Guidance aims to boost uptake of seasonal flu vaccination

Guidelines from NICE and Public Health England aim to drive up uptake of the seasonal flu vaccine. Here’s a quick summary of the guidance, plus an aide memoire for who gets which vaccine

NICE and Public Health England have both issued guidance aimed at increasing uptake of the seasonal flu vaccination.^1,2

PHE has published a guide to boosting vaccination rates in children, with suggestions for setting practice goals, ensuring all eligible children are identified and invited, and how to maximise the impact of invitations. The key message is that general practice nurses should not ‘send a child away unimmunised’.²

NICE’s latest guideline is directed at educators, managers and organisational leads, and calls for a ‘multicomponent approach’ to develop and deliver programmes to increase flu vaccination uptake. NICE says providers of flu vaccination should work together with other agencies, including commissioners, and that a ‘vaccination champion’ should be assigned to manage programmes and work across organisations.¹

NICE RECOMMENDATIONS¹

Increasing awareness

Providers of flu vaccination should work to increase awareness of free flu vaccination among eligible people, at the earliest opportunity from the start of the vaccination season in September. Offer face-to-face advice or a brief intervention on the importance of vaccination. This should include:

• How people get flu
• How serious flu and its complications can be – it is not just a bad cold
• Flu can affect anyone but for people with a long term condition, flu can make it worse
• Flu vaccination is safe, and it can’t give you flu
• It’s the best way of helping to protect against catching or spreading flu
• People should have the vaccination as soon as it becomes available to maximise protection throughout the flu season
• People need to have a flu vaccination every year.

INVITATIONS AND REMINDERS

When inviting people for flu vaccination, it helps if the invitation comes from a healthcare professional that they know, such as you, the practice nurse, or their GP.

• Tailor the invitation to the person’s situation – e.g. to their pregnancy or individual clinical risk factor
• Include information about the risks of not being vaccinated
• Include educational messages to help overcome barriers to accepting the offer of a vaccination
• Use reminders including text messages, letter and email, phone calls, social media or a combination of methods to contact eligible people whose immunisations are due (call) or overdue (recall)

OFFERING VACCINATION

NICE says providers should use every opportunity throughout the flu vaccination season to identify people in eligible groups and offer them the vaccination, e.g. when:

• People register with the practice
• Women have a newly confirmed pregnancy
• People are newly diagnosed with a condition that may place them in a clinical risk group, or have a BMI of 40 or over
• People, including children aged 6 months to 17 years, who are in a clinical risk group attend routine appointments or for other vaccinations

Carers

When considering increasing uptake in carers who are not otherwise eligible for vaccination, use clinical judgement. Base decisions to offer vaccination on whether the carer looks after someone whose wellbeing may be at risk, or who may need hospital or other formal care, if their carer had flu.

Front-line healthcare staff

Employers are urged to consider a ‘full participation’ vaccine strategy in which the expectation is that all front-line staff should be vaccinated. Consider flu vaccination to:

• Protect the people you care for
• Protect yourself and your family
• Protect your co-workers
• Meet professional expectations, such as the RCN’s duty of care statement and the NMC Code.^3,4

PHE: BOOSTING UPTAKE IN CHILDREN²

Practice goals

• Set a higher goal than the previous season
• Create computer searches to measure uptake and assess progress towards the goal
• Calculate practice income depending on uptake – each extra 1% of uptake = £xxx income
• Advertise the practice goal and have a ‘Blue Peter’ style ‘Totaliser’.

PRACTICE LEAD

Every practice should have a lead member of staff with responsibility for running the flu immunisation campaign

• The lead member of staff should identify all eligible children
• Check accuracy of searches and coding to ensure all eligible children are identified
• Make sure that the correct flu vaccination codes are in your system and that staff are aware of them – do not let hard work go unmeasured
• Create IT system reminders to prompt opportunistic immunisation
• Create a system for opportunistic identification of eligible children attending the practice for other clinics or with parents and siblings, Use flags or sticky notes to alert staff. Don’t send a child away unimmunised.

PERSONALISED INVITATIONS

• Send a personalised invitation to eligible children – use the parent’s and child’s names, sign your name at the bottom.
• Phone calls can be more effective than letters: try text messages for reminders.
• Ensure that staff phoning patients have a script but can also answer questions and address concerns.
• Plan phone calls after 4pm when more working parents might be available.
• Send letters if telephone contact is not possible.
• Set a date – invite every eligible child before the end of October.
• Be tenacious – make multiple contacts until child is immunised or an active refusal is received

GENERAL ADVICE

• Plan to have completed all routine immunisation activity by Christmas.
• Use time after Christmas to mop-up unimmunised children, particularly children in at risk groups. If clinically indicated vaccination can be given up to the end of March.
• Continue to offer vaccination, even after you have achieved your practice and campaign goals
• Decide whether you will give timed appointments, run an open access clinic or invite parents to make appointments.
• Allow online booking for appointments.
• Consider family-friendly clinic/appointment times such as after school 3.30pm – 6.30pm, Saturday mornings, or October half term – consider health fairs or parties – incorporating flu vaccination with other vaccines, health checks, health visitor advice.
• Create a child-friendly environment, including room for pushchairs.
• Consider other clinics and busy waiting rooms.
• Ensure all practice staff have had their flu jab – it is powerful to be able to say ‘I’ve had mine’!

REFERENCES

1. NICE NG103. Flu vaccination: increasing uptake, August 2018. https://www.nice.org.uk/guidance/ng103

2. Public Health England. Increasing influenza immunisation uptake among children, 2018 https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/735376/Flu_GP_best_practice_guidance_2018_A4.pdf

3. RCN. Duty of care. https://www.rcn.org.uk/get-help/rcn-advice/duty-of-care

4. NMC. The Code: Professional standards of practice and behaviour for nurses and midwives, 2015. https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf