“I would like to unreservedly recommend the Improving Immunisation Uptake Team as we found their support invaluable in increasing our immunisation uptake figures. Initial meetings including all stakeholders helped us to identify problem areas and find solutions for problems such as missing immunisation histories. We have changed our new registration pack, giving new applicants full information on what we require to ensure complete patient records. We have assigned the task of managing immunisations to a specific administrator who is using tools provided by the Improving Immunisations Team and Child Health. The databases provided support for the practice to monitor and follow up children with missing immunisations. We have changed our process to follow up by telephone rather than by letter and are finding this more effective. It has also helped to identify and deregister ghost patients. The CHIS team have met and are supporting the new practice nurse for administration of immunisations. Many thanks again to the Immunisations Team for your support.” Louise Upton, Practice Manager South Reading and Shinfield Group Medical Practice https://www.srssurgery.co.uk/
The Improving Immunisation Uptake (IIU) team comprises of two clinicians and a data administrator who work directly with GP Practices across the Thames Valley to improve the uptake of childhood immunisations.
The aim was to reduce the significant variation in immunisation uptake between GP practices across the Thames Valley and increase overall immunisation rates to achieve effective health protection for children.
The results of this year long initiative which was funded by NHS England have been extremely positive. At the start of this initiative in July 2018, the variation in immunisation uptake amongst GP Practices across Berkshire, Buckinghamshire and Oxfordshire (BOB) ranged from 40% to 94%. To achieve herd immunity and provide adequate protection to both individuals and the wider community, all GP Practices should be achieving an immunisation uptake rate of 95%. By May 2019, so less than a year later, the original variation had been reduced significantly with all GP Practices across BOB achieving at least 80% uptake and with 90% of GP Practices achieving over 85% immunisation uptake and 5% of GP Practices achieving over 95%. With support from the IIUT some practices have seen an increase of over 20% in their statistics.
This success is illustrated in the monthly tracker above of immunisation uptake in Thames Valley GP Practices. In June 2018, immunisation uptake rates ranged between 40% and 90%, whereas by June 2019 all Thames Valley GP Practices were achieving immunisation uptake rates at or above 80%.
The project set out to reduce the significant variation in immunisation uptake between GP practices across the Thames Valley and increase overall immunisation rates to achieve effective health protection for children. The challenge was to secure the engagement of underperforming GP Practices, who initially were reluctant to be involved. These practices had been identified by the Child Health Information Service (CHIS) Information Team and passed to the IIU team to enable engagement.
A targeted approach was used to identify and prioritise those practices with lower performing child immunisation rates that could most benefit from the teams support. The IIU team concentrated on these target practices using a whole practice approach which involved all the primary health care team working together to review all the process and identify improvements that could be made.
Once practices were identified the IIU team facilitated these multi-professional practice meetings with the aim of-:
Reviewing practice wide processes
Offering 1:1 and group support sessions. These were tailored to each practice’s needs and could involve one or a number of face-to-face sessions, followed by telephone support depending on requirements
Promoting evidence based practice to support operational improvements, for example new processes for databases to manage missing immunisation records
Providing tools produced by the IIU team to support the delivery of the immunisation programme including customisable templates for new registration pack documents to capture child immunisation details, and a GP practice toolkit containing key reference and signposting information
Identifying a practice admin lead to oversee and monitor the immunisation programme by reviewing and cleansing data provided by SCW, following up non-attenders who are not responding to SCW invitation letters; and deregistering identified ghost patients
The IIU initiative has enabled NHS England to improve Immunisation uptake rates significantly across the Thames Valley which has allowed them to achieve their aim of providing greater health protection within the community. After the successful year long pilot scheme the service is now being offered on a permanent basis in the Thames Valley region.
The success of the IIU initiative can be clearly quantified by the improvement in immunisation uptake rates overall and the significant reduction in variation of uptake rates between practices. Individual practices have been given the opportunity to review their approach to immunisations, enabling the practices to work in a smarter way. For instance the initiative has overhauled the new registration process within practices; thereby ensuring the collection of immunisation histories has a raised profile at the earliest contact with the children to ensure accuracy of data. This has the real benefit of children only being called for immunisations that are due, rather than those which are missing from a record. The pilot enabled practices to work alongside families, to better understand their issues and problems and devise solutions to help them participate in the immunisation programme, such as the need for greater flexibility of appointments to fit around family and work commitments
The key lesson learnt is the importance of having accurate and complete data to reliably identify those GP Practices most in need of intervention and to then secure the effective engagement of those practices. To facilitate the necessary change in practices required the involvement and commitment of the entire practice team for the most successful outcomes.