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Overview

This new Guidelines summary aims to increase the uptake of all vaccines provided on the NHS routine UK immunisation schedule by everyone who is eligible.

This summary covers key recommendations for primary care, including:

  • service organisation 
  • identifying eligibility, giving vaccinations, and recording vaccination status
  • invitations, reminders, and escalation of contact.

For a complete set of recommendations, refer to the full guideline.

Service organisation

These recommendations should be read together with the NICE guideline on flu vaccination: increasing uptake.

For recommendations on named vaccination leads and designing and raising awareness of payment schemes, refer to the full guideline.

Making vaccination services accessible and tailoring to local needs

  • NHS commissioners and NHS providers should ensure that they identify:
    • local population needs
    • barriers to vaccine uptake (see box 1)
    • areas or populations with low vaccine uptake (see box 2).

      They should do this using data from the Joint Strategic Needs Assessment and other data sources.

Box 1: Some key barriers to routine vaccine uptake

  • Inflexible and inconvenient clinic times and locations
  • Percieved lack of balanced information (including misinformation)
  • Language and literacy problems
  • Insufficient time in consultations to discuss concerns about vaccinations
  • Lack of staff training in how to discuss vaccinations effectively
  • Uncertainty about vaccine safety and effectiveness
  • Uncertainty about whether vaccines are needed (including how severe the diseases are or how likely it is that someone will be exposed to the disease)
  • Previous negative experiences of vaccination
  • Lack of trust in the government, drug companies and the healthcare system
  • Religious or cultural views that are against vaccination (this may relate to specific vaccinations, for example HPV [human papillomavirus])
  • Individual barriers such as needle phobia or sensory impairment.

Box 2: Some population groups that are known to have low vaccine uptake or be at risk of low uptake

  • People from some minority ethnic family backgrounds
  • People from Gypsy, Roma and Traveller communities
  • People with physical or learning disabilities
  • People from some religious communities (for example, Orthodox Jewish)
  • New migrants and asylum seekers
  • Looked-after children and young people
  • Children of young or lone parents
  • Children from large families
  • People who live in an area of high deprivation
  • Babies or children who are hospitalised or have a chronic illness, and their siblings
  • People not registered with a GP
  • People from non-English-speaking families
  • People who are homeless

Communities with low uptake other than those listed above may also be identified specifically in your local area.

  • In areas with low vaccine uptake, commissioners and providers should consider introducing targeted interventions to:
    • overcome identified local barriers to vaccination (see box 1)
    • address identified inequalities in vaccine uptake between different population groups (see box 2 and the UK Health Security Agency [UKHSA, previously Public Health England; PHE] immunisation equalities strategy).

      If introducing these interventions, develop them as part of a system-wide approach.
  • Commissioners and providers should ensure that they:
  • Tailor service opening hours and locations for vaccinations to meet local needs. This should include providing multiple opportunities for people eligible for vaccination to have their vaccinations at a time and location convenient to them. Locations such as community pharmacies, clinics people attend regularly, and GP practices could be used.
  • Provide a range of accessible options for booking appointments (such as telephone booking and online systems). Take into account that some people may need additional support to use these systems.
  • Consider using sites outside healthcare settings as settings for vaccination clinics, such as mobile vaccination units, children and family centres, or community or faith centres that provide a more family friendly environment, if this would address specific local barriers to vaccine uptake.
  • Consider providing vaccination services during extended hours and extended access appointments in evenings and weekends for people who may find it difficult to attend at other times. These services could be in primary care or community pharmacies, or be provided by a centralised service in each local area. If possible, provide these as part of existing out-of-hours services.
  • Commissioners and providers should coordinate vaccination services between providers to minimise wastage where vaccine supply is limited.
  • GP practices should ensure that contractual obligations and best practice on patient registration is followed (for example, not requiring immigration status or proof of address).

For recommendations on audit and feedback and training and education for health and social care practitioners, refer to the full guideline.

Appointments and consultations

  • Providers should ensure that there is sufficient time in an appointment or consultation to:
    • allow the healthcare professional and individual, family member or carer (as appropriate) to have a discussion where any concerns can be identified and addressed. This could include using written information or websites to help the discussion
    • gain informed consent
    • administer vaccines
    • complete documentation

For information on how to support people to make informed decisions, see the NICE guideline on shared decision making.

Identifying eligibility, giving vaccinations and recording vaccination status

These recommendations should be read together with the NICE guideline on flu vaccination: increasing uptake.

NICE has produced a visual summary on identifying people eligible for vaccination and opportunistic vaccination.

Using compatible systems and processes

  • Ensure that compatible systems or processes are in place to enable vaccination records to be shared and transferred effectively and in a timely way between different parts of the healthcare system, including other vaccination providers such as community pharmacies.

