Guidance

Appendix 2: Examples of local practice

Published 10 June 2026

This appendix presents examples of local practice shared by colleagues through a case study collation exercise undertaken to support the development of this toolkit. The information included has been provided directly by local teams. These case studies illustrate a range of potential approaches to embedding different aspects of the immunisation equity action cycle, reflecting variation in local context. They have not been formally critically appraised by the UKHSA and are not intended to represent a comprehensive list. Additional relevant examples are likely to exist but are not captured here.

Examples of local practice under the preparation phase

Childhood immunisation steering group in Slough

Background

Slough has lower childhood vaccination uptake than regional and national averages, with particularly low coverage in certain wards, schools and general practices (GPs). Drivers include geographical and population inequities, access challenges for busy and/or mobile families, low vaccine confidence driven by misinformation, language, cultural factors and trust concerns affecting some parents. Local stakeholders identified a need to strengthen partnership working and data sharing between the council, NHS, schools and community organisations, as well as support professionals to deliver confident vaccine messages.

What local actors did

To address these needs, a multi-agency Childhood Immunisation Steering Group was established, chaired by the local authority children and young people’s public health lead. Partners include local authority public health, NHS providers, NHS England, the integrated care board (ICB), the Child Health Information Service (CHIS), school-aged immunisation teams, primary care, education and voluntary sector organisations. The group meets every 6 weeks to review preschool and school-aged immunisation data through a CHIS Power BI data dashboard, to identify low-uptake wards, schools and GPs, and agree targeted actions. Key actions have included working with the school-aged immunisation team on school engagement and a flu vaccination pilot, promoting NHS England and CHIS vaccine confidence training for professionals and supporting targeted communications. The steering group partners also work with schools, early years settings, voluntary and faith groups to promote immunisation and explore behavioural approaches to engage underserved groups.

What was achieved

Key outcomes include improved partnership working, data sharing and targeted action. Six-weekly meetings enabled regular review of data to identify low-uptake wards, schools and GPs and monitor uptake, engagement activity, training delivery and progress against agreed actions.

Key learning

This approach brings together a variety of stakeholders, including local authority, NHS, education and community partners, into a single, accountable forum to drive coordinated action.

Enablers:

• strong multi-agency leadership and commitment and shared accountability for actions, embedding immunisation improvement as a shared system priority
• access to timely CHIS Power BI data and established community networks, enabling targeted, data-driven interventions to tackle low-uptake areas

Challenges:

• variation in engagement and performance across GPs, requiring strengthened relationships and improved cooperation
• low vaccine confidence, misinformation and access barriers among diverse populations

Next steps

The steering group is ongoing. Next steps include strengthening engagement with GPs showing low coverage, linking in neighbourhood project work, expanding targeted work with schools and early years settings and building on successful initiatives such as the flu pilot. The group will continue to promote vaccine confidence training, improve data use through CHIS dashboards and deepen partnerships with community and faith organisations. Learning from this work will be used to scale targeted approaches across additional wards and settings to sustain improvements in uptake.

Step 1: strengthening local system leadership and accountability through Maximising Immunisation Uptake Groups (MIUGs) in South West England

Background

In 2022, the NHS England Southwest Vaccination and Screening Team (VST) undertook a regional exercise across the South West to identify priority immunisation programmes with low uptake and marked inequalities. As a result, a need was identified to link with multiple local stakeholders to maximise vaccination uptake across the region.

What local actors did

The NHS England VST spearheaded the formation of Maximising Immunisation Uptake Groups (MIUGs) to bring together local stakeholders to develop coordinated plans to tackle disparities in immunisation coverage aimed at improving vaccine uptake and reducing inequalities.

MIUGs had 4 aims:

1. Create a community of practice and foster learning.
2. Use local intelligence to address inequalities across all immunisation programmes.
3. Work with underserved communities to remove barriers to access to immunisation services.
4. Use relationships and insight into the needs of the local population to deliver acceptable immunisations.

Each MIUG developed its own evidence-based action plan. Based on local knowledge, the MIUG set its core priorities, with clear roles, responsibilities, and reporting mechanisms for each of the partners.

What was achieved

MIUGs have proven successful at improving coordination and reducing overlap at regional and local levels. Stronger system leadership not only improved opportunities for input from community groups but led to greater understanding of how to improve uptake and reduce barriers. By putting a focus on shared leadership, accountability, and evaluation, and with the support of the regional team, they have been able to reach deeper into communities to understand and address complex inequalities in access and uptake.

Key learning

The MIUG structure promoted accountability and coordination, avoiding duplication of efforts while ensuring alignment towards shared outcomes. The Southwest VST provided coordination and support, connecting MIUGs with broader regional inequalities work and facilitating the sharing of lessons and good practices across the wider health system.

Next steps

The MIUGs continue to play an active role in coordinating and progressing local work on immunisation inequalities, including focused work on COVID-19 immunisation and measles mumps and rubella (MMR) catch-up.

