Transfer of vaccination commissioning responsibility: what you need to know
Key points
Over the past decade, uptake rates for most vaccination programmes in England have fallen and significant variation exists.
The recently published Model Region Blueprint of the new NHS operating model in England confirmed that NHS regions will transfer their responsibility for all commissioning, including vaccinations, to integrated care boards (ICBs) following legislation in April 2027.
Ahead of this transfer of commissioning responsibility, ICBs will work closely with their regional teams to prepare for additional responsibility and functions.
To support the delivery of vaccination programmes as greater responsibility is transferred to ICBs, health leaders have called for the national prioritisation of vaccination, a redesign of the contracts governing vaccine delivery, sustainable funding that supports a year-round prevention offer, consistent evaluation of vaccination programmes and improved data availability and sharing. Locally, there is a need for flexibility for local providers to design contracts and deliver services that reflect local need, clarity over local ring-fenced funding and investment in communications.
While there are benefits to the transfer of responsibility to local teams, engagement with NHS Confederation members has highlighted barriers to vaccination programme delivery and uptake that are currently standing in the way of locally tailored outreach and programme delivery.
In advance of the transfer or responsibility, a number of success factors have been identified to underpin vaccination programme delivery and to improve vaccination uptake, with three key themes: improving access and stimulating demand, targeted outreach to support uptake in underserved populations, and a joined-up prevention and vaccination offer.
This briefing provides a background to the transfer of vaccination commissioning delivery, highlights the barriers and critical success factors for successful vaccination delivery, and recommends national and local enablers to improve vaccination programme delivery and uptake.
This briefing is part of a project that has been supported by the Association of the British Pharmaceutical Industry (ABPI) and provides examples and insights from a range of vaccination programmes, which are available on our vaccination hub.
This briefing provides background to the transfer of vaccination commissioning delivery, as well as national and local recommendations to improve delivery and uptake ahead of the transfer of commissioning responsibility.
Overview
Following legislation changes expected in April 2027, NHS regions will transfer their responsibility for all commissioning to ICBs, including the commissioning of vaccinations. This is a core component of the Vaccination Strategy, which aims to reduce morbidity and mortality from vaccine-preventable diseases by increasing vaccination uptake and coverage, particularly in underserved populations.
Ahead of this transfer of commissioning responsibility, ICBs will work closely with their regional teams to prepare for additional responsibility and functions.
These structural changes present an opportunity to consider the local provision and delivery of vaccination programmes, alongside a focus on transferring commissioning responsibilities, to improve the uptake of vaccinations.
To support ongoing national work on commissioning as part of the Vaccination Strategy, the NHS Confederation has engaged with our members to understand the barriers to – and critical success factors for - the effective provision and delivery of vaccination programmes and to gather case studies of programme delivery. This project has been supported by the Association of the British Pharmaceutical Industry (ABPI).
Why a focus on vaccination is needed now
Over the past decade, uptake rates for most vaccination programmes in England have fallen and significant variation exists. For example, since the 2021/2022 flu season, flu vaccination uptake among those aged 65 years and over and those under 65 in clinically at-risk groups has fallen year on year. During the 2024 to 2025 season uptake was 74.9 per cent among those aged 65 and over, and 40 per cent in those aged six months to under 65 years in one or more clinical at-risk group. Human papillomavirus (HPV) vaccination coverage has been steadily declining and current HPV vaccine coverage remains lower than pre-pandemic levels. Across the childhood immunisation programme, there has been a ten-year decline in pre-school immunisation and none of the routine childhood vaccinations have met the World Health Organization’s 95 per cent coverage target since 2021. For example, MMR1 coverage at five years decreased to 91.9 per cent - the lowest level since 2010-11 and Hib/Men C coverage displayed the largest year-on-year decease of all coverage measures in 2023-2024, falling to 89.4 per cent.
Current data masks variation in uptake
There is a need to maximise uptake and coverage for all communities, particularly deprived communities, minority ethnic groups, and those not registered with a healthcare provider. This begins with targeted information and a convenient front door to services. However current data availability makes it difficult to target outreach to these groups. Without this data, strategic commissioning and population health management (PHM) approaches could be impacted.
Fall in flu vaccinations for health and social care staff
Frontline healthcare worker uptake of flu vaccination is variable across the country, but has fallen to its lowest level in almost 15 years, with uptake rates across frontline healthcare workers in NHS trusts and GP practices at 37.8 per cent. (Based on a response rate of 92.3 per cent in NHS trusts and 9.6 per cent in GP practices). Data for the 2024/2025 season, although not comparable to previous seasons due to the later start date of the vaccination campaign, indicates the fourth consecutive season of falling vaccination uptake in frontline healthcare workers. In social care settings uptake is also low. Within the 99.1 per cent of older adult care home providers who had updated their seasonal vaccination data as of March 2025, 13.6 per cent of total staff had received a flu vaccination for the 2024 to 2025 season.
ICBs are experiencing differing levels of readiness for additional vaccination responsibility
Research published in 2025 on ICB readiness for the transfer of vaccination commissioning found that there was a good perceived level of knowledge of the upcoming transfer of responsibilities among those ICBs surveyed (n=20). However, barriers remain and some level of support is required to prepare. The Model Region Blueprint published in September 2025 confirms that regions will transfer their responsibility for all commissioning including specialised services, health and justice, vaccinations and screening and primary care services that are already delegated to ICBs following legislation in April 2027. This provides a window of opportunity to consider the delivery of vaccination services alongside a focus on commissioning.