Keeping records up to date

  • GP practices should ensure that their vaccination records are updated within 2 weeks (or as specified in the GP contract if shorter) in response to new information about a person’s vaccination status.
  • GP practices should use an up-to-date clinical system template that includes relevant SNOMED CT codes to record vaccinations.
  • GP practices should validate their vaccination records at least monthly against data sources received. Check registered populations and vaccine eligibility and status, investigate any discrepancies and correct the record accordingly.
  • Child health information services (CHIS) should give GP practices a monthly update (or as specified in the CHIS contract if shorter) on children who are not up to date with their vaccinations.
  • GP practices should inform CHIS if 3 invitations for vaccination are made but a child remains unvaccinated (see recommendation 1.3.16 in the full guideline).
  • GP practices should ensure that they have up-to-date medical records, phone numbers, email addresses and addresses for people who are eligible for vaccination, or their family members or carers (as appropriate). Include the person’s preferred methods of contact (such as letters, texts, emails or phone calls) and whether there are additional literacy issues or language needs.

Identifying people eligible for vaccination and opportunistic vaccination

  • Use every opportunity to identify people eligible for vaccination. This could include:
    • at registration in general practice
    • during health and developmental reviews as part of the healthy child programme and health visitor and school nursing targeted contacts
    • during the annual learning disability health check for people with learning disabilities
    • when making contact with people in healthcare settings, community health clinics, sexual health services or drug and alcohol services (including hospitals, emergency departments, inpatient services, rehabilitation services and general practice)
    • when making contact with women who are trying to conceive or have a newly confirmed pregnancy, and at antenatal and postnatal reviews
    • when people visit community pharmacies for health advice, a medication review or an NHS new Medicine Service, or to collect prescriptions
    • during home visits for healthcare or social care
    • any health service contact with people who are homeless
    • when new migrants, including asylum seekers, arrive in the country
    • within 7 days of arrival in prisons and young offender institutions, during any contact with healthcare services in these places, and when people leave
    • as part of a looked-after child or young person’s health plan, and during initial health assessments, and annual and statutory reviews (see also the NICE guideline on looked-after children and young people)
    • any contact with home-educated children
    • during occupational health checks for everyone who works in a clinical or social care setting, even if their role is not healthcare related.
  • Offer people (or their family members or carers, as appropriate) access to online systems or apps to allow them to view and check their NHS vaccination records (or those of their child or the person they care for).
  • Providers of online systems or apps should ensure that people automatically have access to their vaccination status as part of their electronic records as the default option.
  • Use the NHS summary care record, or any other available vaccination records (including records held by the person), to opportunistically identify people who are eligible for vaccination.
  • Unless a person has a documented (or reliable verbal) vaccine history, assume that they are not immunised, and plan a full course of immunisations (see the UKHSA [previously PHE] guidance on vaccination of individuals with uncertain or incomplete immunisation status).
  • GP practices should ensure that there is a mechanism in place to check the vaccination status of people registered as temporary residents and offer any vaccinations needed.
  • Providers should routinely use prompts and reminders from electronic medical records to opportunistically identify people who are eligible and due or overdue for vaccination.
  • Add prompts to the records of parents or carers (as appropriate) if children are overdue vaccinations.
  • Midwives should offer vaccination to pregnant women during routine antenatal visits, as recommended by the Green book and the NHS routine UK immunisation schedule. If the midwife cannot administer the vaccine, they should signpost women to vaccination services, drop-in clinics or their GP practice.
  • When uncertainties exist around contraindications and allergies, consult the Green book and seek expert help if needed.
  • When people eligible for vaccination have been identified opportunistically:
    • Healthcare professionals should:
      • if possible, discuss any outstanding vaccinations with them (or their family members or carers, as appropriate) and offer vaccination immediately
      • otherwise, encourage them to book an appointment to dicuss the vaccinations or an appointment for vaccination
      • think about referring a child’s parents or carers to the health visitor or school nurse, as age appropriate.

Recording vaccination offers and administration

  • When offering a vaccination, record in the GP record or other medical record whether it was accepted or declined or there was no response (see the seventh recommendation in the section, Reminders and escalation of contact).
  • The person administering the vaccine should ensure that information is recorded accurately and consistently, regardless of where the vaccine is administered, and includes:
    • details of consent to the vaccination (including if someone else has consented on the person’s behalf, and that person’s relationship to them)
    • the dose, batch number, expiry date, vaccine name and vaccine product name
    • the date, route and site of administration
    • any reported adverse reactions
    • whether the vaccine was administered under Patient Specific Directions or Patient Group Directions. (See the NICE guideline on patient group directions.)
  • Providers should ensure that clinical and patient-held records (including records held on behalf of children) are updated at the time of the vaccination. If the patient-held record is not available at the appointment, give the person a printed record of the vaccination and ensure that the patient-held record is updated at a subsequent healthcare appointment.
  • Providers should use electronic health record templates with compulsory data fields to support accurate recording of vaccination offers and administration (see the seventh and eighth recommendations in the section, Identifying people eligible for vaccination and opportunistic vaccination).
  • Providers should ensure that vaccinations are reported promptly (within 5 working days, or in line with required standards if shorter) to GP practices and child health information services (CHIS) (if relevant).
  • Where commissioned locally, CHIS should send details of vaccinations administered outside of the GP practice to GP practices within 2 weeks or as specified in the CHIS contract if shorter.
  • Providers should ensure that the information they provide to GP practices and CHIS is clear and in a readily accessible format that minimises the need for manual re-entry of data.