Examples of the situational analysis phase

Lewisham Joint Strategic Needs Assessment (JSNA) topic assessment – inequalities in MMR and pre-natal pertussis vaccination uptake

Background

In 2023 to 2024, the Lewisham Council Public Health Team conducted a JSNA topic assessment focused on inequalities in vaccination uptake, specifically childhood MMR and prenatal pertussis. This work aligned with wider system activity across the council, the NHS and local partners responding to rising measles and pertussis cases in London. The topic was selected due to increased system interest and because the previous assessment on immunisations was last completed in 2018. Given Lewisham’s diverse population and strong health equity ethos, including work such as the Birmingham and Lewisham African and Caribbean Health Inequalities Review, the inequalities lens to the assessment emerged naturally.

What local actors did

The JSNA topic assessment was completed without a dedicated steering group due to time and resource constraints, but key stakeholders from the council and ICB were engaged throughout. The local Maternity and Neonatal Voices Partnership supported insight gathering by disseminating surveys. Data sources included publicly available Cover of Vaccination Evaluated Rapidly (COVER) data, local insights from pregnant residents and parent groups, engagement with GPs and limited extracts from GP systems on ethnicity and language.

What was achieved

The assessment produced a detailed understanding of childhood MMR and prenatal pertussis uptake patterns in Lewisham, incorporating both quantitative trends and rich insight from residents and frontline professionals. It also strengthened cross-system alignment by synthesising local improvement work with JSNA findings, supporting more informed decision-making ahead of Health and Wellbeing Board approval in 2024 and publication in 2025.

Key learning

A number of important lessons emerged from the process. Wider system interest acted as a key enabler, opening doors for data access and increasing stakeholder engagement and enthusiasm. Conducting the JSNA alongside real-time NHS insight work allowed for greater completeness and contextual understanding. Where granular local data was unavailable, triangulating national datasets with qualitative insight proved effective. The key challenge for this work was access to data at the level of granularity required for inequalities analysis. The limited and ad hoc data extraction from GP systems did not allow for detailed demographic analysis of local population needs.

Next steps

The JSNA has fed into commissioning, planning and strategic oversight since publication. This includes informing how local commissioning can best target key resident groups, understanding what data is required for quality improvement, and ensuring that the new local immunisation and vaccination strategy is clear on the barriers, enablers and needs of the local population.

Living with COVID-19 conversations in Dudley

Background

During the coronavirus (COVID-19) pandemic, Dudley Council identified low engagement with public health messaging and services among several marginalised ethnic minority communities. Reduced trust in statutory organisations, barriers to accessing information and variable uptake of protective behaviours, including vaccination, were key issues.

What local actors did

A qualitative community engagement programme (“Living with COVID-19” conversations) ran between October 2021 and January 2022 to understand community perspectives and how to improve communication and support. Trained community champions, including faith leaders and respected community representatives, facilitated discussions. The programme was delivered in partnership with the local authority, voluntary, community, and social enterprise (VCSE) organisations, and leaders from Black African, Black Caribbean, Pakistani, Roma and Arab communities. Resources included analytical staff time, champion training, translation and interpretation and partnership with community organisations for recruitment and hosting.

What was achieved

A total of 157 residents participated, identifying barriers including mistrust, confusing messaging, language needs and reliance on community channels. Findings directly informed local immunisation outreach, communication strategies and partnership working. Success measures included participation numbers, diversity of communities reached, actionable recommendations and integration of insights into local public health planning and engagement.

Key learning

Using trusted community champions to facilitate open conversations enabled participation from residents who are often under-represented due to language, literacy, digital exclusion and mistrust. The intervention generated rich qualitative insight into lived experience, information pathways and trust dynamics, which quantitative data alone could not provide. Findings informed service changes, strengthening culturally appropriate communication and partnership working. The initiative increased trust, responsiveness to community concerns and equity in public health delivery.

Enablers:

• trusted community champions and faith/community leaders
• strong partnership between local authority and VCSE organisations
• flexible engagement with face-to-face conversations and language support

Challenges:

• initial mistrust of statutory organisations
• language barriers and digital exclusion
• rapidly changing national guidance during the pandemic

Engagement is most effective when delivered through trusted community networks rather than statutory channels.

Next steps

The approach will be embedded into routine public health engagement beyond COVID-19. Community champion networks will support wider health priorities such as vaccination, screening and prevention initiatives. Insights will inform culturally tailored communication materials and co-production of interventions with communities. The model is scalable and can be applied to other inclusion health groups and future public health incidents.

Examples of the planning and co-design phase

Developing and implementing the City and Hackney Immunisation Strategic Action Plan

Background

City and Hackney are dynamic and diverse inner London areas with a rich cultural, socioeconomic and ethnic mix. Immunisation coverage across these areas is suboptimal, with some communities experiencing vaccine-preventable disease (VPD) outbreaks. Local inequities in immunisation uptake are driven by multiple factors, such as cultural and language barriers, misinformation, low vaccine confidence, institutional mistrust and accessibility challenges. A comprehensive and targeted approach was taken to address the unique needs of City and Hackney residents.

What local actors did

In 2023, a multi-pronged and collaborative effort was taken to develop an Immunisation Strategic Action Plan, co-led by the City and Hackney Public Health Team and the North East London Health and Care Partnership (1). Development of the plan involved a vaccination data review to explore coverage in City and Hackney, a literature review of interventions shown to increase vaccination uptake to inform evidence-based actions and visits to GPs to gather qualitative insights and local intelligence on drivers of vaccination uptake. The plan was also aligned with national, regional and local policy priorities, and shaped through stakeholder engagement. Input was received from partners across the North East London Integrated Care System through to the voluntary and community sector. The plan was endorsed by several partners, including UKHSA, and socialised across governance structures and related fora, with overall accountability for delivery held by the City and Hackney Health and Care Board.

