Paediatricians blame GPs systems for poor uptake of childhood vaccinations
‘Stubborn barriers’ to accessing childhood vaccinations, including around booking a GP appointment, are contributing to the ‘worrying decline’ in uptake, paediatricians have claimed.
A report from the Royal College of Paediatrics and Child Health said some parents face significant barriers getting their child vaccinated which is contributing to growing inequalities in coverage.
The current system is fragmented, hard to navigate, and too often fails the very families who need it most, the report found.
A lack of reminders from the GP about upcoming vaccinations as well as having no easy way to check vaccines their children have and have not had were among the issues raised by the college.
Falling vaccine uptake is too often blamed on anti-vaccine sentiment or misinformation when in reality many parents who want to vaccinate cannot access services that work for them, it concluded.
Inflexible appointment systems, inconvenient clinic hours, limited availability of slots or costs of travel all contribute to missed vaccinations, the year-long analysis that included interviews with NHS staff and parents found.
More can also be done to improve outreach initiatives, it said, as well as better data-sharing to help healthcare professionals track who has missed a jab.
But parents also feared being judged for raising concerns about vaccines or having beliefs in alternative medicine. They need clear, accurate and accessible information ‘format and location’ that is convenient as well as opportunities to ask questions.
Healthcare professionals, including allied staff, also need training to feel confident in answering parental concerns and ‘support positive messages’ around vaccination, the report recommended.
A lack of continuity of care was also contributing to the problem, the RCPCH found, with many parents seeing a different GP or clinician at each visit.
Yet the absence of health visitors was an especially significant factor because it prevented better understanding of individual family circumstances that could influence vaccination decisions, the report noted.
Data shows high levels of support for childhood immunisation yet not a single routine childhood vaccine has hit the 95% target recommended by the World Health Organisation since 2021.
Outbreaks of measles and whooping cough last year show the consequences of falling uptake and waning immunity, the report added.
Some ethnic minority groups, socioeconomically disadvantaged families and migrant communities reported specific challenges such as language difficulties, digital exclusion, difficulties in navigating the NHS, and a lack of targeted outreach, the report found.
RCPCH officer for health improvement, Dr Helen Stewart, said: ‘Steady declines in vaccination rates in a wealthy country such as the United Kingdom is extremely concerning.
‘It poses a significant risk to public health, with outbreaks of preventable diseases such as measles and whooping cough already being seen.
‘Parents are often blamed for vaccine hesitancy, but the reality is that there are many who simply need better support and easier access to appointments.
‘With the right guidance and access, they’d gladly protect their children with these essential vaccines. If we are ever to truly tackle low uptake, then we must first ensure that everyone who is willing to be vaccinated is able to do so quickly and easily.’
Dr Julie Yates, deputy director, immunisations programmes at the UK Health Security Agency said: ‘We know our colleagues in general practice and other services are working exceptionally hard to deliver our immunisation programmes and through their efforts they protect millions of children each year.
‘However, we must not become complacent and UKHSA is committed to working with the NHS and partners to improve childhood vaccine uptake.’
She added that the NHS England Vaccination Strategy was already working to improve the ‘front door’ to vaccination, ensuring more flexible appointment booking systems, making vaccines more widely available, making access easier and responding to the specific needs identified within each community.
Professor Helen Bedford, professor of children’s health at University College London, said in the UK, overwhelming majority of parents vaccinate their children ‘without hesitation’ but progress was reversing.
‘Unfortunately, there are large and widening inequalities in vaccine uptake with the most disadvantaged children less likely to be protected.
‘In the face of adversity, it can be challenging for many families to simply get to vaccination appointments, particularly if they are offered at inconvenient times or inaccessible locations.
‘Lack of information about which vaccines are due when, or no opportunity for parents to have a chat with a health professional about their questions and concerns can all present unsurmountable barriers to vaccination.’
But she said implementing the RCPCH recommendations would need investment in infrastructure and staff.
RCGP chair Professor Kamila Hawthorne said: ‘The Childhood Vaccination Programme is one of the great successes of the NHS, but vaccines can only work if enough people have them. Falling take-up rates are therefore extremely concerning and this review does some vital work in identifying the factors that could be behind this and how they can be resolved.
‘We know that some parents do face practical barriers in getting their children vaccinated and, where possible, these need to be broken down. The report’s proposals to achieve this by ensuring there is sufficient funding for vital vaccine services would be an important step, and this should extend to general practice which plays a crucial role in vaccine delivery as the wrap-around care we provide means we’re able to steer patients towards relevant services.
