Seasonal NHS Influenza Immunisation Programme. Planning across South West 2018/19

Transcription

1 Seasonal NHS Influenza Immunisation Programme Planning across South West 2018/19

2 About Public Health England Public Health England exists to protect and improve the nation's health and wellbeing, and reduce health inequalities. It does this through world-class science, knowledge and intelligence, advocacy, partnerships and the delivery of specialist public health services. PHE is an operationally autonomous executive agency of the Department of Health. Public Health England Wellington House Waterloo Road London SE1 8UG Tel: Facebook: Prepared by: The South West Screening & Imms team For queries relating to this document, please contact: Crown copyright 2014 You may re-use this information (excluding logos) free of charge in any format or medium, under the terms of the Open Government Licence v2.0. To view this licence, visit OGL or Where we have identified any third party copyright information you will need to obtain permission from the copyright holders concerned. Any enquiries regarding this publication should be sent to [insert address]. Published September 2018 PHE publications gateway number: 201XXXX This document is available in other formats on request. Please 2

3 Contents About Public Health England 2 Executive summary The National Flu Plan 2018/ Implementation of the National Flu Plan across South West 2018/19 7 Appendix B1 17 Appendix B2 22 Appendix C 26 Appendix D 27 3

4 Executive summary Flu occurs every winter in the UK and is a key factor in NHS winter pressures. It impacts on those who become ill, the NHS services that provide direct care, and on the wider health and social care system that supports people in at-risk groups. This Flu plan aims to reduce the impact of flu in the population through a series of complementary measures. The national flu immunisation programme is a key part of the plan and it is being extended to children in a phased roll-out. Vaccinating children each year means that not only are the children protected, but also that transmission across the population is reduced, lessening the overall burden of flu. Implementing this programme is therefore an important contribution to increasing resilience across the system through the winter period. Results from the implementation of the primary school childhood flu programme are encouraging, with reduced numbers of GP attendances for influenzalike illness and reduced emergency department respiratory attendances in all age groups. We anticipate that the children s programme, once fully implemented, will avert many cases of severe flu and flu-related deaths in older adults and people in clinical risk groups. But we should continue to work hard to ensure that we are communicating the benefits of the vaccine among all recommended groups, making vaccination as easily accessible as possible, including for frontline health and social care workers. In addition to immunisation, influenza antiviral medicines and a range of other measures aimed at reducing transmission of flu and other respiratory virus infections (in particular good hand and respiratory hygiene) are vital elements in reducing the impact of flu each year and plans to improve these will be developed alongside this plan. This is the 8 th Flu plan to be published. It supports a co-ordinated and evidence-based approach to planning for the demands of flu across South West England. It is based on, and makes reference to the National Seasonal Influenza Plan which has the support of the Chief Medical, Pharmaceutical and Nursing Officers and the PHE Chief Nurse, and the outcomes detailed in the South West Seasonal Influenza Programme Annual Report 2017/18. The purpose of this plan is to outline to colleagues across the South West the activities that have taken place to prepare for the 2018/19 flu season and to outline actions and accountabilities which will inform and support the effective delivery of the Seasonal Flu Immunisation programme across the South West d the 2018/19 Flu season. We hope that you find it useful in preparing for this coming winter. Yours, Dr Julie Yates Lead Consultant for Screening and Immunisation South West 4

5 1.0 The National Flu Plan 2018/ The National Flu Plan 2018/19 The National Flu Plan (Flu Plan) 2018/19 sets out a co-ordinated and evidence-based approach to planning for and responding to the demands of flu across England, taking account of lessons learnt during previous flu seasons. It aids the development of robust and flexible operational plans by local organisations and emergency planners within the NHS and local government. It provides the public and healthcare professionals with an overview of the co-ordination and the preparation for the flu season, and signposting to further guidance and information. The Flu plan includes details about the continuation of the extension of the flu vaccination programme to children, which is being implemented gradually due to the scale of the programme. 1.2 The strategic intentions: The aim of the NHS influenza immunisation programme is to protect those who are most at risk of serious illness or death should they develop influenza, and reducing transmission of the infection in the population, thereby contributing to the protection of vulnerable individuals with suboptimal response to their own immunisation and individuals who are unable to receive the immunisation directly. This will be achieved by: increasing immunisation uptake rates, in accordance with the vaccine uptake ambitions set out in the annual flu letter 1, for all children aged 2 to 9 years, aiming to maximise uptake, raise the performance in the lowest performing areas, and ensure an even spread across these age cohorts delivering the programme in general practice for pre-school children or, usually, in schools for school-aged children. Immunisation of children in these cohorts will improve protection for them and for the wider community continuing to offer flu immunisation to all who are eligible, and to seek to increases in vaccine uptake among clinical risk groups, pregnant women, health and social care workers maximising protection by immunising the eligible population as early in the season as possible improving patient access (eg through the continued provision of flu immunisation via GP practices, schools, pharmacies, and other settings such as maternity services) promoting recording of all activity data by all providers in a format such that accuracy of uptake data is improved