What was achieved

The plan aims to safeguard communities from VPDs through community-, data- and system-led insights. Over 50% of the plan’s objectives were delivered in year 1 (2024). Key achievements included reviewing outreach and service delivery approaches, operationalising a health protection communications calendar, delivering an early years podcast, peer-support training for health champions, contributions to the North East London ‘Bright Start to Life’ campaigns, development of a making every contact count (MECC) training programme, embedding immunisations within the Healthy Schools Award, a best-practice toolkit for GPs and completion of 94% practice support visits. There have been improvements in school-based uptake and the rate of decline in childhood vaccination uptake has slowed, suggesting some stabilisation.

Key learning

The plan was informed by the evidence of what works and local intelligence to enable actions to be targeted towards areas of greatest need. Collaboration and buy-in were key for both the development and implementation of the plan, with several actions having been delivered by system partners. Delivery of the plan has been supported by a strong system infrastructure including primary and secondary care networks, the Enhanced Immunisation Service commissioned to improve uptake in North East Hackney (where uptake is particularly low), voluntary and community sector organisations, children and family services, community and wider-sector partners, and local fora. This coordinated partnership approach recognises that improving and addressing inequalities in uptake require a multi-layered response and tailored approaches across diverse communities, rather than a one-size-fits-all model.

Enablers:

• human resourcing and coordination: dedicated capacity to coordinate the plan, oversee implementation and maintain system oversight across partners and workstreams
• proactive funding: investment to mitigate the risks associated with coverage below herd immunity. This includes investment to sustain immunisation infrastructure that can be rapidly mobilised during incidents and outbreaks, while supporting routine uptake and targeted work
• system buy-in and partnership working: strong collaboration across system partners to overcome barriers, share intelligence, coordinate planning and delivery and align resources to improve vaccination uptake

Challenges:

• data limitations: despite a comprehensive data review, gaps in data granularity limited tailored insights for specific groups and communities (proxy indicators were possible)
• changing immunisation landscape: the plan needed to allow flexibility due to the uncertainty in the evolving commissioning and delivery landscape
• workforce continuity: development and delivery of the plan has required maintaining capacity and continuity of personnel despite staff changes and changes to the workforce

Next steps

Delivery of the plan is ongoing. The next phase will focus on continuing delivery and further socialising existing outputs and assets (for example, the podcast and MECC training), to ensure they are embedded into business-as-usual practice rather than remaining as standalone initiatives. Work will also focus on expanding reach to additional communities based on emerging intelligence and identified risks.

Strengthening vaccine conversations through training and collaboration in Bromley

Background

Childhood vaccination uptake has been declining in Bromley, reflecting national and global trends, driven by persistent vaccine misinformation and reduced public confidence. Frontline professionals reported limited confidence in discussing immunisations with families, highlighting the need for improved skills, consistent messaging and stronger cross‑sector collaboration.

What local actors did

The Bromley local authority Public Health Team led a training initiative to strengthen frontline staff skills in vaccine communication, using the empathetic refutational interview (ERI) technique, developed as part of the JITSUVAX  project (2). Interactive workshops with role‑play helped staff build confidence and apply the method in real conversations. The initiative was first delivered to healthcare professionals such as health visitors and schools nurses. It was then expanded to non-healthcare workers including with the Early Intervention and Family Support (EIFS) team, whose close daily contact with families places them in a unique position to influence health behaviours. The training aimed to turn routine interactions into opportunities for building vaccine confidence. It required trained facilitators, protected staff time and supporting materials such as communication guides and signposting resources.

What was achieved

Feedback showed significant increases in staff knowledge of how vaccines work and where to find reliable information. Participants reported a clearer understanding of the causes of low vaccine confidence and of how to use the ERI technique to support effective conversations. Many felt more confident discussing immunisations and intended to apply the method in their roles. While participants initially felt unsure about giving advice as non‑healthcare professionals, overall feedback was positive and described the training as empowering and highly valuable.

Key learning

This approach uses behavioural science to address real‑world communication challenges and enables a wider group of professionals to support vaccine confidence. The ERI method helps staff to explore concerns empathetically, address misconceptions sensitively and signpost families to trusted information. The initiative strengthened partnership working between public health and EIFS, demonstrating how cross‑sector collaboration can enhance public health impact and extend the reach of consistent, supportive messaging by MECC.

Enablers:

• strong partnership between public health and EIFS teams
• use of an evidence‑based and structured communication techniques (JITSUVAX/ERI)
• staff willingness to engage in interactive learning

Challenges:

• some staff initially hesitant about giving advice as non‑healthcare professionals
• resource required, including staff time and facilitator expertise
• broader context of persistent public misinformation, undermining confidence

Training non‑clinical staff can significantly widen the impact of vaccine confidence initiatives and the practical nature of the ERI method supports delivery across settings.

Next steps

Additional sessions, refreshers and ongoing support are planned. Further resources will be developed to help staff apply the ERI technique confidently, and the initiative will align with MECC principles to sustain improvements in vaccine conversations and uptake.