‘Falling take-up rates are a serious risk to public health – if they continue, then outbreaks of conditions including measles and whooping cough will become more likely, putting children and their families at greater risk of potentially deadly health consequences.
‘Maintaining high vaccination rates is a top priority for GPs and we will continue to urge all parents to ensure that their children’s vaccinations are up to date.’
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READERS' COMMENTS [12]
Please note, only GPs are permitted to add comments to articles
Patients struggle to access GP services.
Who knew?
Attempting to bully patients into having COVID vaccines they did not want or need has consequences for trust; who would have guessed?
Has anyone from the RCPCH worked in or have any awareness of primary care ?
Never thought we would be blamed for another thing we have no control over. Who would have thought it would just be easier to blame the GPs rather than doing something about it. What next? GPs to be blamed for more than a year waits to be seen in hospital as they refer too much? GPs blamed for lack of social care amd loneliness? GPs blamed for poor education of 4 to 18 year olds? GPs blamed for high energy costs across the UK. It just goes on and on.
It used to work brilliantly with health visitors until they push it to the struggling GP with unrealistic limitations on timing so we do the work but do not get paid.
Not sure that the “no control” argument is entirely convincing from those happy to accept bonus payments for achieving higher vaccination rate targets. Perhaps return the monies if undeserved?
DH what are you on about? What bonus payments? You are obviously not an informed GP if you are a GP at all. Only 96% imm target cliff thresholds below which general practice receives paltry remuneration despite major effort. And what happened to personal responsibility ensuring your child is vaccinated,? Why are we always expected to chase patients who are not availing themselves of FREE healthcare? Inconvenient, can’t get an appointment for childhood imms – utter garbage
Yes poor uptake fewer GPs no nurses decimated Health Visitor service impossible KPIs crappy IT systems …. With investment in WF NHS General Practice was once world leader in imms!
Ahh DH … that old chestnut that GPs get bonus for X,Y,Z.. Al Don’t people realise that General Practice is run like a corner shop and Capitation and Targets are our income which after expenses (WF mainly), tax, NI, superannuation….. comes the salary. There are no bonuses! Just multiple impossible to reach KPIs
We have 5 families are our small practice who refuse to get their children vaccinated.
They have been invited a grand total of 20 times each by telephone, text message, letter, voicemails, and requests to have the child vaccinated (including appointments booked at a time told to be convenient) when they rarely attend the surgery with the child unwell (typically with an upper respiratory viral infection or a viral exanthem – we’re in the North West, where measles has recently taken a life and swabs are coming back multiple times a day in GPOOH showing positive cases).
Their refusal – in the absence of any exclusion criteria for parental dissent – meant that despite every Thursday morning being “baby clinic” for imms and ad hoc appts being made (all DNA’d), our repeated communication efforts, the 92% achievement for the 5in1 was worth only 1.4 of 18 total QOF points – our first year of non-100% achievement since I joined the partnership in 2020. Not a single one of the nonsense points made in this above report from the RCPCH rings true for the situation at my surgery. We bend over backwards to get them in and they DNA.
None of the families, incidentally, reply to our messages either saying “Please let us know if you wish to opt out of immunisations” – as they don’t want to have it documented that the officially oppose them – they simply “Ghost” us.
Maybe I’ll refer them all to child safeguarding?
If you lose all the income for one refusenik then the target becomes actually less motivational. Do 85% of the work no pay only paid if get 90% so miss small having put a lot of work in a very vaccine doubtful internet world. Or if you are going to miss then may as well miss big and fail to be be paid for less rather than more work.
PS what is a health visitor are they in the fossil records?
Tj Motown…..spot on!
The idiotic and disastrous decision to ban “exception reporting” for immunisations has had totally predictable results. Once several families totally refuse, there is zero chance of hitting 95%…..so why the Hell sweat blood chasing everyone else for no reward?
So instead of slagging off GPs (again), reinstate Exception Reporting and watch those immunisation rates soar.
Clearly SOME Paediatricians haven’t a clue what they are talking about.
Vaccination clinics are booked and reminders sent out by the Child Health (HV) team, not GPs, who are only told on the day who is coming. The Child Health Department keeps records that they can easily consult as to which vaccines had/due.
GPs can easily check a patient’s vacination history from their GP records, but ONLY those that the Child Health Team tell us about, plus those given by GPs in surgery.
The real cause is the covid vaccination debacle, and prominence given to issues in USA and anti-vaxxers. If PH and CH come clean, they ought to provide mandatory training to the Paediatricians on how thier systems work (or not work, as in case of WIS) to educate them how hard GPs have to work to promote immunisation in such a fragmented and under-resourced system imposed by DoH.