the 10 CCGs surpassed 90% uptake and two CCGs in significantly deprived areas still managed to achieve 85% vaccination uptake.
This initiative to enable more homebound citizens to receive a vaccination was praised at the North West vaccine delivery meetings for its effectiveness in reaching diverse communities. In terms of ethnicity, 10% of the vaccinations were delivered identified as of white background, 8% to the Asian community and 6% considered of African descent. Similar requests have followed to identify housebound individuals awaiting a second COVID-19 dose.
A thorough evaluation undertaken by the North West and the IMS Regional Improving Immunisation Uptake Support Team found 52% of eligible individuals remained unvaccinated within two weeks of the reports being sent to the region. This granular insight helped identify local and national data quality issues. Resolution of these data quality issues is ongoing, which will further improve COVID-19 vaccination uptake rates.