Improving human papillomavirus (HPV) vaccination uptake in the South East of England

Background

HPV vaccination coverage has declined since 2020, remaining below the 90% national ambition, with particularly low uptake among boys. Local stakeholders highlighted gaps in accessible resources for both health professionals and the catch-up cohort of young people entering higher education, who missed school immunisations during the COVID-19 pandemic. Under the Surrey and Sussex HPV immunisation improvement plan, 2 complementary pieces of work were developed to strengthen communication, awareness and equity in access across the region.

What local actors did

Developed regional HPV resources toolkit

A multi‑organisational working group was established, chaired by the Screening and Immunisation Team. Local stakeholders involved in HPV immunisation, including local authority colleagues across the region, the local ICB and school-aged immunisation teams, were invited to contribute and share resources they used in practice. Additional resources were identified online. All identified resources were compiled into a toolkit, published on the Surrey and Sussex Cancer Alliance website and circulated to relevant stakeholders (3). The aim was to provide a single, accessible repository for staff supporting HPV vaccination uptake across the region.

Designed a targeted communications campaign for the catch‑up cohort

Funding from the local Cancer Alliance supported development of targeted communications for the catch‑up cohort (4). Focus groups with university students from across Surrey and Sussex shaped the design and messaging, with additional input from system‑wide communications teams. A graphic design company produced posters and flyers encouraging students to register with a GP and check their HPV, MMR and MenACWY immunisation status. Posters were displayed across campuses and flyers handed out during Fresher’s Weeks. A social media video demonstrating a GP catch‑up appointment was created and promoted through paid TikTok and Snapchat campaigns targeting 14 to 24 year‑olds, including the wider non-student population, across Surrey and Sussex.

What was achieved

Toolkit

The toolkit was shared widely across the South East and received positive feedback. It improved access to high-quality resources for professionals working in immunisation and increased awareness of existing materials for groups with lower HPV uptake, such as boys, people with learning disabilities and ethnic minority communities. The mapping exercise also helped identify gaps in local resources, leading to the development of the targeted communications campaign described above.

Communications campaign

Around 400 posters and 10,000 flyers were shared and received positive feedback. The Snapchat video was viewed over 2.8 million times, with a 0.27% overall click‑through rate, 1.93% among 18 to 24 year‑olds living in Surrey and Sussex. A TikTok campaign is ongoing. GP HPV immunisation activity increased by 117% in university GP surgeries in the local area in September to December 2025 compared to the same period in 2024. A comparison non-university GP surgery within the social media video area had increased activity of 633%. A comparison university GP surgery outside the local area had a 42% decrease.

Key learning

Both pieces of work strengthened local collaboration, utilised co-production and addressed unmet resource and communication needs. Particularly for the communications piece, co‑producing materials with students ensured relevance and impact, and involvement from multiple universities strengthened reach. Using platforms such as Snapchat and TikTok expanded access to younger audiences and far exceeded the reach of traditional channels. Challenges included limited local expertise in newer social media platforms and evaluating impact, which was difficult due to limited routine data for catch‑up cohorts and overlap with national GP immunisation campaigns, complicating attribution of change.

Next steps

The toolkit will be kept up to date by the Screening and Immunisation Team, incorporating new resources as they are developed. Screening and Immunisation Teams will continue to promote the toolkit to school immunisation teams, GPs and local authorities ahead of HPV delivery in the 2026 to 2027 academic year, and downloads will be monitored via the Surrey and Sussex Cancer Alliance website. Potential next steps for future HPV immunisation improvement include re‑running the university communications for the 2026 to 2027 intake with stronger links to university GP surgeries, repeating the social media campaign using underspend, expanding communications to local colleges to reach more of the catch‑up cohort and working with stakeholders to develop resources targeting adolescent boys to support school‑aged immunisation services.

Developing vaccination resources for Gypsy, Roma and Traveller communities

Background

Vaccination uptake is lower among Gypsy, Roma and Traveller communities, with barriers including literacy, digital exclusion, language, historic discrimination and mistrust in statutory services. Previous resources on vaccination were text-heavy, generic and not accessible or effective at building trust, contributing to significant immunisation inequities. In the summer of 2024, there were outbreaks of measles and whooping cough within Gypsy, Roma and Traveller communities in England.

What local actors did

A suite of short-animated films and a testimonial video on maternal and childhood immunisation were co-developed with and for Gypsy, Roma and Traveller communities, led by Friends, Families and Travellers in partnership with UKHSA and Roma Support Group (5)(6). A lived experience steering panel and 2 focus groups shaped the content, language, imagery and tone. Three co-production workshops with a community illustrator refined scripts, visuals and branding and identified the need for elders’ testimonies to build trust. Community members recorded English voiceovers and translators produced versions in 3 different Romanesque languages. The resources required included staff time for community engagement and coordination, partner input from UKHSA and Roma Support Group, professional illustration and animation, recording facilities, translation fees and appropriate remuneration for participants.

What was achieved

The project delivered a suite of materials more accessible, relatable and non-judgemental than previous written materials. Community feedback indicated that the resources reflected real concerns and clarified key questions about safety, eligibility and choice. Reach and engagement indicators included a national webinar (over 600 attendees) to launch the resources to health professionals and community organisations, publication of the maternal and childhood immunisation film by Traveller Times at the request of a local public health team, and use of the films on loop on a health bus during outreach in Enfield. Dissemination of the videos on community-controlled platforms prompted conversations, supporting peer-to-peer trust-building.

