Guidance

Increasing flu immunisation uptake in preschool children: best practice for GPs

Updated 12 September 2023

All children aged 2 and 3 years old on the 31 August of the current flu season are offered flu vaccination via their GP surgery.

GP surgeries continue to offer flu vaccination to children in at risk groups aged between 6 months and less than 18 years of age, although at risk children of school age will usually be vaccinated at school.

Rationale for the programme

The programme will help to protect children against flu which can, although rarely, cause serious complications. By having the flu vaccination children are less likely to pass the virus on to friends and family, and the wider community. Evidence and best practice examples demonstrate that certain key strategies can improve vaccine uptake. This guidance provides a summary of those strategies that will help to increase flu vaccine uptake among children aged 2 and 3 years old.

Pre-season preparation

All eligible patients should be vaccinated before flu starts circulating (which is usually December). Following vaccination immune responses take about 2 weeks to fully develop. Advanced preparation is vital for a successful programme to achieve high vaccine uptake. Clinical judgement should be used to assess whether to vaccinate beyond December particularly if it is a late flu season

Staff responsibilities

All staff should understand the reason for the programme, have up to date training and access to UKHSA resources.

Every practice should have a lead member of staff with responsibility for running the flu immunisation campaign and all staff should know who the lead person is. Make sure every member of the practice is familiar with their role and responsibilities.

Registered staff delivering the flu programme under a Patient Group Direction (PGD) should have read and understood the content; and signed the document prior to administering flu vaccination. Staff who are delivering flu vaccination under a Patient Specific Direction (PSD) should have completed the necessary training and have been assessed as competent to undertake vaccine administration.

Get all staff involved in promoting the vaccine message to parents.

Hold regular meetings so that all staff know the practice plan and progress.

Include health visitors, midwives, pharmacists and other healthcare professionals linked to your practice in your planning.

Practice goals

Setting practice goals can be a really positive way to encourage uptake of the vaccine over the flu season, with each season being an opportunity to set a higher goal and improve. Some ways to set and meet these goals include:

• creating computer searches to measure uptake and assess progress towards the goal
• calculating practice income depending on uptake – each extra 1% of uptake = £xxx income
• advertising the practice goal and have a ‘Blue Peter’ style ‘totaliser’ or goal chart

Identifying eligible children

The lead member of staff for flu vaccination should be responsible for identifying all eligible children and checking the accuracy of searches and coding to ensure all eligible children are identified. Check that all flu vaccination codes are up to date and work across all practice systems.

Make sure staff are all aware of the vaccination offer and eligibility criteria. Create a system for opportunistic identification of eligible children attending the practice for other clinics or with parents and siblings – using flags or sticky notes to alert staff.

IT system reminders can be very helpful for opportunistic immunisation reminders.

Don’t send an eligible child away unimmunised.

Inviting and contacting parents

Be tenacious when contacting parents and guardians, continuing to offer the immunisation opportunity until the child has received their flu vaccination or an active refusal is received. Staff contacting patients should have a script to follow and be able to answer common questions about the flu vaccination programme.

Send a personalised invitation to eligible children before the end of October – use the parent’s and child’s names, sign your name at the bottom. Template invitation letters are available to download.

Other contact strategies include:

• using phone calls where possible– personal contact can be more effective than letters

• using text messages for reminders

• planning phone calls for after 4pm when more working parents might be available

• sending additional letters if telephone contact is not possible

Promoting the vaccination offer to parents

Promoting the offer of a flu vaccination will look different for every practice. Some ideas that may work for your locale are:

• ensure every parent has a personalised invitation for their child

• display UKHSA child flu immunisation posters and leaflets in the reception and waiting rooms (these can be ordered for free)

• engage with local pre-school nurseries, children’s centres, libraries, toddler groups in your area – ask staff to put up posters and issue leaflets to parents of 2 and 3 year olds and highlight the benefits of their children being immunised to these preschool groups and nurseries

• place prominent information about the child flu immunisation programme on the practice website

• engage with the local primary school – ask if they can give leaflets to parents with pre-school age children and/or display posters on school and parent notice boards

Clinics and appointments

Plan to have completed all routine immunisation activity before Christmas. Then use time after Christmas to mop-up unimmunised children, particularly children in at risk groups as where clinically indicated vaccination can be given up to the end of March.

Other practical arrangements for appointments include:

• deciding whether you will give timed appointments, run an open access clinic or invite parents to make appointments

• allowing online or text message booking for appointments where possible

• offering family friendly clinic and/or appointment times such as after school 3.30pm to 6.30pm, Saturday mornings, or October half term

• having a presence at health fairs or parties

• incorporating flu vaccination with other vaccine appointments, health checks and health visitor advice appointments

• creating a child friendly environment, including room for pushchairs

• considering other clinic locations and busy waiting rooms, where necessary

Ordering vaccines

All centrally procured flu vaccines for children will be available to order online.

The live attenuated influenza vaccine (LAIV) should be offered unless it is medically contraindicated or otherwise unsuitable (including objection to LAIV on the grounds of its porcine gelatine content). In such cases, an alternative injectable vaccine should be offered.

Order small and frequent quantities of flu vaccines, throughout the flu vaccination period.

Remember that you can order weekly and receive weekly deliveries.

Hold no more than 2 to 3 weeks stock in your practice fridge to reduce the risk of stock loss through cold chain failures or expiry before use.

Remember that stock ordered later will have a later expiry date.

Ordering will be subject to controls and the most up to date information on these will be available on ImmForm news throughout the ordering period.

During the flu season

Increasing resources in-season is difficult so comprehensive preparation and planning is critical.

There are things you can do to help sustain efforts and uptake, such as:

• review your uptake against your goals and financial plan; celebrate and promote success as the programme progresses

• remain tenacious – re-run searches for eligible children

• continue to offer vaccination, even once you have achieved your practice and campaign goals

• keep staff engaged and enthused – consider incentives, promoting staff competition

• ensure all practice staff have their flu jab – it is powerful to be able to say to patients “I’ve had mine”; another way staff can signal this is by wearing stickers available to order for free

Post season actions

Review your campaign, measure and celebrate success – thank everyone involved.

Share the review of your campaign with your stakeholders, patient focus group and partners who helped you achieve your goals.

Capture lessons learnt and adapt next year’s plan – aim for higher uptake next year.

References and resources

NICE Guidelines on increasing flu vaccine uptake.

Training slides and resources from the UK Health Security Agency (UKHSA).

Vaccine update is a regular newsletter describing the latest developments in vaccines, and vaccination policies and procedures.