Shared learning database

North East Lincolnshire Care Trust Plus
Published date:
January 2012

Use of a community engagement approach to support children and their families in accessing GP practices for missing childhood immunisations.

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

To increase uptake of childhood immunisation in one electoral ward in North East Lincolnshire. - To engage with families who were known to have children missing or not started their immunisation schedule and bring up to date.
- To understand some of the barriers for these families in accessing primary care services.
- To show the cost effectiveness of this method of community engagement.

Reasons for implementing your project

Baseline-Low uptake of childhood immunisations in one electoral ward. Families were not accessing GP practices when called for their children's immunisations. Immunisation coverage was less than the 95% for herd immunity therefore a risk of a vaccine preventable disease outbreak with associated health and social costs. Opportunity to support families to access GP practices for childhood immunisations by a low cost community approach and increase uptake levels.

How did you implement the project

Public health worked with local community groups to identify solutions. The barriers were that the community wanted the GP practices to come to the children centre and provide immunisations on site. This was not possible as at least 3 GP practices served that children centre and due to the way contracts and payments are made to individual practices this was not possible. Other barriers were the ordering and supply of vaccines to a children centre as this is not a 'health' building and therefore not licensed. We therefore commissioned a pilot project with a social enterprise who had a good history of community engagement to work with families to access GP practises for their immunisations. This work incurred costs as we had to pay the worker for 5 hrs a week.

For more detail about the methods employed by the community worker to encourage parents to take their children to vaccination, please view the supporting material

Key findings

We monitored the number of children who the community worker contacted, and the number of children who went on to be immunised from our baseline figures. Our main results were a 93% uptake (76/82) in immunisations for those children either starting or completing their missing immunisations. The impact on patient outcomes were reducing vaccine preventable diseases and helping to improve population herd immunity. The project helped to save costs indirectly by reducing the number of repeated appointment letters being generated for immunisations when a direct contact by the community worker was more effective and efficient. The GP practice staff delivering the immunisations were also more productive as they did not have so many missed appointments and were able to work with the families and community worker to immunise the child/children at a suitable time for all. We also identified some of the barriers for families not presenting for their immunisations when invited and presented these as case studies. Some were related to poor transport links, not liking their GP practice or chaotic lives where appointments sent by letter became lost or less important than other things.

Our project exceeded out expectations in the number of families contacted and who were brought up to date. In addition families also accessed other services when they attended the GP practices ie cervical screening for the women.

Key learning points

- Use a community worker/organisation that knows the area and some of the barriers existing.
- Ensure that the community worker has/is provided with basic immunisation knowledge to build self-confidence and also to help dispel myths in the community. This can be through working with an experienced immuniser and self-directed learning.
- Ensure that all organisations and professional groups are aware of the worker and their role. To this important when a family is willing to access a service and they can be seen straight away.
- Ensure that the worker is only used to follow up families that are not accessing GP practices for immunisations after the GP practice has tried a number of different and less traditional ways and not used as a general resource.
- Don't assume that parents/families do not want to have their child/children immunise-very few actively refused.

Contact details

Isobel Duckworth
Locum Consultant in Public Health
North East Lincolnshire Care Trust Plus

Is the example industry-sponsored in any way?