Shared learning database

NHS South of England (Central)
Published date:
May 2012

This guideline is based on the childhood immunisation policy developed by NHS Hampshire and the NICE Guidelines published in 2009. It focusses on increasing immunisation uptake among children and young people aged less than 19 years in groups and settings where immunisation coverage is low. The overall aim has been to ensure that every opportunity is used to encourage the increased uptake of childhood vaccines therefore reducing the incidence of disease and the possibility of outbreaks and epidemics.

Guidance the shared learning relates to:
Does the example relate to a general implementation of all NICE guidance?
Does the example relate to a specific implementation of a specific piece of NICE guidance?


Aims and objectives

The guideline provides the minimum standard of care that must be in place in all practices across NHS South of England (Central) that provide childhood vaccinations, and is integral to the Healthy Child Programme. It has been adopted in order to clarify the process for inviting children and young people for vaccination, the steps to be taken when they do not attend the first appointment and to aid in streamlining the process for immunisation reporting. It also sets out the standards expected for the training and education of immunisers. The objectives are:
- For all South Central Primary Care Trusts (PCTs) to aim for at least a 95% trajectory target for the uptake of childhood immunisations.
- For it to be a commissioning requirement that certificates of immunisation competency are withheld until the practical component of the training is completed within the agreed timescales.
- That Local Enhanced Service arrangements with practices should be considered regarding achievement of higher target levels for immunisation cover.

Reasons for implementing your project

Immunisation coverage across the region was posing a challenge for increasing uptake and reaching the projected trajectory in line with World Health Organisation guidance. There was a lack of consistency across the region, which prompted a baseline assessment to identify the outliers. The potential for increasing efficiency was identified in the adoption of a standardised process that could be audited by immunisation leads and used as an expectation for good practice.

How did you implement the project

We established an expert reference group to identify best practice and to give the guideline the appropriate stakeholder credibility. We wanted each practice to identify an immunisation champion who could provide more effective links with the relevant PCT immunisation leads. The guideline was widely consulted on, including responses from Health Protection Agency colleagues. We did not incur any costs as at the time of the development as we had dedicated time from a project lead. The main challenge has been to ensure that all immunisation leads had implemented the standard, and were prepared to audit their practice across their locality. There was some initial concern around resources regarding the presence of two people at immunisation sessions. However once we had clarified that this could be admin support and did not necessitate another qualified immuniser, these concerns were resolved.

Key findings

Following on from the circulation of the best practice guideline for Primary Care to practices in 2010, the SHA requested that Public Health Departments in PCTs undertake an audit post implementation of the guideline. A childhood immunisation assessment tool for practices was developed and each organisation was requested to complete and return this for September 2011. The available results were collated by the end of November 2011 and have informed the project. The intention is to repeat the audit in 2012, and to encourage Clinical Commissioning Groups to embed this guideline as good practice.

Key learning points

The consultation and development of such guidelines must include all the relevant stakeholders, to ensure that there is significant credibility attached to the implementation and service delivery. Consultation feedback questioned the implications for particular aspects of the guideline and whilst there was some flexibility allowed in local interpretation, the essence of the guideline was adopted as best practice by the majority of primary care organisations. However, to ensure that this process remains effective, it requires the determination of immunisation leads in whatever guise they may be in the new architecture. Determination is required to continually review the implementation of the standard, to audit practice and ensure that new and developing organisations adopt this best practice.

Contact details

Christine Etheridge
Children young people and maternity lead
NHS South of England (Central)

Is the example industry-sponsored in any way?