In 2022, CEG launched a programme in North East London to make it simpler for GP practices to call children for the right vaccination at the right time. An evaluation of the programme, published in Vaccine, found that the proportion of children receiving their first measles, mumps and rubella (MMR) vaccination on time increased by 4.1% (77.7% to 81.8%) as a result. This equates to 92 additional children being protected every month, or more than 1,100 children a year.
North East London has high levels of deprivation, a diverse, mobile population, and some of the lowest childhood vaccination rates in England – the success of the programme here is a proof-of-concept for what works to improve timely vaccination in the areas that need it most.
Measles is a serious infection that can have life-changing consequences for some children, but it is preventable by vaccination. The World Health Organization recommends that 95% of children are vaccinated to prevent a measles outbreak, but no region in England is currently meeting this target. North East London has some of the lowest rates of protection in the country. Primary care is under significant pressure, so CEG is working with stretched local NHS teams to help them protect more children on time.
This locally-led programme includes a free software tool, called ‘APL-Imms’, that helps GP practices navigate the complex childhood immunisation schedule. The tool uses data from the practice’s health records to list all children who are approaching their due date for vaccinations. Its algorithm accounts for 16 pre-school vaccine doses administered on seven separate occasions, for every child registered at the practice. This tool runs without any health data leaving the GP practice, which maintains patient confidentiality while making information actionable by healthcare professionals. The tool was built in-house by CEG, and devised locally by CEG GPs and facilitators who work in, or closely with, GP practices in the area.
The programme also includes CEG ‘primary care facilitators’ - team members who go out to GP practices and help staff embed the tool into their processes. The evaluation found that these visits were key to the programme’s success - practices using the tool who also had a facilitator visit improved almost twice as much as those who did not.
In response to an anonymous survey sent to users by CEG, a practice administrator/ manager in City & Hackney said: “The tool makes managing what can be a complex area easy to understand. I use it weekly to call those that are due that week. This was not happening prior to the tool, and it has proven to be successful in ensuring that children get the right vaccines at the right time.”
Two years into the programme, GP practices maintained their success, but the rate of improvement levelled off. Interviews conducted as part of the evaluation revealed that staff found it difficult to sustain the initial rate of improvement without the resources for more flexible appointments, or the time to address parents’ questions about the safety and side effects of the MMR vaccine.
Few GP practices in North East London are receiving funds to support their continued efforts to deliver timely MMR vaccination. The Quality and Outcomes Framework (QOF) is a major incentive scheme for GP practices across England. It incentivises the first dose of MMR, however last year the minimum threshold for payment was still out of reach for half of all practices in North East London, which means that despite improving they received no payment for that indicator. Insights from the evaluation interviews suggests that some practices are prioritising other QOF targets because they are more achievable and therefore practices are more likely to be reimbursed for their work.
Dr Milena Marszalek, local GP, lead author of the evaluation and research fellow at CEG, said: “The success of our programme demonstrates it is possible to deliver more vaccinations on time by simplifying the process using digital tools and facilitator support. This is an exciting prospect for other areas of the country with a similar CEG-style support model in place.
“Despite the improvement we’ve seen, MMR immunisation rates are still below the levels needed to prevent measles outbreaks – GP teams in the region are working incredibly hard to deliver vaccinations on time, but to reach the WHO targets practices need achievable financial incentives that support our efforts.”
Professor Carol Dezateux, co-author and Professor of Epidemiology and Health Data Science, said: “This tool is especially relevant in North East London, where diverse and mobile communities have some of the lowest childhood vaccination rates in England. We will be taking our findings to the NHS Integrated Care Boards in north east London to discuss how a local incentive scheme can be devised to better support local practices and avoid costly catch-up programmes and disease outbreaks.”
This programme was made possible by an existing fully-funded collaboration between the Clinical Effectiveness Group at Queen Mary University of London and North East London Integrated Care Board (ICB), with additional funding from Barts Charity, London Health Data Strategy partners, the NHS Digital First programme in North East London, and NIHR School for Primary Care Research.
Victoria King, Director of Funding and Impact at Barts Charity, said: “The proportion of children protected against vaccine-preventable infections such as measles, polio, and whooping cough has dropped sharply in recent years and this work, supported by Barts Charity, demonstrates ways to increase the timely receipt of the first routine MMR vaccine for young children in Northeast London, this protects their health especially against the backdrop of rise in measles outbreaks.”
Luke Readman, Director of Digital Transformation NHS England (London Region), said: “I congratulate the Queen Mary University Of London team on their success in increasing the timely uptake of child vaccinations. As one of the OneLondon Pathfinder Projects we were delighted to support this pioneering work to help us learn valuable lessons about joining up and using data across the Capital. The insights from this successful project will support our work to develop the OneLondon Secure Data Environment that will be a world leading resource for health and care improvement in London.”
Chris Griffiths, Professor of Primary Care, and Research Lead for the NIHR School for Primary Care Research at Queen Mary, said: “Queen Mary’s membership of the NIHR School for Primary Care Research has enabled this rigorous evaluation, contributing important evidence of what works to support primary care in vaccinating children on time. The funding has also enabled a local GP, Dr Milena Marszalek, to develop her academic skills and put these to use to improve population health in the community.”
The evaluation is a mixed-methods study, comprising a time series analysis of vaccination data from health records, and thematic analyses of interviews and “think aloud” exercises (where researchers listened to and observed practice staff using the APL-Imms tool for the first time). Using both methods provides better insight into how the tool was used on the ground and its impact.
The evaluation interviews allowed the programme team to engage with users of the tool and respond to their ideas to improve it. The ongoing programme follows an iterative cycle of listening and improvement - the current APL-Imms version 3, released in September 2024, includes additional features co-developed with users.