In 2022, the Clinical Effectiveness Group (CEG ), Queen Mary University of London launched a programme in North East London to make it simpler for GP practices to deliver vaccinations to pre-school children. In an evaluation of the programme, published in Vaccine, researchers found that the number of children receiving their first measles, mumps and rubella (MMR) vaccination on time increased by 4.1%. This equates to approximately 1,100 children a year.
Anonymous feedback has been equally positive, with one practice staff member from City & Hackney saying:
“The tool makes managing what can be a complex area easy to understand. I use it weekly to call those that are due that week. This was not happening prior to the tool, and it has proven to be successful in ensuring that children get the right vaccines at the right time.”
Lowest rates of MMR vaccinations since 2018
Measles, mumps and rubella are highly infectious and can lead to serious health complications for some children. Studies have shown that one child with measles in a classroom can infect up to nine other unvaccinated children, making it one of the most contagious diseases in the world – more contagious than COVID-19. To keep communities protected, the World Health Organization recommends that at least 95% of children need to be vaccinated to prevent a measles outbreak.
In the UK, children are eligible to receive their first MMR vaccination around the age of 1. This is alongside a more comprehensive vaccination schedule that includes polio and diphtheria.
However, uptake of all pre-school vaccinations in the UK are at their lowest since 2018 and no region is meeting the target recommended by the World Health Organization.
North East London has high levels of deprivation and some of the lowest childhood vaccination rates in England.
A new tool to simplify the vaccination timetable and support GPs to identify unvaccinated children on time
In England, parents and carers are notified about their healthcare using a ‘call-and-recall’ system. This is used to contact patients who may otherwise be missed and to encourage timely care, including vaccinations. The ‘call-and-recall’ system includes postal letters, text messages and phone calls to patients. However, the system is sometimes not used enough or there isn’t enough support to use it effectively.
The free APL-Imms (Active Patient Link tool for Immunisation) tool, developed by the CEG, helps GP practices navigate the complex vaccination schedule for children under five. Using routinely collected health data from the practice’s records, the tool helps list all children who are approaching their due date for vaccinations. This is done without any health data leaving the GP practice.
Primary care facilitators based at the CEG visited GP practices to give hands-on support on how to integrate the tool into daily workflows. The practices that took up the offer of support improved twice as much as those who were not visited. The researchers suggest this shows the importance of training and support as part of the programme.
The success of the programme also suggests what may work in other areas to improve vaccinations where they’re needed most.
“The success of our programme demonstrates it is possible to deliver more vaccinations on time by simplifying the re-call process through digital tools and facilitator support. This is an exciting prospect for other areas of the country with a similar CEG-style support model in place. ”Dr Milena Marszalek, local GP, lead author of the evaluation and research fellow at Queen Mary’s Clinical Effectiveness Group.
Maintaining success to meet vaccination targets
Dr Milena Marszalek added: “Despite the improvement we’ve seen, MMR immunisation rates are still below the levels needed to prevent measles outbreaks – GP teams in the region are working incredibly hard to deliver vaccinations on time, but to reach the WHO targets practices need achievable financial incentives that support our efforts.”
The results of the study were published in Vaccine.
Our support
In 2018 we supported the ambitious REAL Health programme, led by the Clinical Effectiveness Group at Queen Mary. The programme combines big data and health data science to address important clinical and public health issues in child health, respiratory health, and cardiovascular health to reduce inequalities in our local community of East London.
“The proportion of children protected against vaccine-preventable infections such as measles, polio, and whooping cough has dropped sharply in recent years and this work, supported by Barts Charity, demonstrates ways to increase the timely receipt of the first routine MMR vaccine for young children in North East London, this protects their health especially against the backdrop of rise in measle outbreaks.” Victoria King, Director of Funding and Impact at Barts Charity.