6 1.3 Objectives The objective of the National Plan is to minimise the health impact of influenza through monitoring, prevention and treatment, including: actively offering flu vaccination to 100% of all those in eligible groups, through an active call/recall process vaccinating of at least 75% of those aged 65 years and vaccinating of at least 75% of healthcare workers with direct patient contact improving uptake for those in clinical risk groups to at least 55%, particularly for those who are at the highest risk of mortality from flu but have the lowest rates of vaccine uptake for pre-school children, achieving a minimum uptake of 48% For school age children, achieving an average of at least 65% across each school year vaccinating those in long stay residential homes providing direct protection to children by extending the annual flu immunisation programme to include school year 5, and also cutting the transmission of flu across the population monitoring flu activity, severity of the disease, vaccine uptake and impact on the NHS providing public health information to prevent and protect against flu managing and implementing the public health response to incidents and outbreaks of flu These objectives have been incorporated into the local South West plan as follows: 6

7 2.0 Implementation of the National Flu Plan across South West 2018/ Aim To provide a single, robust operational plan to be used across the South West to support health and social care partners to deliver the 2018/19 annual flu immunisation programme effectively and safely and in accordance with the strategic intentions of the national plan. 2.2 Objectives To gain assurance of programme delivery including that: providers are delivering the programme as per the service specification, including offering the correct vaccination to specific eligible cohorts providers are signed up to and working according to contractual agreements 100% of eligible patients are identified and invited providers have ensured access to an appropriate and adequate supply of vaccine vaccination records are maintained in accordance with national and local requirements Hospital and community providers, GP practices, and social care providers are delivering the FHCW programme and are supporting the programme for eligible patient through raising awareness, signposting and / or delivering vaccines to eligible people where appropriate The local programme includes access to vaccination for Social care staff and those working in the independent Hospice section To monitor flu immunisation uptake in eligible patient groups and for Frontline Health and Social Care Workers throughout the flu season and to work with providers to encourage them to achieve national targets,including supporting CCGs to deliver the Frontline Health Care Worker CQUIN To support the commissioning and delivery of the programme to maximise uptake in accordance with national priorities and locally agreed strategies To oversee the implementation of a region-wide integrated, collaborative, multi-agency communication strategy 7

8 2.3 Flu programme oversight Planning for the 2018/19 Flu season commenced in April 2018 with a full debrief and review of the previous season s outcomes and activities. The outputs from this consensus conference, which was held with members of all organisations who contributed to the planning and delivery of the programme and system response in 2017/18 have been used to inform the identification of priority areas for action and for the wider development of this plan. This year there will be single oversight and a single plan (this plan) covering the whole of the South West geography. Two locality sub-groups of the Strategic Flu Group will run in parallel covering the north and south localities within the southwest in order to enable flexibility to account for local population needs. The purpose of the North and South Strategic Flu Groups is: To provide system leadership and strategic oversight for the planning and implementation of the 2018/19 seasonal flu immunisation programme. To ensure effective monitoring during the flu season to ensure issues and areas of concern are identified and rapidly addressed thoughout the season. To enable any additional activity to be implemented promptly as required to mitigate any risks To ensure robust evaluation post season to inform planning for the 2019/20 season. The terms of reference for these groups is provided at Appendix A. These groups will meet virtually (by webex) on a monthly basis between September and March and will be facilitated by a Screening and Immunisation Lead from the SW SIT. The two sub-groups will be brought together in face to face joint meetings in July, September, December to ensure full South West system-wide oversight and to enable networking and sharing of good practice across the region. These meetings will be chaired by the Lead Consultant for Screening and Immunisation for the South West. The area covered by each locality sub-group will be as follows: North: B&NES, Gloucestershire, Swindon, Wiltshire, Bristol, North Somerset, & chaired by the Lead Consultant for Screening and Immunisation South West. South Gloucestershire South: Devon, Cornwall & Isles of Scilly, Somerset and Dorset Representation is expected from all partner organisations (as listed at the front of this document), and across all localities. Both locality based Flu Groups will follow the same standing agenda format. A single SW action plan will be developed and will be monitored by the locality and steering groups (See Appendix B 2). This plan will be continually updated throughout the season to reflect any additional needs identified. 8

