Practical Challenges in the New General Practice Vaccination and Immunisation Services Guidance

The new guidance from NHS England on General Practice Vaccination and Immunisation Services, effective from 1st May, aims to streamline the administration of essential vaccines, including the Pneumococcal vaccine. While the comprehensive standards and core contractual requirements provide clarity, there are significant practical challenges in the call and recall process, particularly when dealing with patients who choose not to vaccinate.

The Call and Recall Process: A Practical Perspective

The call and recall process is crucial in ensuring high vaccination uptake. It involves inviting patients for vaccinations and following up with those who do not attend. However, this process can be fraught with difficulties, especially with childhood immunisations.

Challenges with Non-Responding Patients

1. Parents Choosing Not to Vaccinate:
   • A significant challenge arises with parents who decide against vaccinating their children. Research indicates that parents often avoid explicitly informing their GP practices of their decision not to vaccinate. This can stem from various reasons, including:
     • Fear of Judgement: Parents may fear being judged or criticised by healthcare professionals for their decision.
     • Hesitancy to Engage: Some parents might be uncertain about their decision and prefer to avoid confrontational conversations.
     • Miscommunication: In some cases, the message might not get conveyed accurately due to administrative errors or oversight.
2. Impact on Follow-Up:
   • The ambiguity regarding a patient’s vaccination status necessitates multiple follow-ups, typically starting with reminder letters and escalating to phone calls. This process is time-consuming and resource-intensive. GP practices often struggle with the sheer volume of follow-ups required, which can detract from other essential services.

Practicalities of Following Up by Phone

1. Resource Allocation:
   • Following up with patients by phone requires significant administrative resources. Staff must be allocated to make calls, track responses, and update records. This process can overwhelm practices, particularly those already operating at full capacity.
2. Patient Engagement:
   • Despite efforts to contact patients, reaching them can be challenging. Patients may not answer calls, return messages, or update their contact information regularly, leading to repeated attempts and further strain on practice resources.
3. Cost Implications:
   • The cost of follow-ups, both in terms of time and financial resources, is substantial. Practices must balance the necessity of these follow-ups with their available budget and staffing levels.

Utilising the ARRS Team

The Additional Roles Reimbursement Scheme (ARRS) provides an opportunity to mitigate some of these challenges by leveraging a wider team to support the call and recall process. Health coaches, particularly those trained in Motivational Interviewing, can be highly effective in this regard.

1. Health Coaches:
   • Health coaches can engage with parents and patients who are hesitant about vaccinations. Their training in Motivational Interviewing allows them to address concerns empathetically and encourage informed decision-making without judgement.
2. Enhanced Support:
   • The inclusion of health coaches in the call and recall process can alleviate the administrative burden on existing staff, ensuring that follow-ups are conducted efficiently and effectively.

The Importance of Effective Communication

Effective communication strategies are essential in addressing these challenges. Practices should consider:

1. Clear Messaging:
   • Provide clear, non-judgemental information about the importance and safety of vaccinations. This can help reduce hesitancy and encourage open dialogue with parents.
2. Multichannel Approaches:
   • Utilise a mix of communication methods, including text messages, emails, and phone calls, to improve the likelihood of reaching patients. Digital tools can streamline this process and reduce the administrative burden.
3. Training for Staff:
   • Equip staff with training on how to handle vaccine hesitancy and refusal sensitively. This can foster a more supportive environment for patients to discuss their concerns.

Conclusion

The new NHS guidance on vaccination and immunisation services aims to enhance public health outcomes by ensuring high vaccination uptake. However, the practicalities of implementing the call and recall process, especially in the face of vaccine hesitancy, present significant challenges for GP practices. By adopting effective communication strategies, utilising digital tools, and leveraging the support of the ARRS team, practices can mitigate some of these challenges and improve their vaccination outreach efforts.

As we move forward, it will be crucial for NHS England to consider these practicalities and provide additional support and resources to help practices manage the complexities of the call and recall process efficiently. For more detailed information on the guidance, refer to the NHS England document.