Peterborough Locality: Improving MMR vaccination uptake in response to an outbreak in a neighbouring system

Overview

Peterborough Locality Integrated Neighbourhood Team, within the North Cambridgeshire and Peterborough Care Partnership, supported Thistlemoor practice to improve MMR vaccination uptake in response to an outbreak in a neighbouring system.

Key outcomes

• Within three weeks of interventions, MMR uptake increased by 208 per cent to baseline data.

• Uptake rose 270 per cent across January and February 2024, 

• DNA rates reduced due to introducing simple online booking.

What the organisation faced

Thistlemoor practice serves around 30,000 patients in central Peterborough. The patient population experiences high levels of deprivation and is highly diverse, with 120 languages spoken in the area. With an atypical young population, the practice has seen children over five steadily rising from 2,240 in 2021–22 to 2,370 in 2023–24, increasing the capacity required to deliver routine childhood immunisations and maintain coverage in line with national targets. Among children under five, the main ethnic groups are Eastern European (45 per cent), English (10 per cent), and Punjabi/Kurdish (8 per cent), highlighting the need for culturally tailored services.

The practice has previously delivered effective population health interventions but often struggles with the capacity and resource to sustain the required level of activity across a range of services. In recent years, challenges delivering vaccinations had increased, and uptake had declined.

In 2024, the practice was identified as among the lowest scoring practices for MMR uptake in the ICS, with only 55 per cent of patients taking up the vaccine. This raised significant concern given it was below the 95 per cent required for herd immunity, and neighbouring system Birmingham and Solihull was experiencing a measles outbreak. With fears that the disease may begin to spread across Cambridgeshire, the ICS worked with primary care networks and practices to improve vaccination rates.

What the organisation did

With support from neighbourhood partners across the Peterborough Locality including the ICS, Public Health and the North Cambridgeshire and Peterborough Care Partnership, Thistlemoor Medical Centre delivered a targeted programme of practice support and patient engagement. The programme adopted an integrated neighbourhood approach to address the needs of their population. Fortnightly project group meetings brought together the ICS vaccination team, public health in Peterborough, and the neighbourhood team to drive the project.

Messaging and communication

Call/recall was identified as one of the most impactful interventions in improving uptake, so practice staff began a case-finding exercise using clinical searches to identify patients who had not received the vaccine. These patients were then engaged through the call/recall service and a total of 5,373 invitations were sent by text message to around 95 per cent of parents of children under five who had not yet had the vaccine.

The practice also focused on improving the accessibility of public health messaging for patients with English as a second language, who made up most of the practice list. They launched a social media campaign sharing resources in multiple languages and providing targeted myth busting on vaccine misinformation. In addition to the social media campaign, the practice worked with staff to drive conversations around vaccine hesitancy and safety in practice. The staff of Thistlemoor are part of local communities and speak the same range of languages as their patients. Staff were supported to engage with patients in their preferred language and have discussions that allowed patients to ask questions and learn about the benefits of vaccination.

To reach patients beyond the practice, Thistlemoor also sent staff out into the community. In one example, trainee GPs from Thistlemoor attended a parents evening at the local school to deliver a talk on the benefits of vaccination for pupils and parents. To support additional outreach, the ICS used funding for access and inequalities to provide vaccination staff to attend community groups including those for vulnerable communities, such as asylum seekers. These staff ran education sessions and brought vaccines, which they delivered to willing patients following each session.

Ease of access (capacity and booking)

To improve patient uptake, the practice team sought to improve access. The surgery held seven additional clinics in partnership with NHS Reservists and Hertfordshire Community NHS Trust between January and March 2024, including Saturday sessions, and two walk-in clinics. Additional clinics were also provided during the February half term holidays, to encourage maximum attendance from families.

In addition to increasing the volume of available appointments, the practice used digital booking systems to simplify the total access process. To encourage patients to book, links to the digital booking service were sent directly to patients via text message. 132 appointments were booked through the text links, equating to 80 per cent of all booked appointments. Using text messages also saved around 15 hours’ worth of calls out to patients, and reduced DNAs by offering patients more choice of times.

Results and benefits

• Within three weeks of interventions, MMR uptake increased from 55 per cent of patients to 68 per cent – an increase of 208 per cent compared to baseline data.

• Uptake rose 270 per cent across January and February 2024, 

• The simple online booking system led to a reduction in DNA rates.

• Using text messages also reduced DNAs by offering patients more choice of times, while saving around 15 hours’ worth of calls out to patients.
• In the seven additional clinics there were approximately 35 attendees per clinic, ultimately vaccinating 245 patients. Of those vaccinated, almost 61 per cent were English-speaking patients, and 39 per cent were non-English-speaking patients, demonstrating the practice’s reach across its diverse population.
• By creating a range of materials in the languages spoken locally, patients were able to access the information they needed. By encouraging multilingual staff to have conversations with patients in their preferred language, the team was also able to make patients feel more engaged in the process, and to answer questions about vaccination safety. 

Challenges

• Health literacy: Many patients with English as a second language were not benefitting from previous vaccination information materials. There are still patients in the area that the team is working towards supporting, including the local Romanian community which currently experiences high levels of distrust for health professionals and is not represented in the languages spoken by practice staff.
• Sustainability: Thistlemoor has shown that the team can have a significant impact when they commit energy and resources to a project. However, capacity and resource are limited, and the result is a ‘boom and bust’ process of delivering temporary improvements before having to move onto the next priority project.

Key learning

• Impactful communications: The team found that by making the tone of campaigns more serious, and providing information on the impact of measles, patients were more likely to respond to offers of vaccination.
• Patient engagement: Patients appreciated being able to have an in-depth discussion with staff at appointments or community events. Making time for these discussions and making them accessible to patients with English as a second language, supported patients to make more informed decisions about their care.
• Complacency can be overcome: By making appointments easier to book and directly sending the link out to patients mobilised some patients who had become complacent about booking and were ‘getting around to it’.