14 | Nursing in Practice | Summer 2023 |
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a total of 103 homes were visited and an additional 68 vaccinations were administered , alongside other health checks for older household members .
‘ This disproves that it is only vaccine hesitancy ,’ says Dr Kumar , ‘ because when we reached out , we were able to do many more injections .
‘ Some of these people are working zero-hours contracts ; they can ’ t afford to miss work to come for an appointment . They want to get their child immunised , but they can ’ t actually afford to miss work or get the bus to come to town . It ’ s really small things sometimes that are compounding why these people aren ’ t accessing us .’ Given the challenges some families face , Lorraine Meadows , head of service and clinical lead for the Child Health Information Service ( CHIS ) for South Central and West NHS , says it is ‘ no wonder families weren ’ t accessing services ’.
Yet , while Covid-19 may have impacted negatively on vaccine confidence , Jane Lambert , chief executive of ECG Healthcare , which provides vaccination training for primary care staff , says it has also given healthcare leaders the freedom to work more flexibly to improve access .
‘ I don ’ t think that children going into their GP practice for immunisations is sustainable , that could be the first choice of location but there need to be other options to access .’
Ms Lambert , a registered nurse , describes a project she is undertaking with Northampton Council to provide a mobile vaccination bus .
The council provides the bus and drivers while ECG Healthcare staffs the bus with nurses . Currently the service is commissioned to carry out Covid-19 and flu vaccinations as well as health checks , but Ms Lambert hopes to expand the service to catch-up immunisations .
‘ The point of the bus is to get to people in hard-to-reach communities , and to give people another opportunity .
‘ Sometimes we ’ re in a really deprived area , sometimes we ’ re outside Tesco , but it ’ s about actually trying to make healthcare more convenient .’
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I don ’ t think that children going to their GP practice for immunisations is sustainable , we need other options Jane Lambert
References 1 UK Health Security Agency . Young people at risk of disease as concerning numbers miss out on life-saving vaccines . 2023 . tinyurl . com / UKHSA-imms 2 Heneghan C et al . The impact of COVID-19 restrictions on childhood vaccination uptake . Preprint . DOI : 10.1101 / 2021.06.25.21259371 3 McQuaid F et al . Uptake of infant and preschool immunisations in Scotland and England during the COVID-19 pandemic . PLoS Med 2022 ; 19:2 : e1003916 . tinyurl . com / McQuaid-uptake
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Immunisation into the future There remains little consensus on how to go about making healthcare access more convenient . While immunisation uptake rates in England fell during lockdown , research from 2022 found that uptake of infant and preschool immunisations in Scotland was improved during this time . 3 This was thought to be due to active measures taken to promote immunisation at local and national levels .
Programmes like Dr Kumar ’ s outreach service achieve good results by targeting the proportion of the population considered least likely to access immunisation services in traditional settings .
Likewise , Ms Meadows and her colleague Charlotte Marshall , CHIS inequalities insights lead at South Central and West NHS , tell Nursing in Practice they have achieved significant improvements through targeted support for struggling practices .
But , while Ms Meadows believes ‘ GPs need to get into the community more ’, such programmes are costly in terms of resources and time , and require lots of data .
On the other side of debate , Ms Lambert says she would like to see immunisation move further out into the community . In a view that was recently supported by health minster Maria Caulfield , she suggests nurse-led immunisation could also be run out of community pharmacies , which she says have an excellent model of access .
‘ They ’ re open evenings , they ’ re open weekends , and people have developed a good rapport and trust with their community pharmacist over years .’
Ms Lambert says these advantages , if combined with nurses ’ experience and confidence with patients , could mean nurse-led immunisation from venues such as community pharmacies becomes a valuable future option .
Falling rates of immunisation could ultimately be tackled in a number of ways , and it is clear nurses will continue to have a central role to play .
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ALAMY |