In 2020, the UK Government launched an expanded flu vaccination programme for delivery during the 2020/21 flu season. This expanded programme included the introduction of new cohorts eligible for NHS flu vaccination and increased uptake ambitions in existing cohorts.
The expanded programme was in response to the COVID-19 pandemic and concerns about the impact of SARS-CoV-2 co-circulating with influenza viruses on health outcomes of vulnerable individuals, and the associated additional impact on the NHS and social care system.
SCW was commissioned in July 2020 by NHS England to deliver an NHS Immunisation Management Service (IMS) to support the expanded flu programme.
The primary objective of our IMS solution was to optimise the uptake of the flu vaccine in both existing and new cohorts of citizens across England.
Following a request from NHS England for feedback from GP Practices, Primary Care Networks and Clinical Commissioning Groups that achieved a high flu vaccination uptake in 2020/21, the SCW Immunisation Management Service (IMS) regional teams collated the following best practices from across all seven NHSE/I regions.
Thank you to all those who contributed.
Best practices in optimising flu vaccination uptake
Of paramount importance to the success of the programme was the availability and usability of accurate, real-time data.
- A single data store – this was provided by the National Immunisation Management System (NIMS), which provided real-time live data, updated daily at 6am.
- An analytics dashboard for vaccine uptake.
- Drilldown data that informed operational planning from Clinical Commissioning Group (CCG) level to individual cohorts by GP practice.
- Deprivation and inequality analysis and reports.
- Regional data analysis and reports to inform operational planning.
- Citizen insight - ‘Free text’ comments reporting, provided insights on citizens’ responses when called by Call and Recall service. This highlights themes and trends, such as vaccine resistance/ hesitancy and positive feelings about the vaccinations.
2. IMS support
Each of the seven NHSE/I regions was supported by a dedicated IMS Regional Programme Support Lead, Co-ordinator, and System Support Specialist.
- This ensured the timely and accurate reporting and provision of intelligence on uptake of all cohorts eligible to receive the Flu vaccination. It enabled the provision of valuable operational information to regional commissioners on uptake by geography, relative level of deprivation of an area, age, gender, and ethnicity.
- Lower performing GP practices were identified particularly those performing poorly in comparison to GP practices in the same area and with comparable practice populations. They could then be supported with improvement plans.
- Care homes with low or unrecorded uptake rates for residents were also identified and support offered.
- IMS Regional Support teams worked collaboratively with regional Flu Leads, Screening and Immunisation Teams and all relevant agencies and shared experiences, ideas, and insights with fellow regions.
3. Vaccine supply
Planning and sharing information on flu vaccine supply across Primary Care Networks (PCN) and regions helped with managing vaccine supply.
- Proactive operational planning and advance vaccine order placement, which is usually in January once NHSEI has confirmed which vaccines are both recommended (following JCVI review), what the programme will likely look like (based on DHSC Policy), and finally what the NHS will reimburse.
- Regular stocktaking and monitoring of stock levels, aligning stock where needed.
- Stock sharing managed at a PCN level with communications between PCNs as necessary under a centralised policy for transfer of stock.
- Orders were shared within PCN to enable the inclusion of smaller GP practices whose order requirement may sit below the minimum order level.
- Initial vaccine supplies shared within the region.
- Enhanced refrigeration capabilities.
The workforce needs were for flexibility, collaboration, and expert support provided at a national and regional level.
- Some School Aged Immunisation Providers (SAIPs) subcontracted to Vaccination UK to obtain additional vaccinators for the school-age immunisation programme, allowing completion of all school visits on time.
- Community pharmacies increased capabilities to deliver flu vaccines.
- Volunteers captured in database, for example, volunteers willing to assist with additional pop-up clinics.
- GP practices were made aware of available staff in the Sustainability and Transformation Plan (STP) workforce bank who could support with vaccination clinics and improve throughput.