Invitations, reminders and escalation of contact

These recommendations should be read together with the NICE guideline on flu vaccination: increasing uptake.

Vaccinations for babies, infants and preschool-aged children, and adults

Nice has produced the following visual summaries:

Initial invitations

  • Invite people who are eligible for vaccination or their family members or carers (as appropriate) to book an appointment or attend an open access clinic. Do this opportunistically during consultations if possible, or by letter, email, phone call or text. Use the person’s preferred method of communication for invitations if possible.
  • Practitioners working in maternity services and other healthcare practitioners who have contact with pregnant women should ensure that pregnant women are invited for vaccination or signposted to vaccination services or drop-in clinics.
  • Ensure that the following people (or their family members or carers, as appropriate) know how to get home visits for vaccination if they cannot attend vaccination clinics or other settings where vaccinations are available:
    • people who live in care homes or residential settings
    • people who are housebound
    • babies and children whose parents or carers are housebound.
  • Consider sending the vaccination invitation and any subsequent reminders from a healthcare professional or service that is known to the person or their family members or carers, such as a school, GP practice, doctor, nurse, midwife or health visitor.
  • Ensure that the vaccination invitation contains:
    • The vaccines being offered (named in full) and the targeted diseases.
    • A statement that the NHS and the relevant provider (with the type of provider specified) recommends the vaccination.
    • Details on contacting a healthcare professional (for example, practice nurse, GP, school nurse or pharmacist) to discuss any concerns the person (or their family members or carers) might have (including about possible contraindications or allergies that could affect whether the person can have a vaccination).
    • Instructions for how to book an appointment at a vaccination clinic, if relevant, or where and when drop-in clinics are held. If possible, include options for online booking.
    • A reminder to bring any relevant patient-held records for updating.
  • If space allows, include the following in the vaccination invitation or provide links:
    • Information on the vaccines, including:
      • the potential severity of the targeted diseases
      • the risks and benefits of vaccination, including individual benefits (including to the baby for maternal pertussis vaccination) and population benefits (protecting other people in their community)
      • if relevant, the importance of having all doses of a vaccination course
      • if relevant, why some vaccines are given at specific ages (for example, the HPV [human papillomavirus] vaccine).
    • Instructions for accessing additional videos and information (including interactive information and decision tools) from trusted sources such as the Oxford University’s Vaccine Knowledge Project, NHS England and the World Health Organization. Include hyperlinks or QR codes if possible.

Reminders and escalation of contact

  • Providers (such as GP practices) should identify people who do not respond to invitations or attend clinics, vaccination appointments or other settings where vaccinations are available and send a reminder. (See also the fourth recommendation in the section, Initial invitations.) Confirm that the person has received the reminder.
  • At a pregnant woman’s first appointment after the 20-week scan, antenatal care providers should check whether they have been offered and accepted vaccination against pertussis in this pregnancy. If not, ensure they receive offers of vaccination or reminders (as relevant) at subsequent antenatal appointments or during any contact with their GP, midwife, health visitor or any other healthcare provider.
  • Talk to parents or carers (as appropriate) of children aged 5 or under who have not responded to a reminder if a vaccination delay is approaching:
    • 2 weeks, for immunisations for babies up to age 1 year
    • 3 months, for immunisations for children aged 1 year and over.
  • Explore with them the reasons for their lack of response and try to address any issues they raise.
  • For pregnant women and older people who do not respond to reminders, consider more direct contact such as a phone call. Explore with them the reasons for their lack of response and try to address any issues they raise.
  • Consider a multidisciplinary approach to address any issues raised in the previous two recommendations, involving other relevant health and social care practitioners such as health visitors, social workers or key workers, while respecting the person’s decision if they refuse vaccination.
  • Consider home visits for people who have difficulty travelling to vaccination services. Discuss immunisation and offer them or their children (as relevant) vaccinations there and then (or arrange a convenient time in the future).
  • If someone declines an offer of vaccination, record this with the reason why, if given, and make sure they know how to get a vaccination at a later date if they change their mind.

For recommendations on people who are not registered with a GP practice and vaccinations for school-aged children and young people, refer to the full guideline.

 

© NICE 2022. Vaccine uptake in the general population.  Available from: www.nice.org.uk/guidance/ng218. All rights reserved. Subject to Notice of rights.

NICE guidance is prepared for the National Health Service in England. All NICE guidance is subject to regular review and may be updated or withdrawn. NICE accepts no responsibility for the use of its content in this product/publication. 

Published date: 17 May 2022.

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