In January, the National Institute for Health and Care Excellence (NICE) published a new quality standard document on increasing the uptake of flu vaccination among those eligible (NICE, 2020) (Box 1). Quality standards can be used to compare the care general practices currently provide to understand which priority areas to focus on for quality improvement.
Box 1.Quality standard (QS190). Flu vaccination: increasing uptake
- Statement 1: Providers use a range of different methods to invite people in eligible groups for flu vaccination
- Statement 2: People in eligible groups receive invitations for flu vaccination that include information about their situation or clinical risk
- Statement 3: Non-general practice providers notify the relevant GP practice when they vaccinate their eligible patients
- Statement 4: Health and social care staff who have direct contact with people using services receive flu vaccination from their employer
The quality standard refers to all eligible groups, except for the over 65 age group, in whom uptake is already quite high. During the 2018–19 season, the percentage of people vaccinated was as follows (Public Health England, 2019):
- 48.0% of eligible patients aged 6 months to under 65 years old in one or more clinical risk group(s)
- 45.2% in all pregnant women
- 44.9% in all all 2-and 3-year-olds.
Invitation for vaccination
GP practices need to have systems in place that enable staff to identify people eligible for flu vaccination. Suggested methods of contacting patients include by writing (letter, email or text message), by phone, through social media or through a combination of methods.
Practice nurses should take in to account a person's eligible group and any other demographic information available when deciding which invitation method should be used. The standard highlights the importance of considering the literacy levels and the preferred language of people being invited for vaccination.
Information on vaccination
As uptake of flu vaccination is lower than desired among people in eligible groups, and varies across these groups, people should receive invitations for flu vaccination that include information about their own particular situation or clinical risk, to help them understand the benefits of having the vaccination. Practice nurses should ensure information is given using a range of methods, including face-to-face interactions, if the opportunity arises.
Information sharing
The third quality standard recommends that non-general practice providers, such as a pharmacy for example, notify the relevant GP practice when they vaccinate their eligible patients. This reduces waste of resources and time by preventing unnecessary invites to people who have already had the vaccine and helps to avoid inadvertently vaccinating a person twice.
Having accurate uptake figures can also help providers to plan future vaccination programmes and to meet their targets.
Vaccinating health and social care staff
Practice nurses should have a flu vaccination each year. Vaccinating front-line health professionals reduces the risk of transmission of flu to vulnerable people and can protect staff from the effects of flu. It is the responsibility of employers to enable staff who have direct contact with people using services to have a flu vaccination.
Auditing care
Taking part in audits can give insight into ways to improve care. General practices and other providers can use NICE's template to make an initial assessment of their service compared with a selection of quality statements. It allows assessment of current practice, recording of an action plan and monitoring of quality improvement.
Conclusion
Practice nurses are well-placed to monitor flu vaccination uptake in their practices, as well as to find strategies to improve it. The new NICE quality standards are a useful resource to help improve uptake and potentially save many lives.