- Community district nurses were utilised to vaccinate housebound patients in their own homes in conjunction with GP practice staff.
5. Improving accessibility to increase uptake
Several initiatives played a significant part in improving accessibility to the flu vaccine and therefore uptake. Some key examples below:
- Provision of out-of-hours and stand-alone clinics.
- Drive-through or walk-through vaccination clinics for both adults and for parents to bring children to. Provision of drive-through clinics for the 2- to 3-year-old flu cohort proved particularly effective.
- Additional off-site clinics such as at village halls, set up in advance ready to operate at the start of published ready date.
- Clinics run in mosques.
- Additional on-site medical tent clinics.
- ‘Jab-a-thons’ and peer-to-peer roving vaccinators.
- Roving model, for example to housebound patients, sometimes undertaken by GP practice staff and community trust providers.
- Offering vouchers to incentivise uptake by homeless cohort. These would be for example £10.00 Costa vouchers.
6. Health and social care workers
- A standardised letter of eligibility was developed for health and social care workers to provide proof of eligibility to GP practices and pharmacies for a free vaccination.
- Hospital trusts regularly encouraged to provide flu vaccinations to staff.
- Regional flu teams closely monitored staff uptake in hospital trusts, following up those with below-average uptake.
- Flu vaccine ‘bleep holder’ established to drop into wards on request to deliver flu vaccine to staff (including overnight to reach night staff).
7. Regional and Primary Care approach
Early regular planning meetings to determine the campaign for the upcoming flu vaccination season are regarded as contributing significantly to success. Some regions start weekly planning meetings in March of each year, a full six months ahead of the flu season commencing.
- Establishing an STP strategic flu group with fortnightly meetings chaired by a local GP lead proved highly beneficial. This provided a forum at which areas requiring an increase in flu vaccine uptake rates could be discussed and improvement plans agreed. It also provided a forum at which joint communication plans could be developed and agreed.
- Strong working relationships between CCGs and Primary Care are beneficial.
8. GP practice-level initiatives
- GP practice nurses or healthcare assistant contacted patients directly to explain vaccination benefits and book patient a vaccination appointment. This was effective in reaching patients in ‘at risk’ groups including learning disabilities as it can be easier to explain rationale in a call.
- Ad-hoc invitations issued to patients to attend same-day clinics.
- Surveymonkey.co.uk was used at some GP practices to gain insights, such as for delivery models and uptake feedback.
- GP practice staff trained and encouraged to check patient flu vaccination status on GP practice system and offer flu vaccination opportunistically. This included:
- GP practice receptionist staff checking flu vaccination status when patients phone practice for appointment booking or repeat prescription or for any other reason.
- Opportunistic vaccinations by GPs and practice nurses if seeing patient for another reason. This included on home visits.
- Having designated member of admin staff within GP practice for contacting patients with learning difficulties.
- GP Practice Manager Flu Vaccination Working Group enabled beneficial knowledge sharing.
9. School-aged flu immunisations initiatives
A significant barrier to achieving high levels of vaccine uptake in the school-aged flu cohorts is obtaining the necessary consent.
- Paper consent forms given in some regions to schoolchildren to take home for completion.
- Some CCGs called parents to obtain consent to vaccinate their children.
Effective comms are crucial to any programme. Here are some best practices in this area, again from all regions.
- Social media informed about flu vaccination and local clinics.
- Media articles for example across local radio and newspapers.
- Staff bulletin updates, highlighting initiatives and informing on the progress of flu vaccination programme.
- Targeted comms, for example, regional area letters to specific groups such as diabetics.
- Informative multimedia comms in different languages.
- Using a variety of comms for patient contact, social media, leaflets, posters, letters, phone calls, text messages. Proactive contacts with citizens certainly improved uptake.
- South Central & West (SCW) Immunisation Management Service (IMS)
- IMS Regional Programme Support Teams
- NHSEI Regional Teams
- PCN and GP practices
- Care homes