Key learning

Co-production was embedded at every stage, positioning Gypsy, Roma and Traveller community members, not as passive recipients, but as co-designers with real influence over messages, imagery, formats and dissemination. By using community voiceovers, a community illustrator and elders’ testimonies, the project translates complex immunisation information into trusted, culturally resonant content while maintaining clinical accuracy. The choice of short animations and multilingual audio directly addresses literacy and language barriers, making information genuinely accessible. Partnership working bridged lived experience and public health expertise. The “evergreen” design supports sustained use in routine programmes and outbreak contexts, offering a scalable model for equitable health communication.

Enablers:

• established, trust-based relationships between Friends, Families and Travellers, Roma Support Group and the communities, enabling meaningful recruitment and honest feedback
• use of community members as illustrators, narrators and translators, which increased authenticity, cultural relevance and acceptance of the final materials

Challenges:

• tight timelines and complex multi-stakeholder sign off created pressure on script development and revisions while needing to remain aligned with public health guidance
• literacy barriers and hesitancy about being publicly associated with immunisation messaging limited the pool of narrators/translators and made recording more challenging
• underlying system issues (GP registration, incomplete records, migrant entitlements) sat outside the project’s direct remit but strongly shaped messaging and community concerns

Genuine co-production with trusted VCSE partners is essential. Investing in relationships and community leadership increases relevance and impact and can be replicated with other inclusion health groups. Build in time and flexibility for iterative feedback, translation and sign off, including clear roles and a single coordinating contact to manage multi-agency input. Dissemination works best when resources are embedded in both professional pathways (ICBs, primary care networks (PCNs), maternity services, health buses) and community-controlled channels (local Facebook groups, community media, faith networks).

Next steps

These resources will continue to be promoted in the communities and to healthcare professionals. Qualitative feedback will be gathered from Gypsy, Roma and Traveller communities and practitioners on how the resources are used in practice. The resources will remain available as “evergreen” assets, with UKHSA and partners using learning from this project to strengthen future immunisation equity work and support ICBs and local authorities in addressing inequities.

Examples of the implementation phase

Information workshops for Somali mothers in Camden

Background

To improve local MMR uptake, coffee morning sessions were arranged by Camden Council and the British Somali Community Centre in the summer of 2024 to discuss childhood immunisation with Somali mothers. During these sessions, it became apparent that there was a lack of trust between this community and the wider health system.

What local actors did

A total of 7 workshops ran across the 2 years to build trust and address wider health issues that were of concern to Somali residents. Most sessions were run by a Somali GP. Topics included: childhood immunisation (twice), autism and MMR (with clinicians from the local autism diagnostic service), breast screening, nutrition and fasting and menstrual problems. Each workshop, delivered in Somali and English, was led by a clinician to give a presentation about the topic followed by an hour for discussion with the women. Inequalities funding for immunisations from the local ICB was used to fund the British Somali Community Centre and clinicians delivering the session. Translated disease information sheets on MMR provided by the ICB were used in the immunisation workshops that attendees took away with them.

What was achieved

Attendance at the workshops ranged from 7 to 23 women, with the session on MMR vaccine and autism being the most well attended. Feedback, collected as a show of hands after the workshops, indicated a decrease in the proportion of attendees who thought the MMR vaccine caused more harm than benefit for their child (42% to 14%), increased understanding and awareness of the signs and symptoms of measles (42% to 100%) and a decrease in the proportion of attendees who felt strongly that MMR vaccine caused autism (33% to 0%).

Key learning

Community engagement is a continuous process and must be sustained and gradual to build trust. Working with a trusted community leader and/or organisation can facilitate this engagement.

Enablers:

• working with a local community centre that the community frequently attended and trusted
• utilising a Somali GP who could speak the language helped to communicate the technical elements of the MMR vaccine
• providing information that participants wanted

Challenges:

• mistrust of the information provided
• lack of participant scientific background
• language

Next steps

The council’s Public Health Team are in the process of co-creating videos with the Somali GP and community members about the new MMR plus varicella vaccine, delivered in Somali and English, alongside a co-produced dissemination strategy.

Winter vaccines on the public health bus in Wandsworth and Richmond

Background

In Wandsworth and Richmond, there are wide disparities in uptake of winter vaccinations, such as flu and COVID-19, among certain demographic groups and borough wards, often overlapping with areas of higher deprivation. Reasons for lower uptake include low vaccine confidence, complacency and access barriers.

What local actors did

Launched in 2022, Richmond and Wandsworth Council offer free flu and COVID-19 vaccinations on a health bus, to provide a more accessible offer for eligible residents facing barriers in traditional settings (7), (8). Branded as “Come and Have a Chat”, it gives residents a space to speak with health professionals and get immunised. Using ward-level data, the bus is deployed to areas with historically low vaccination rates. To maximise visibility and convenience, locations have included supermarkets, high streets and community events. Alongside immunisations, residents can speak to trained staff and receive support with smoking cessation, NHS Health Checks and advice on energy efficiency and cost of living. The initiative is delivered with community pharmacists, NHS and VCSE organisations. VCSE partners help identify locations that are most appropriate and accessible for their communities, include the health bus in events they host and promote the offer to their community groups to encourage engagement. 

