Boosting childhood immunisation rates through collaborative, person-centred support

The challenge

Vaccination is one of the world's most effective public health interventions, preventing up to three million deaths globally every year. However, in England, uptake rates for routine childhood immunisations are falling. For measles, mumps, and rubella (MMR), uptake is now below the 95% recommended by the World Health Organisation (WHO), diminishing herd immunity and leading to a resurgence in preventable diseases like measles.

This decline is not uniform; it is significantly more pronounced in areas of high deprivation, exacerbating health inequalities.

For one of the country's most deprived and diverse Integrated Care Boards (ICBs), these challenges are particularly acute. Serving a population of 1.26 million people, childhood immunisation rates are consistently below the national average and continue to fall. In one area alone, over 7,000 children under the age of six were not fully vaccinated.

GP practices are under pressure to improve these rates. While practices receive lists of children who are overdue for vaccination, these are often sent to a generic inbox that is not consistently monitored. Faced with high workloads and limited administrative resources, practice staff lack the time to do more than send a standard text message, which has a limited impact on uptake.

Most significantly, they lack the capacity for the time-consuming, sensitive conversations needed to address vaccine hesitancy, which is a notable barrier, particularly among parents of young children. Without a new approach, vulnerable children remain at risk from preventable diseases.

The solution

To address this public health challenge, the ICB commissioned CHASE to design and implement an innovative, collaborative, and patient-centric support service. The project provides GP practices with an enhanced patient identification and recall service focused on the entire routine childhood immunisation schedule for under-5s, with a priority focus on MMR. The service is delivered remotely by a dedicated team of CHASE Primary Care Immunisation Facilitators (PCIFs). This skilled resource is available to practices free of charge, as the programme is fully funded by the ICB.

Key elements of the solution include:

• A person-centred approach: Recognising that a simple text message is not enough, the CHASE model focuses on direct, personal engagement. PCIFs have the time to conduct sensitive telephone conversations with parents and guardians, spending up to half an hour per family. This allows them to build trust, understand and address the root causes of hesitancy, provide NHS-approved information, and triage to a practice clinician for expert advice when needed.

• A specially trained team: The PCIFs were recruited for their primary care experience. The team underwent a comprehensive training programme, including specialist training on handling vaccine hesitancy, empowering them to apply these vital skills where time-pressured practice staff cannot. The team also includes multilingual speakers, with the ability to speak in Gujarati, Punjabi, Hindi, and Urdu to serve the area's diverse communities better.

• Bespoke and collaborative integration: The service is not a one-size-fits-all solution. CHASE works closely with the ICB, place-based leads, and individual practices to secure buy-in and tailor the approach. Whether a practice prefers no text messages, a single message before a phone call, or three messages, the service adapts to their preferred workflow, ensuring it is as seamless as possible while removing the administrative burden.

• Driving innovation with technology: To ensure continuous improvement and efficiency, the project is piloting two innovative technologies.

• An automation platform is being trialled in 20 practices to manage the entire recall process, from running searches to contacting parents via their preferred channel, including the NHS App, WhatsApp, and SMS, with automatic message translation.

• AI-powered real-time translation software is being discussed to facilitate live, two-way conversations with parents and guardians in their native language over the phone, breaking down communication barriers.

The outcome

While the 12-month project is still in its early stages, it has already started to deliver impressive results, demonstrating an urgent need for this type of support.

• ‍Outstanding GP engagement: The response from primary care has been highly positive. Within the first week of outreach, 57 of the 171 GP practices (33%) across the ICB signed up to the service, a result that exceeded expectations. The project is on track to meet its target of engaging at least 85% of all practices.

• Building a foundation for measurable success: With this strong foundation of engagement, the project is now focused on its key performance indicators: contacting 95% of all eligible families, achieving a 75% appointment fill rate, and delivering a 15% increase in vaccination uptake across each programme.

• Creating a sustainable legacy: The objective extends beyond short-term goals. By working with practices over a 12-month period and embedding, efficient processes, the project aims to leave a lasting legacy of improved knowledge, capability, and effectiveness in delivering immunisation programmes.

By blending a person-centred approach with innovative technology and collaborative working, this project is proving to be an effective model for tackling one of public health's most pressing challenges.  Even a 10-15% uplift in childhood vaccination rates represents a big win, helping to restore vital herd immunity, protect the community, and enable practices to achieve crucial quality and performance targets. The project is also proving helpful in supporting the correct coding of vaccinations, thereby maximising Item of Service (IOS) payments and improving QOF figures.