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Case study: How to tackle low immunisation rates

Michael Woodhead explains how GPs in Brent tackled low immunisation rates

In 2008, the Brent area of London had the lowest rates of immunisation coverage in the UK.

For children aged one, for example, vaccination coverage for DTP, pertussis and Hib were only 66%, while only about 45% of children aged two had their pneumococcal or Hib/meningococcal C boosters vaccinations. Vaccine coverage was especially poor for five-year olds, with only 21% having DTP, polio and pertussis boosters and 28% having MMR boosters.

A Childhood Immunisation Task Group was set up by Brent Council and involved GPs, the PCT and other groups such as child health centres.

The task group looked into reasons for the low immunisation rates and found that poor data management and lack of call and recall processes were significant factors. In many cases, GPs and PCTs did not have the same figures on who had been immunised.

Although the area has a high proportion and black and other ethnic minorities, cultural and social factors were not found to be a major factor in the low immunisation coverage.  However, the high rate of population movement made it difficult to ensure who had been immunised, and some children were not registered with a GP in the area.

The task force recommended a ‘clean up’ of the database and this resulted in 6,000 more names being added to the 23,000 names already on the immunisation database.

At the same time, all 70 GP practices started to send their immunisation data electronically every month to the PCT, and immunisation results for each practice were published, with a ‘red amber and green’ alerts to identify those with low rates.

GP practices with low immunisation rates were asked to develop a childhood immunisation scheme plan, which detailed how each practice would ensure patients were informed of due immunisations and what the follow up actions would be if patients did not attend for vaccination.

Some of the ways that GP practices tackled low immunisation rates in their practice included:

Monthly searches on the practice clinical system to identify immunisations which are due or overdue.

Phoning parents to make appointments for due/overdue immunisation, and texting or phoning with reminders 24 hours before the appointment

Making the next appointment for immunisation during the visit for the last vaccination.

Flagging due or overdue immunisations on the practice clinical system and follow up when the patient presents.

If a patient did not attend, following up with a telephone call or a letter.

Practices were also encouraged to train front line staff such as receptionists in promoting the importance of immunisation and to help them dispel concerns and misinformation about vaccinations such as MMR.

As a result of the campaign, Brent was able to increase its immunisation rates by 30% within a year.

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