Lucy Rumbellow is an Immunization Commissioning Manager at NHS England (London Region), England. She has over 10 years’ experience working in public health, health and well-being and is a registered public health practitioner on the UK public health register.
Statement of the Problem: In June 2015, a national publicly funded meningococcal ACWY (MenACWY) immunization programme was introduced in the United Kingdom (UK). This was in response to the rapid rise of invasive meningococcal disease caused by the capsular group W (Men W) particularly amongst adolescents (10-18 years) and young adults (19-25 years). The immunization programme is commissioned by NHS England (NHSE) as part of its Section 7a immunization programmes. It is offered as a routine vaccination to adolescents aged 14 or 15 (UK school years 9 or 10) alongside the teenage booster in the school-based vaccination programme. Uptake is low in London compared to national (76% in Year 9 and 63.1% in Year 10 compared to 84.1% and 77.2% nationally in 2016). It is also lower than the HPV programme given in year 8 (85% in 2016). We set out to explore the factors impacting upon good service delivery in order to improve the commissioning of the services and thereby the uptake. Methodology &Theoretical Orientation: The study design was two-fold. In May 2015, we surveyed our 18 school aged vaccination provider organizations (which cover 32 boroughs and a population of over 1,500,000 school age children) to assess their preparedness for delivery of the MenACWY immunization programme. Five barriers to successful implementation were anticipated: consent forms not being returned; staff capacity; lack of administrative staff; lack of finances and; increasing volume of child flu vaccine delivery. We resurveyed our providers (now reduced to 11 organizations) in July 2017 to see if the same barriers remained and used the survey as a purposive sampling frame for in-depth interviews to explore the facilitators and barriers to MenACWY uptake in schools. Findings: All anticipated barriers remained to good delivery. Six representatives from six organizations agreed to be interviewed. Five main themes emerged from the thematic analysis: people largely accepting but; lack of school support and engagement; poor return of paper consent forms; parents not understanding that MenACWY is different to Men C given to infants and; school delivery impedes meaningful engagement with adolescents. Conclusion & Significance: MenACWY are a well-accepted vaccine yet reported uptake is lower than expected in London. Delivery of the programme is affected by the mechanics of school based delivery including poor return of paper consent forms. Normalizing of school aged vaccination programmes is needed including building relationships with school staff and the wider school community and utilizing digital consent forms and other forms of communication.
Catherine Heffernan is Principal Advisor for Commissioning Immunization and Vaccination Services at NHS England, London Region, England. She is a Consultant in Public Health and has spent the past five years as the London regional lead for immunizations at Public Health England, advising NHS England, London Region on commissioning section 7a immunization programme. She is also an accredited Educational Supervisor for Public Health Registrars and GP trainees and is an Honorary Senior Clinical Lecturer at London School of Hygiene and Tropical Medicine.
Statement of the Problem: Patient invite-reminder systems (also known as call/recall) are consistently cited as being one of the most cost effective ways to improve uptake of vaccination services. It is unknown how applicable this is to routine practice in the UK. The aim of this study is to provide a cross-sectional description of what is currently happening in London GP practices and to provide insights into the facilitators and barriers to embedding good call/recall processes. Methodology & Theoretical Orientation: The study design was two-fold: a survey to provide a cross-sectional description of call/recall systems in London GP practices and qualitative semi-structured interviews to gain further insight into the facilitators and barrier. Between October 2016 and February 2017 we undertook a census of all 1,301 London general practices. The survey was used as a purposive sampling frame for in-depth telephone interviews on experiences and perspectives on operating call/recall system for immunizations. Findings: We had a 60% response rate (684 GP practices) and 25 GP practice managers volunteered to be interviewed. Call/recall processes are variable and decline with age of patient (figure 1) Letters (81%) and telephone calls (80%) are the most popular methods for delivering invite-reminders. No significant difference was found between practices that did call/recall and those who didn’t in terms of deprivation, population demographics and vaccination uptake of 0-5’s national childhood immunization programme. Five main themes emerged from the thematic analysis: (1) no call/recall system was the same; (2) practice preference for letters and phone calls over emails and texts; (3) lack of clarity on what good call/recall should look like; (4) preference to do it themselves rather than automate it and (5) call/recall is time consuming, costly and patients aren’t bothered. Conclusion & Significance: This is the first study to describe how call/recall is utilized in routine practice. Delivery of call/recall is variable, human and paper intensive and not wide-spread. Implementing best practice evidence will require investment and consorted effort.