What was achieved

Success is measured through vaccination counts, demographic and geographic reach and resident feedback. Across the past 3 winters, the outreach offer delivered more than 300 flu and COVID-19 vaccines. The original 2022 campaign delivered almost 600 COVID-19 vaccinations. Resident feedback has been overwhelmingly positive, with frequent praise of the bus’s accessibility, convenience and friendly staff.

Key learning

The health bus removes structural barriers by taking vaccines directly into areas where uptake is lower. A visible mobile clinic encourages engagement, offers wider health services, supports holistic wellbeing and helps residents with low vaccine confidence overcome barriers.

Enablers:

• data-driven identification of low-uptake areas
• visible, flexible mobile clinic reduces physical, psychological and digital access barriers
• strong partnerships with NHS providers, community pharmacies and VCSE organisations

Challenges:

• adverse weather conditions and staffing capacity in winter
• limited physical access to all borough areas

Next steps

The health bus will continue to offer seasonal winter immunisations. Deployment sites will be reviewed using updated uptake data and evaluation findings to ensure the offer remains effectively targeted.

Breakfast townhall meetings: a 3Ts model applied in Enfield

Background

Long‑standing health inequalities and challenges accessing services have left Black communities with poorer health outcomes and limited involvement in decision‑making. COVID‑19 highlighted these issues, including cultural and historical mistrust, wider health determinants and practical access barriers such as language, time and convenience. Enfield has low adult and childhood vaccination uptake, with low levels of vaccine confidence compounded by these challenges.

What local actors did

Launched by Pastor Nick Chanda during the pandemic, town halls were held every 4 weeks on Saturdays through 2022, and ad hoc from 2023 to 2025. Breakfast was provided and was the main driver for most attendees. Enfield Council and North Central London ICB brought healthcare professionals to lead discussions, while the Revival Christian Church of Enfield provided the venue, food, advertising and community insights. Sessions included presentations from community partners followed by questions and answers.

What was achieved

Feedback showed that the supportive environment helped attendees become better informed and more proactive in seeking advice about immunisations and other health issues. This demonstrated the vital role of voluntary and faith groups in community engagement and co‑produced initiatives. Between September 2021 and November 2022, COVID‑19 vaccine uptake rose from 51% to 57% in Black Caribbean residents and from 49% to 53% in Black African residents.

Key learning

The 3Ts model - trusted leaders, trusted voices and trusted places – proved key for community empowerment. Breakfast town halls enabled open discussion of sensitive immunisation issues in safe, familiar settings and allowed cultural and religious factors to be addressed appropriately. Strong partnership working and co‑production early-on were essential, with church leaders providing unique insight into what would work for their community and acknowledging the intersection between faith and health in a way that would not have been possible.

Enablers:

• buy-in from all stakeholders at the start of the project
• community motivation and commitment to improve health outcomes
• funding

Challenges:

• lack of long-term funding
• wider system challenges within the NHS
• lack of trust

Next steps

The 3Ts model developed in Enfield resulted in a series of Vaccination and Screening Groups being created by NHS England colleagues across London, utilising the elements of the model.

Improving health literacy and immunisation access for English for Speakers of Other Languages (ESOL) students in Penge

Background

Penge is one of the areas of lowest vaccination uptake in Bromley. ESOL learners at the local adult education centre face significant barriers to accessing healthcare, including language difficulties, limited digital skills, low awareness of NHS services and incomplete immunisation histories. As many students are migrants, refugees or asylum seekers, they lack confidence navigating healthcare and may miss opportunities for preventative care.

What local actors did

Over the past 2 years, the Adult Education College, Bromley Public Health and One Bromley partners delivered targeted engagement and health events for ESOL students. Tutors and preparatory outreach identified students’ health needs and concerns. Educational sessions covered immunisations, NHS access and women’s health. Co‑produced health and wellbeing events and pop‑ups were held onsite with partners and community organisations, offering vaccinations, blood pressure and health checks, digital support and signposting. Family-friendly activities were included during school holidays. Resources required included staff time, clinical teams, venue space and tailored promotional materials.

What was achieved

The events brought together adults and children from diverse backgrounds, enabling meaningful engagement across the community. Attendees received flu and COVID‑19 vaccines, alongside health checks. Surveys showed increased understanding of NHS services and greater confidence accessing care. Many had meaningful discussions about vaccines, screening and digital health access. Partners noted strong engagement and valued the opportunity for face‑to‑face conversations. Feedback from attendees was highly positive, praising the family-friendly environment and usefulness of the advice, checks and activities.

Key learning

Meeting communities in a trusted setting and combining education with practical healthcare access was highly effective. The approach reduced language and system barriers, using tailored engagement and integrated multiple services in one accessible event. Collaboration across partners provided a holistic offer that built trust, improved awareness and strengthened the ongoing partnership with the College, improving long‑term access for underserved groups.

Enablers:

• strong collaboration between Public Health, Adult Education College, One Bromley partners and community organisations
• tailored engagement, including pre‑event education and targeted promotion
• delivery in a trusted, accessible environment for ESOL learners and local residents

Challenges:

• language barriers, limited digital literacy and unfamiliarity with NHS systems among attendees
• event timing and poor weather, which reduced attendance at some pop‑up clinics

Preparatory education and community‑specific engagement increase participation, while embedding immunisation information and pop-ups into wider health events held in familiar, trusted venues improves access for underserved communities and increases vaccine confidence. This model is highly replicable for areas with low uptake or diverse populations.

