How SCW’s Improving Immunisation Uptake (IIU) team delivered a significant reduction in the variation of immunisation uptake across the Thames Valley and an overall increase in uptake of childhood immunisations.
The IIU team initiative was developed following the evaluation of an NHS England (NHSE) commissioned health inequalities pilot project that took place in 2017. This initial pilot project demonstrated that health inequalities could be reduced when the nurse leading the project worked closely with the Child Health Information Service (CHIS). As a result, a further one-year pilot was commissioned by NHSE, and SCW's Improving Immunisation (IIU) Team was established. The initial IIU team consisted of two clinicians with a substantial immunisation background and a specialist data quality lead with extensive experience in CHIS.
The objective of the IIU team initiative was to use the CHIS GP level data and clinical input to reduce variation and improve vaccination uptake in 0-5 year olds, with particular focus on under-served children and communities in the Thames Valley.
Having the correct skill mix of data quality and analytical skills within the IIU team was important to ensure that time in the practice was maximised. Vital time could be spent in effective engagement with primary care colleagues to achieve sustained improvements in immunisation uptake rates. Being able to carry out all the necessary data cleansing and data quality work before visiting the practice meant that more time could be spent working with the practice team on improving the immunisation process. The approach also relied on having clinicians within the IIU team who can work with the whole GP Practice team. They needed to be able to enthuse and empower practice teams to improve their immunisation uptake performance. The success of the IIU initiative relied on the team being able to secure the practice engagement and commitment needed to implement the required system and process changes.
This approach ensured targeted support was provided, which not only improved immunisation uptake rates in the short term but also empowered general practice to develop their own robust strategies/processes, to achieve long term and sustainable high vaccination uptake rates.
Since 2018, the IIU team have delivered a significant reduction in the variation of immunisation uptake across the Thames Valley (TV) and overall increase in uptake of childhood immunisations. The image below is an example of an uptake report by postcode area on a map.
The image below is an example graph that shows variation in uptake for 0-5 year-old immunisations
- Ongoing facilitation of change management was crucial.
- Practices benefited from the promotion of evidence-based immunisation processes. Many practices had not reviewed their processes and/or were using outdated processes.
- Many practices didn’t have a clinical/admin immunisations lead. Even in practices where there was a named lead, often their role and responsibilities were not clearly defined and/or agreed.
- Many Practice Nurses (and some Practice Managers) were unaware of their immunisation uptake rates and how robust processes (such as new registrations), could help improve these.
- Vaccines being given too early was commonplace in some practices.
- Availability and flexibility of immunisation appointments was a common challenge identified by both staff and parents.
- Sharing good practice across GP’s, helped individual surgeries recognise where they could make improvements and the benefits that could be realised as a result.
- Many practices didn’t fully understand the role of CHIS and their processes/data requests.
- Data quality was a major ongoing issue for practices with “ghost patients” (patients still registered but no longer living in the area/country) commonplace on missing immunisation reports, with no process in place to identify these and deregister where appropriate.