Guidance

Immunisations: applying All Our Health

Published 3 January 2020

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This publication is available at https://www.gov.uk/government/publications/immunisations-applying-all-our-health/immunisations-applying-all-our-health

1. Introduction

This guide is part of ‘All Our Health’, a resource which helps health and care professionals prevent ill health and promote wellbeing as part of their everyday practice. The information below will help frontline health and care staff use their trusted relationships with patients, families and communities to promote the benefits of immunisation.

We also recommend important actions that managers and staff holding strategic roles can take. View the full range of ‘All Our Health’ topics.

2. Promoting immunisation in your professional practice

Along with clean water, immunisation has had a very significant impact on public health globally. Smallpox was declared eradicated by the World Health Organization (WHO) in 1980 and the UK currently has WHO elimination status for both rubella and polio. As a result of successful immunisation programmes, the UK has seen significant reductions in serious and potentially life-threatening infections such as pertussis, diphtheria, measles and meningitis and septicaemia caused by meningococcal, pneumococcal and Hib bacteria.

High immunisation uptake is desirable to protect as many of the eligible population as possible. For certain diseases like measles, uptake of 95% or higher is needed for herd, or population level immunity. Where herd immunity exists, those who cannot be vaccinated (for example children under one year of age are not routinely vaccinated against measles), are protected by those around them.

Immunisation is offered throughout the life-course to provide timely protection against vaccine-preventable infections. For example, pertussis (whooping cough) and influenza vaccines are offered to pregnant women to protect them and their baby from birth.

The routine childhood immunisation programme is designed to provide early protection against vaccine-preventable infections from 8 weeks of age, with boosters offered at 12 months and before starting primary school. Further vaccines are offered in adolescence such as HPV and MenACWY.

Some infant immunisations are not offered routinely, but are instead targeted at those at increased risk of infection, for example neonatal BCG and neonatal hepatitis B.

Throughout adulthood vaccines may be offered for those at increased risk of infection, such as pneumococcal vaccines for asplenics and influenza vaccines for those with chronic heart, lung, liver and kidney diseases. In older age groups, vaccines are offered against influenza, pneumococcal disease and shingles.

For a variety of reasons, some individuals may not be fully vaccinated, and since 2013 there has been a decline in the uptake of childhood vaccines in England. Ideally immunisations should be given at the appropriate stages in an individual’s life, however some may have missed vaccines and no opportunity to assess their immunisation status and offer missing doses should be missed.

3. Core principles for health and care professionals

This ‘All Our Health’ immunisation information has been created to help all health and care professionals:

  • understand specific activities and interventions that can prevent sub-optimal vaccine uptake and associated risk of vaccine-preventable diseases
  • think about the resources and services available in your area that can help people access credible sources of immunisation information, where and how to access immunisation
  • think about the resources available to immunisers to support their practice and where they can seek clinical advice when necessary

4. Taking action

If you’re a frontline health and care professional:

  • think about changes that might improve access to vaccines, such as clinic times that are suitable for those with young families
  • where possible, flag patients’ records if vaccines are outstanding to help facilitate opportunistic immunisation
  • use other contacts with patients as a means to check their vaccination status and offer outstanding doses or signpost to immunisation services, for example health visitor led child health reviews, walk-in centres and accident and emergency departments
  • school nursing teams, working with GP practices and schools, should check the vaccination status of children and young people when they transfer to a new school or college
  • provide parents, young people and patients with tailored information, advice and support to ensure they know about the recommended routine vaccinations and the benefits and risks of immunisation
  • check the immunisation history of new migrants, including asylum seekers, when they arrive in the country
  • prison health services should check the immunisation history of young offenders and outstanding doses should be offered
  • looked after children may not be fully vaccinated and checks of their vaccination status with opportunistic catch up can help bring them up to date
  • provide information in different formats, for example translated leaflets, for those whose first language is not English
  • signpost parents and patients to reliable sources of information about vaccination, for example NHS and PHE websites and leaflets
  • ensure young people fully understand what is involved in immunisation so that those who are aged under 16, but considered sufficiently capable, can give their consent to vaccination, as per chapter 2 of the Green Book

If you’re a team leader or manager:

  • have an identified healthcare professional in every general practice who is responsible for immunisation programmes and who provides clinical leadership to support immunisation programmes
  • check call and re-call systems are working so that parents and patients are aware of vaccination appointments
  • consider use of text messages to remind patients and parents when immunisation appointments are due
  • confirm all non-prescribing staff involved in immunisations have access to the Green Book and suitably authorised Patient Group Directions (PGDs) or Patient Specific Directions (PSDs)
  • ensure updates to immunisation programmes and any changes to the commissioning arrangements are monitored and services adapted appropriately
  • check enough immunisation appointments are available so that all children and adults can receive the recommended vaccinations on time. Waiting lists for vaccination are not acceptable
  • make sure there are arrangements in place to immunise housebound patients, for example seasonal influenza vaccines for those not able to attend a general practice or community pharmacy in person
  • where vaccines are administered outside of a general practice (for example at an antenatal clinic, school or community pharmacy), make sure systems are in place to inform the GP
  • within general practices, ensure information on vaccines given elsewhere are recorded and appropriately coded on the clinical IT system
  • make sure immunisers are up to date with immunisation training and know where to obtain additional advice if needed
  • ensure guidance and updates on immunisations are disseminated to relevant professionals and implemented
  • make use of existing immunisation communication resources from reputable sources, for example PHE/NHS leaflets, which can be ordered free of charge

If you’re a senior or strategic leader:

  • consider how best to target underserved groups with immunisation services. For example, community teams that offer domiciliary vaccination and vaccination for gypsies, travellers and asylum seekers
  • ensure immunisers access basic immunisation courses (in line with minimum training standards published by PHE) and updates, appropriate to their immunisation service provision
  • check there is a systematic method for recording, maintaining and transferring accurate vaccination information. Vaccination information should be recorded in patient records, the personal child health record (the “Red Book”) and the child health information system (CHIS)
  • ensure records are transferred when a patient moves out of the area, ensuring information is not duplicated and follow up on any missing data
  • make sure accurate and up-to-date data on vaccination coverage is available and disseminated to all those responsible for delivering immunisation programmes
  • use local immunisation uptake data to drive improvements in vaccination coverage
  • ensure there is collaboration between head teachers, school governors, managers of children’s services and immunisation teams to facilitate schools becoming or remaining places where vaccination takes place

5. Understanding local needs

Useful sources of vaccine uptake data include COVER (Coverage of Vaccine Evaluated Rapidly) and ImmForm. Public health profiles are also available from PHE.

6. Measuring impact

As a health and care professional there are a range of reasons why it makes sense to measure your impact and demonstrate the value of your contribution. This could be about sharing what has worked well in order to benefit your colleagues and local people, or help you with your professional development.

Provider organisations can use their own in-house data to assess their uptake of immunisations. Data from the sources listed above can also be used to assess vaccine uptake on a larger footprint, for example at regional and local authority levels.

7. Further reading, resources and good practice

7.1 Advice for patients and the public

Resources for parents and patients:

7.2 Professional resources and tools

Resources for immunisers include:

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