Boosting Your Childhood Immunization Rates & Earnings

This article re England immunization practice can easily be adapted to US pediatric practices. Karen

Your immunisation figures may be low - but is that poor uptake or just poor reporting? Dr Anita Shah offers 10 ways to avoid losing income

Payments for child immunisation depend on hitting uptake targets. GPs will be eligible for full target payments if, on the first day of a quarter, the proportion of immunisation courses completed for each childhood vaccine averages 90% or higher across all children aged two. The lower payment threshold is 70%. But an audit into immunisation uptake in north London showed many practices were not sending in regular monthly reports to Child Health, making the uptake figures appear much lower than they really were.

Based on the difficulties practices say they are encountering in sending reports, as well as advice from practices reporting 90-100% uptake, here are 10 tips to improve uptake of childhood immunisations.

1 Ensure your patient lists are up to date

Regular list cleansing will ensure that the individual and primary care organisation performance figures are accurate, which may then improve the uptake recorded.

If patients have moved away but this has not been recorded they will be included in the uptake figures and on the scheduling lists sent by Child Health or its equivalent. These patients need to be removed from the practice system and the PCO informed.

2 Send your PCT the correct information at the correct time

This includes the quarterly target reports and the reports sent to Child Health. There are various cut-off dates to submit these reports by and reports submitted late or not at all may affect your payment for childhood immunisations. Perhaps keep a list of these deadlines and stick it on a wall in an obvious place for all staff to see. If your practice is unaware of these dates, ask your PCT for more information.

In an audit on MMR in a north London PCT, the actual figures for uptake showed an appreciable difference when compared with PCT performance figures, with the practice reporting leading to an underestimate of vaccine uptake.

3 Check the format your PCT requires for immunisation data

Some PCOs use systems where Child Health may be able to extract data straight from the GP computer system, but others rely on practices sending in monthly data to the PCO on childhood immunisations given.

4 Draw up quarterly target reports to highlight overdue immunisations

Use this opportunity to recall those patients with missing immunisations such as MMR or the pre-school booster.

By running these patient lists at the beginning of the quarter you can use the next few months to recall children who have missed immunisations. Phone these patients in addition to sending a reminder letter, as this can be mistaken for junk mail and may be disregarded. You could send texts to remind parents, though this may not always be possible or appropriate.

5 Provide information on MMR with recall letters

Some parents may still have reservations regarding the risks of the MMR vaccine and its supposed link to autism so may need further information. It is necessary for parents to understand the risks of not having the vaccine and to ensure that they are reassured there are no links to autism. A leaflet may allay their fears and encourage them to vaccinate their child.

6 Increase flexibility of nurse-led clinics and run them in evenings or school holidays

A lot of parents do not book appointments for their child to be immunised as they do not want them to miss school time. This is also the case for teenagers having the second MMR vaccine. Some practices in north London have scheduled a few extra clinics in school half- term holidays as part of the MMR catch-up programme and have found this has increased their uptake.

7 Encourage staff to check children's immunisation status opportunistically

Opportunistic checks may identify children who have missed immunisations, and parents can then be encouraged to book an appointment on the spot. Staff should check whether any immunisations have been missed or whether any are due soon.

8 Set up alerts on your database systems for children who are due immunisations

Automatic pop-up alert messages are another way of highlighting those children missing immunisations. Some database systems such as EMIS and Vision have the facility to add message alerts to a child's records, to remind you to check their immunisation status.

9 When parents register a baby, encourage them to book the first immunisations then and give them an information leaflet

Parents may not always be aware of what immunisations are due when and may find it confusing. It is very important that they keep the Red Book up to date and follow the vaccination programme.

10 Ensure Read codes for all immunisations are entered correctly

When newly registered patients are entered into the database, it is crucial that efficient notes are recorded, summarising all immunisations and including correct Read codes. This will allow accurate searching of the practice database. Some practices may have uptake figures that are inaccurate because the system is not picking up some immunisations, such as the pre-school booster. Most systems pick this up as pre-school booster when running a report but some practices may have entered it as separate vaccinations, which the system will not detect. If you are unsure of the Read codes used for your particular system your provider will be able to help.

Dr Anita Shah is a GP trainee in north London and has just completed an attachment in public health at Enfield PCT

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