Children with outstanding immunisations: Transfer from HV to SN caseload Leigh Pusey: Immunisation Coordinator, BCUHB 19/04/2018

ACKNOWLEDGMENTS The small army of dedicated immunisers and support staff in north Wales GP practices and BCUHB colleagues who never give up on a child VPDP, in Public Health Wales for the data Heart of Birmingham PCT; Working smarter, Improving performance 2006 19/04/2018

Presentation overview Background Outline of the project Key actions Results of the targeted work Issues identified Next steps 19/04/2018

Background Improve uptake for 5 year olds Cohort 7,956 2nd MMR and 4 in 1 Preschool booster average uptake 92-94% Avoid an abundance of unvaccinated children entering schools Reduce risk of an outbreak at younger age Increase in additions/deductions in the area 19/04/2018

‘Active patient management’ in the Betsi Cadwaladr University Health Board Background A phase coined by Heart of Birmingham Teaching Primary Care Trust. Proactively targeting apparently under immunised children approaching first, second and fifth birthdays 19/04/2018

Action taken If the immunisation is truly outstanding the parents are contacted by phone and encouraged to attend for immunisation by the Health Visitor Queries about immunisation are discussed with the parent Some children are home immunised Some children remain unimmunised 19/04/2018

Childhood schedule - to obtain lifelong protection Very important sequence of events Get the 1 year olds on target  Then the 2 year olds Then the 5 year olds To stand any chance of getting the Teenage booster and 2nd MMR up to target - the last safety net before they leave school 19/04/2018

Outline of the project There are two key tasks 1.Data cleansing – reconciling data held on the Child Health Information System with the medical record held by the GP practice to ensure COVER report is accurate 2. Proactive follow up of children – Liaising with HV/SN managers to request the Health Visitor follow up each child and facilitating the immunisation. 19/04/2018

Parents fall into four categories: Presume the ‘system’ will pick them up and invite them in. Do not realise their child is missing an immunisation Persistently default appointments and may not prioritise immunisation appointments Do not give consent 19/04/2018

Key actions Checking: If the child is still here If the child has moved in with hand held records Translate records and move onto UK schedule Check with GP if vaccines have been given Review consent status to avoid hanging in the system and not being appointed, avoid deferred ? Have discussion about egg allergy advice Focus on children that have had some vaccines 19/04/2018

Key actions Facilitating the appointment Encourage and remind parent of missing vaccines Make appointments Support offered to transport to GP appointment Home vaccinate 19/04/2018

Results of the targeted work East 2016 pre cleanse 2018 post cleanse % Increase No. of children 4 in 1 94.4% 96.8% 2.4% 90 2nd MMR 94.2% 96.5% 2.3% 87 Central No. of children 92.3% 95.8% 3.5% 95 92% 95.5% 96 West 94.7% 1.8% 51 93.9% 2.6% 58 Health Board Total 92.6% 96.4% 3.8% 236 96.1% 241 19/04/2018

Issues identified Children have moved in from abroad and we were not always made aware Children were not always transferred onto the incomplete schedule algorithm Information regarding immunisations was not sent to Child Health Information System 19/04/2018

Know how you CHIS works GP practices reminded about completing immunisation information correctly Children can’t come for immunisations unless they are invited Too many deferred consent status CHIS works well if everyone in the chain knows how to use them If any part of the system does not understand it uptake rates will suffer 19/04/2018

Next steps The scheme was well worth implementing Repeated for children commencing school 2018 Audit of form filling and training planned Constant monitoring and awareness raising about treatment queues Identify schools with lower uptake 19/04/2018