There is no doubt that it is tough to hit the flu vaccination targets of 75 per cent uptake for both those over 65 and those with added risks under 65. In Wales, there were only four practices that achieved both targets under the 2013/14 programme, according to the Public Health Wales website.
One of those was my 2,870-patient practice – the AfanValley Group Practice in Port Talbot which is based in a rural area of high deprivation. As of the end of January, we achieved uptake of 82.6% for the over 65s group and 75.4% in the under 65s. Nasal spray flu vaccine uptake for two and three year olds was 95 per cent and 92 per cent respectively.
How did we do this? It has required a year-by-year incremental improvement with refined processes and a more targeted approach. With an income of £10 per jab it makes financial sense to aim high and put the effort in. Some of the income earned is used to boost our staff socialising fund and pay end of year bonuses.
Here are my top 10 tips for achieving the targets:
- For the first few weeks of the season, run the flu clinics as normal, accommodating those regular patients that are keen attendees.
- After the first few flu clinics have run, use the audit module on your software to drill down to those patients that still need to be targeted. Don’t waste time making your own searches, the data is there ready for you.
- Do not rely on letters to those remaining patients who, by the third or fourth week, have yet to attend. We find that, in the main, letters are ignored. Instead designate capable staff members to work from printed lists (accessed from the audit modules) and make telephone calls to each patient.
- Invest the time training clinical team members such as your nurse or healthcare assistant (or a motivated receptionist) to make personalised calls to patients from these lists, that make particular reference to the patient’s medical history and explain fully why it’s important they receive a flu jab. Taking this approach is much more persuasive and makes it harder for a patient to decline. It’s just good old‘informed consent’. The list may be enormous in large practices but you ought to have correspondingly large staff numbers and the effort for patient care and income is worth it.
- During phone calls, record the code ‘9OXD. Influenza vaccination verbal invitation’ to mark where patients have received an invitation, understood it but not refused it. Or use the code ‘90XD5100 seasonal flu vaccine refused’ so you don’t mistakenly call the patient again and risk irritating them.
- Regenerate the audit list every week so you are eventually left with those who have not refused and not been verbally invited. Aim for nil by early January. Everyone will have either had the jab, refused the jab or been verbally offered the chance to have the jab. I think that’s the more sensible target we should aim for.
- During the flu campaign season, we have found using a specially designed flu guideline/template very useful. This allows us to instantly identify why the flu jab is needed, when it was given, whether the patient has already been rung, or whether they have refused. It also provides links to PGDs and local guidance. It means we don’t have to flick through clinical records and saves time. The GPs administer a jab every 45 seconds, which just about gives us time to say:‘hello, are you well?’; administer the pre-filled vaccination; use keyboard express to record the dose and batch; and reference the guideline where someone is under 65 years, to check criteria.
- Once the initial rush of flu clinics has passed, offer the remaining eligible patients open-access slots so they don’t have to make an appointment. We ring patients each day and offer them the chance to turn up anytime between 9am and 10am, or 3pm and 6pm. This will encourage increased uptake.
- To reach the house-bound, nurse practitioners and GPs support the district nurses and do a good number of patients themselves.
- Dr Mark Goodwin is a partner at the Afan Valley Group Practice in Port Talbot, South Wales.