Next steps

Bromley will continue delivering accessible, community‑based health events to support ongoing engagement on immunisation and health literacy and build trust. Future activity includes expanding pre‑event promotion, particularly multilingual materials, and strengthening collaboration with community champions.

Addressing barriers to vaccine uptake among Charedi communities through community-driven approaches in Hackney

Background

Hackney is home to one of the largest Charedi (strictly Orthodox) Jewish communities in Europe. This community has been disproportionately impacted by VPD outbreaks and has lower vaccination uptake, due to a preference for delayed vaccination and perceived concerns regarding “overload of immune system of multiple vaccinations”. A recent measles outbreak occurred within the community between May and December 2025, with 178 linked cases and 30 hospitalisations (9).

What local actors did

An extensive response plan was initiated within days of the outbreak. Local PCNs set up additional vaccination clinics (6 days per week across several GPs) and offered both appointments and walk-ins at accessible community venues. Leaflets, frequently asked questions and clinic details were co-designed with residents, community groups and organisations, for culturally sensitive, and accessible information, responding to community insights. Local schools, early years settings, and faith and community leaders shared advice, and encouraged families to check immunisation records and use infection prevention/control measures.

What was achieved

The overall measles risk to children and young people was reduced as a result of the reactive response: 51 vaccination clinics were delivered via 6 GPs and one children’s centre between 1 May and 28 July 2025. Key outcomes included: 1,025 walk-ins, 520 booked appointments, 1,544 children vaccinated (99% Charedi) and 2,584 vaccines given, nearly half for MMR to children across 11 practices (including 3 in Haringey).

Key learning

The outbreak response in Hackney highlighted the critical importance of strong collaborative working, effective system leadership and the value of a well‑established immunisation network. Partners were able to rapidly mobilise because of shared values, with a collective focus on reducing inequalities and supporting vulnerable groups. Readily accessible funding, established operational protocols and an experienced workforce also contributed to the swift and coordinated effort. Community engagement and co‑design proved essential, ensuring culturally sensitive and accessible information that helped address complacency, confidence and convenience barriers. Local cascade communication channels enabled information to flow quickly within the community, while bi‑directional, real‑time communication between community partners and the wider system strengthened trust and responsiveness.

Enablers:

• sustained proactive routine immunisation capacity
• the ability to readily mobilise an effective system outbreak response, which relied on robust and established infrastructure, rapid access to funding and clear operational protocols
• collaborative partnership networking and ways of working, alongside community engagement and co-design

Next steps

The community responded quickly to the outbreak due to higher perceived risk. The next step is to work to ensure that immunisation is continued to be understood as routine and protective, outside of an outbreak scenario. Changing this dynamic will require engagement, co-designed communication and the continued delivery of accessible, culturally appropriate services that empower the community to adopt a protective stance against VPDs.

Step 5: evaluating the Healthier Hostel pilot in Wolverhampton

Background

The idea for the Healthier Hostel pilot was first established in August 2021, following intelligence that poor access to primary care services was having a wider impact on the health and wellbeing of hostel residents with tuberculosis. As a result, a partnership was formed between the City of Wolverhampton Council, Black Country Integrated Care Board and Thornley Street Surgery, to deliver onsite open access primary care clinics for residents of the hostel, through health inequalities funding. There were 2 to 4 drop-in clinics per month with an average of 8 people attending per clinic, of the 28 living in the hostel, that registered with the service (February 2023 to March 2024). These clinics provided holistic care, including support for physical and mental health, including immunisation and screening services.

What local actors did

This evaluation, led by the City of Wolverhampton Council, drew on both quantitative and qualitative methods. An analysis of data extracted from GP patient records was undertaken to determine how impactful the service had been in terms of primary healthcare interventions. Routinely collected anonymised demographic, service use and SNOMED code data on patient and practice characteristics were extracted from the GP clinical system and a full audit of patient records was conducted. The sample included all residents registered with Thornley Street Surgery (n=28) and the searches were triggered across two consistent time periods, prior to and during the pilot, to enable comparison. Qualitative methods were used to understand the personal impact of the service, including a questionnaire issued to people living at the hostel (using validated questions from the GP Patient Survey and Homeless Health Needs Audit) and 6 semi-structured interviews of hostel staff, the lead GP and the primary care commissioning lead. A task and finish group was established to design the questionnaire. Results of both quantitative and qualitative aspects of the evaluation were triangulated, and thematic analysis was used to determine key themes.

What was achieved

Providing an onsite drop-in clinic enabled residents to access primary care services in a more equitable way, by recognising that multiple, complex health, care and support needs alongside negative previous experiences of health care services were barriers to help-seeking and positive health outcomes. With regard to vaccination, an increase in uptake of seasonal (COVID-19 and/or flu) vaccines was observed, with 13 eligible residents vaccinated during the pilot compared to 3 the previous year. These findings illustrate the value of accessing routinely collected primary care data for evaluating engagement and system impact within inclusion health populations. The use of validated questions in the questionnaire and triangulating of quantitative and qualitative data improved robustness and credibility of the evaluation.

