How can I improve the immunisation uptake?

1. How can I improve the immunisation uptake? Leigh Pusey Clinical Lead for Immunisation, Children and Maternity Services Flintshire Local Health Board

2. Which programme/ • MMR? • Pre-school booster? • Teenager booster? • PCV? • Flu (at risk groups)? • For hard to reach groups? • The articulate refusal?

3. Your starting point • Find out what your immunisation uptake is per course of vaccines e.g. • Primary course ( 5 in 1, Meningitis C, PCV) • MMR • Pre school booster • Teenage booster • Flu • Pneumococcal

4. Why is it so important to know your uptake? • Unless you know your uptake you cannoteffectively: • know if you have a problem • identify any target groups for additional sessions • see any improvements to uptake • ask for support/additional staff time • evaluate your strategy and learn lessons about what works to maximise uptake or improve outcomes

5. Where can I find out my uptake • Quarterly COVER data:- per LHB area but is historic • Practice specific COVER data:- per practice but is published twice a year but is historic • Children:- Child Health for outstanding immunisations - can be used to invite • BSC Exeter target list:- for payment but applies for 2 and 6 year olds - can be used to invite • Practice reports from clinical systems - can be used to invite

6. Numerator and denominator % or 75/100 • Increase the numerator (getting as many patients immunised as possible) • Decrease the denominator (accurate lists) - Improves the % uptake - Improves accuracy, reporting and will be a true uptake - Ensures you are not undertaking futile activity

7. Simple maths 75/100 = 75% 78/94 = 82.9% 90/94 = 95.7%

8. Good Housekeeping • Ensure you notify Child Health about children who are not registered with your practice, attend your school, you are their Health Visitor • If they are on your list then they are not receiving vaccines elsewhere • Notify changes of address • Ensure immunisation histories are inputted onto your system and child health from out of county

9. Check ‘your’ way of managing the immunisation service • Children:-Do you have a dedicated person who manages the campaign in the practice, school setting or clinic? • scheduled forms for children • invitations • obtaining consent (schools) • completing immunisation form • returning immunisation form

10. Child Health • Are you confident you know enough about the Child Health System? • The importance of returning forms on time • Completing of forms • The ability of the system to add more sessions, different sessions for specific vaccines e.g. MMR add more patients etc. • Do you know who to contact in Child Health • Check your set up – tomorrow!

11. Evaluate your appointments • Are you flexible enough with clinic sessions? • Do you provide opportunistic vaccinations? • Do you have markers on the patient record? • Could you offer more vaccinations in school holidays? • Are you sessions on a benefit payment day Tuesday for Child Benefit Thursday for Pension? Are you predisposing yourself to a high rate of defaulting

12. You have a low uptake - children • Identify the patients per vaccine • Are they persistent defaulters? • Have they consented? • Are they a ‘family in need’ or a ‘family in need of protection’? • Are they frequent visitors to the practice or clinic for other reasons, think opportunisitically • Are they registered with a GP practice? • Are they vulnerable (a traveller, asylum seeker or migrant)

13. The categories of those with outstanding immunisations • Families in need/ defaulters/vulnerable gorpus • No consenters – worried parents, red top newspapers, grandparents (pertussis) • No consenters – oppose the principles of vaccination with an articulate refusal The Super Child Syndrome – affluent families, well read?

14. Patients at risk of missing immunisation • Large families 3+ children • Families ‘in need’ • Families ‘in need of protection’ • Looked after children (LAC) • Travellers • Migrant families • Single parents • Domestic violence situations

15. Families in need - Consent is given on records • Set up an additional session for large numbers, use an Inset Day (check with your Local Authority) • Liaise with Health Visitor or school nurse if any problems with the family • Phone patient to discuss - many forget • Offer home immunisation if appropriate – target families with 3+ children

16. If no consent - due to concerns about vaccine • Check with patient if ‘no consent’ is still their option • Clarify what their concerns are and address these specifically • Inform them that many parents are now having children vaccinated – the confidence is back. • Direct them to the websites as considerable more information is available from a reputable source. www.immunisation.nhs.uk www.mmrthefacts.nhs.uk Many change their minds

17. If no consent- due to beliefs about principles of vaccination • Faculty of Homeopathy website • Information about herd immunity • The risks of contracting the disease • Re-emergence of the diseases • Every child's right to receive vaccination WHO

18. Teenage boosters • Usually given in school setting • Have posters with immunisation information and web sites • Develop Health Days (Give up smoking, drug and alcohol awareness) • Participate in PSE sessions • Know your uptake per school ask Child Health

19. Activities to improve teenage booster • Organise date well in advance to secure rooms and avoid trips and exams • Cross check Child Health appointment list with school list for accuracy • Identify children who do not have a GP • Identify those outstanding immunisations and offer extra session • Child protection cases - think about home immunisation

20. Flu campaign • Have a planning meeting early in the year to devise a strategy • A team approach: all staff are clear on their role within the team • Identify potential patients :65 years and over and at risk groups and carers • Order vaccines sale or return

21. Flu campaign • Invitations poster/invite/phone call/reminders on prescriptions/personal • Identify housebound and code them to develop a list • Identify district nursing patients • Identify carers and code them • Ensure children are called up who are ‘at risk’

22. Flu campaign • Encourage patients to ring after busy period after 10 am lessens frustration when phone is constantly engaged • Discuss with police about parking restrictions prior to sessions • Raise awareness about flu vaccines, personal contact helps

23. Promotion of vaccine to patients • 65 years and over. Eligible to have flu jab if 65 years before March 31st. Send them a birthday card early. • At risk groups: advise during contacts throughout the year about the importance. • Invitations are useful, then a phone mop up • Keep an up to date list of those invited • Keep a stock check on vaccines • Have flags on the system to identify patients, then opportunistically immunise

24. Outcome of invitations survey • Those practices who send personal invitations to 100% of 65 years and over have the highest uptake • Practices which actively invite patients have a higher uptake in 65 years and over and are more likely to achieve 70% in this target group

25. Distribution of practice uptake rates

26. 2004-5 uptake 2005-6 uptake

27. Provide up to date information • Have notice boards with up to date information about immunisation • Make sure boards are not too cluttered as message can be lost • Have website addresses available • Promote immunisation with national and local campaigns

28. April 21st April 27th 2008

29. In summary • Find out what you uptake is – it is important • Ensure good housekeeping of patient lists • Evaluate your system and make changes • Have a dedicated person to oversee programmes • Be organised- key theme from FLU VIP project • Collaborate with colleagues for support-

30. Prevent Protect Immunise • If it were that easy to do all vaccine programmes would have an uptake which exceeds 95% • Dedicate more time to immunisations as it is worth it to protect the public - you are saving lives • Be confident and positive about immunisation - it makes a difference