Build on Covid-19 learnings
Covid-19 vaccine deployment was largely independent to other programmes. While the Covid-19 vaccination programme provided learnings for wider vaccination programme delivery, the operating model now needs to be brought alongside other programmes and build on the learnings in a new operating context.
How can the current policy landscape support improved uptake?
The decline in vaccination uptake rates has been well recognised within national policy, with policy commitments to support uptake across vaccination programmes and to equip systems as they take on increasing responsibility for vaccination programme commissioning and delivery. The table below shows the vaccination commitments in the 10 Year Health Plan, NHS England’s Urgent and Emergency Care Plan, and the NHS Vaccination Strategy.
Barriers to vaccination programme delivery
NHS Confederation members have told us that several barriers stand in the way of vaccination programme delivery:
Complex contracting and procurement policies
Currently there are multi-point, and multi-layered contracts that can delay programme delivery, require significant workarounds, create siloed working between providers including pharmacy and general practice, and impact how and where services are delivered.
Limited and fragmented funding
This can impact development of bespoke outreach services and fragmentation of funding meaning it is not clear which funding streams can be used to support outreach programmes.
Challenges when moving vaccines between providers
This can put pressure on existing supply and lead to siloed working between organisations.
Variable data availability
This can make it difficult to develop targeted outreach programmes. Sharing data between providers was also cited as a barrier to programme delivery.
Limits to the vaccinator workforce
The Human Medicines Regulation 2012 governs how medicines and vaccinations are developed, tested, authorised marketed, distributed and used and sets out who can administer vaccinations. Members have expressed concern that the regulation limits the vaccinator workforce and without updates, the full potential of vaccination delivery is not being realised.
Barriers to uptake
These include language, trust and cultural barriers, health literacy and service accessibility.
Barriers to booking
These include low levels of digital literacy, variation between booking systems and availability of online booking.
Declining population demand for vaccination
This results from factors including low vaccine confidence, complacency or lack of understanding of the risks of vaccine-preventable disease, difficulty prioritising vaccination and vaccine fatigue. While there are many factors for this, changing attitudes and vaccine fatigue following the Covid-19 pandemic were cited as key reasons.
Growing online misinformation and disinformation
This includes on social media, which can impact vaccination uptake amongst citizens and staff.
Variable approaches to programme evaluation
This can make it difficult to evaluate and quantify the effectiveness of outreach programmes.
Critical success factors for vaccination programme delivery
Drawing on successful examples from health leaders across the country, we have identified key success factors that underpin effective vaccination programme delivery and address the barriers highlighted above. These themes are explored further in our vaccination hub:
Improving access and stimulating demand
Provision of vaccination services in a range of settings and at convenient times
Access to vaccination services in multiple settings and providers, including mobile clinics, is important for building trust with communities. These services need to be supported by a range of ways to book, balancing pre-bookings (including online) with walk in appointments.
A focus on improving demand alongside access
Combining a focus on access to services is key, with initiatives that encourage demand through information provision and targeted outreach.
Vaccination delivery by multidisciplinary teams
Using staff from across the NHS workforce to vaccinate in convenient community settings can lead to improved programme uptake. This needs to be responsive to local need, recognising that different population groups may respond differently to different healthcare professionals.
Targeted approaches to staff vaccination
Staff vaccination programmes need to be delivered at convenient times and in accessible locations for staff, with targeted communication programmes that address any concerns.
The timing of vaccination campaigns needs to be considered
Case studies show that demand declines around religious or major holidays, and this must be considered when planning and evaluating services.
Targeted outreach to support uptake in underserved populations
Flexible and agile outreach approaches
Using flexible approaches to outreach enables local leaders and providers of vaccination services to tailor interventions to local needs.
Community activation
Approaches that build relationships with communities, including the voluntary, community and social enterprise (VCSE) sector are key to tailoring approaches and understanding community need. Working with vaccination champions has been identified as one way to support improved awareness of programmes.
Evidence-based communication and targeted messaging
Using evidence-based communication approaches, campaigns and targeted messaging that address any concerns or hesitancy around vaccination, are tailored to specific communities, reading levels and translated where needed, can improve health literacy and uptake but must be delivered alongside an active engagement plan.
Call and recall services
Targeted communication using different channels can build trust and support, informed by community insights and call and recall services that facilitate one-to-one conversations between patients and clinicians.
Data and local insights that can be shared between providers
Using quantitative data and ‘soft data’ including local community insights can shape approaches to targeted local outreach, engagement and follow up.
Local collaboration
Where programmes are delivered across practices or providers, a collaborative approach that makes use of shared resources and local insights can minimise duplication and ensure services are tailored to need.
A joined-up prevention and vaccination offer
Sustained relationships and trust building by providing other prevention services prior to vaccination
Long-term relationships that start with wider health support and education can build trust. Once trust has been established, vaccinations can be introduced into discussions with patients. These relationships must be managed year-round.
Recommendations for change and key actions for members
To support the delivery of vaccination programmes that are underpinned by these critical success factors, we have identified the following national and local enablers.
How we are supporting members
The NHS Confederation will work with members to prepare for the transfer of vaccination commissioning by April 2027 and will continue to collate case studies that showcase different ways of vaccination programme delivery.
We will also continue to engage with NHS England, DHSC and UKHSA on behalf of members to represent their views on the reality of delivering vaccination programmes in the current environment and to showcase the different approaches being taken to programme delivery.