Key learning

Overall, this evaluation demonstrated that proportionate, mixed‑methods approaches can generate meaningful learning in complex settings, even where data and engagement challenges exist. However, funding and time constraints meant the evaluation was largely retrospective rather than embedded from the outset.

Enablers:

• multi-agency collaboration
• routinely collected primary care data enabled pre–post comparison, strengthening the evaluation beyond purely descriptive findings
• mixed methods evaluation design

Challenges:

• accuracy of the quantitative data from GP patient records, particularly from the period prior to the pilot
• response rate of the questionnaire (54% of residents who were registered at the GP)
• some voices, particularly from those not registered or not engaging, were under‑represented

Next steps

Findings were used to inform local decision‑making on when and where outreach and in‑reach primary care models may be most effective, particularly for preventive health programmes. The evaluation contributed to system‑level discussions about homelessness and health inequalities, supporting the case for place‑based, flexible service models.

Step 5: evaluating outreach COVID-19 vaccination clinics for urban and coastal communities in Dorset

Background

As part of the 2023 autumn and winter COVID-19 campaign to tackle health inequalities, Dorset HealthCare collaborated with statutory and voluntary partners to pilot outreach clinics in trusted community locations alongside larger vaccination sites. Nine 3-hour clinics were run in coastal and urban areas with lowest uptake (including areas with higher proportions of ethnic minority groups), and at rural sites identified opportunistically (for example, to coincide with a health and wellbeing event). Overall, 151 vaccines were delivered, some alongside co-located health promotion offers, including blood pressure checks and smoking cessation.

What local actors did

Drawing on the UKHSA immunisation evaluation framework and with public health support, the core team planned a pragmatic evaluation to assess the effectiveness of the outreach clinics. In practice, this included collecting data on the numbers vaccinated by location, insights from a bespoke paper-based patient survey (including demographics, motivation to attend and patient experience) and ad hoc patient, staff and partner feedback and observations. The survey specifically asked respondents: “Had today’s clinic not been on, would you have been vaccinated? If yes, why and where? If no, why not?”. Clinical staff administered the survey and completed data entry using Microsoft Excel for analysis. It was not possible, as originally planned, to formally capture partner feedback or assess the impact of co-located health promotion activities.

What was achieved

Overall, 151 vaccines were delivered across the outreach clinics, with between 3 and 26 vaccinations per clinic. The evaluation survey achieved a 99% response rate and provided valuable insights into several key areas, including the demographics of participants reached; notably, no patients from ethnic minority groups were vaccinated. The findings showed that the majority of people vaccinated (90%, 130 of 149 respondents) would not otherwise have received the vaccine, rising to 94% among those aged 65 to 74 years. The survey also provided information on how attendees heard about the outreach clinics, such as through local press, social media, or their GP, as well as reasons for attending, including ease of access, lack of personal transport, the cost of public transport and difficulties with national digital booking systems. There were examples of people whose vaccine confidence was improved due to ease of access, and partner feedback confirming the benefit of co-located health promotion activities such as blood pressure checks leading to GP referral as appropriate.

Key learning

The key learning was that early consideration of evaluation adds clear value but requires a pragmatic approach within busy clinical environments where dedicated evaluation or administrative capacity may be limited. Paper‑based data collection was found to be resource‑intensive and unlikely to be sustainable for clinical staff, indicating that digital solutions should be considered, with appropriate wrap‑around support to enable survey completion. However, for groups at highest risk of health inequalities, such as people experiencing homelessness, more innovative approaches to gathering feedback are necessary. Despite some formatting issues, the structure of the UKHSA evaluation framework template was helpful in creating a shared understanding of the intervention, the evaluation tasks required and respective roles and responsibilities. The evaluation also benefited significantly from public health expertise, and without this support the UKHSA evaluation framework template may have been more challenging to navigate.

Next steps

This evaluation generated practical evidence which has shaped the outreach vaccination programme moving forwards, leading to strengthened and expanded collaboration with community partners and guiding use of outreach clinics for most impact. The evaluation also invited discussions about where community engagement to build trust needs to be prioritised moving forwards, for example within some ethnic minority communities.

References

1.     City and Hackney Public Health Team, North East London Health and Care Partnership. City and Hackney Immunisations Strategic Action Plan 2024-2027. London: NHS North East London, City of London, Hackney Council; 2024.

2.     JITSUVAX. Empathetic refutational interview (ERI) training. No date. (Accessed: 20 February 2026)

3.     NHS England South East Surrey and Sussex Screening and Immunisation Team. HPV vaccination resources toolkit: NHS England South East, 2025. (Accessed: 17 February 2026).

4.     NHS Surrey and Sussex Cancer Alliance. The human papillomavirus (HPV) vaccine programme No date. (Accessed: 13 March 2026).

5.     Friends Families and Travellers. Vaccination information for people from Gypsy, Roma and Traveller communities., YouTube; 2025 (Accessed: 18 February 2026).

6.     Friends Families and Travellers. Methodology report of vaccination films for Gypsy, Roma and Traveller communities. London: FFT; 2025.

7.     Wandsworth Council. Health bus 2026. (Accessed: 13 March 2026).

8.     London Borough of Richmond upon Thames. Health bus 2026. (Accessed: 13 March 2026).

9.     Department of Health and Social Care. Chief Medical Officer’s Annual Report 2025: Infections. London: DHSC; 2025.