9 The responsibility for updating the action plan rests with the SIT (specifically the Screening and Immunisation Co ordinators and Managers). Oversight and accountability rests with the Screening and Immunisation Leads responsible for leading the programme. Stakeholders will be required to provide a local monthly update on the progress of the programme within their areas of accountability / geographical area, and on any other issues by exception which require the support of the steering group and / or further escalation to the Screening and Immunisation or national teams. This update is required 2 weeks prior to the formal meeting and provides a potential mechanism for rapid identification of emerging issues. A template reporting form is detailed at Appendix C. Additional informal communication will occur between stakeholders and the Screening and Immunisation Team to ensure that any urgent issues can be notified and addressed outside of this formal mechanism, as required. 2.4 Delivery of the programme: assurance Planning and delivery of the seasonal flu programme involves many different providers and commissioners. For 2018/19 the programme includes GP delivery (for individuals in all eligible groups), a national advanced pharmacy service (for any eligible adult), a schools based programme for healthy school aged children in reception year 5, vaccinations being offered in ante-natal care settings, and vaccination of Front line Health and Social Care workers at their place of work, via General Practice or via Pharmacy. A key role of the Strategic oversight group is to gain assurance that all of these programmes are being delivered effectively within a multi-agency health system and to be able to provide assurance on the performance of the South West programme to local, regional and national system leaders. The national flu plan states that NHS England teams need assurance that providers have robust plans in place to meet or exceed national uptake targets, and that providers can identify all eligible at-risk patients and two-nine year olds. The use of the GP checklist continues to be recommended as a tool to achieve this assurance (See Appendix B). Commissioners also need to be able to demonstrate that there has been a 100% active invitation for immunisation to all those eligible, including children. NHS England will seek assurance that the GP checklist is being used and that all those eligible are offered vaccination. NHS England will address performance and any contractual concerns with providers, in particular they will actively monitor Frontline Health Care Worker uptake rates in GP Practices and seek evidence that all eligible patients are personally invited for a vaccination. This will be achieved via surveys out to all GP practices, with active follow up of nil returns. Additional assurance relating to this, and any other eligible groups, will be provided through completion of all local, regional and national information and data returns as required. 9

10 Monitoring flu vaccination uptake The review of uptake data before, during and after the flu season is vital in order to be assured of the effective performance of the programme and to identify areas where particular focus is required to achieve improvement. The Screening and Immunisation Team (SIT) will monitor data on uptake via a number of different sources (ImmForm, PHE weekly sentinel and NHSE digital weekly data) and will provide monthly data to GPs and all other stakeholders via the locality flu sub- groups, in order to inform further planning and delivery of the programme. In addition, the team will send individually tailored reports to GP practices that detail both their uptake of vaccinations amongst at risk groups and the numbers of patients that have not received vaccinations,therefore resulting poorer outcomes for patients and potentially missed income for the provider. An initial report will be sent prior to the flu season as a baseline, detailing the figures for the 2017/18 season. This will be repeated periodically throughout the 2018/19 season to ensure that practices are aware of their progress both individually and in relation to other practices in their locality / CCG. Appendix D provides an example of data reports that will be produced. The SIT will also work closely with PHE teams in Field Epidemiology and Health Protection to ensure that stakeholders are provided with surveillance data on Influenza like illness and outbreaks, on a regular basis throughout the season, in order that remedial action and responses are effectively joined up across the South West, where required. Improving uptake in priority groups National ambitions for improving uptake for eligible groups are detailed in the Annual Flu Letter 2. The South West Plan includes activities designed to meet these ambitions wherever possible. In addition, an end of season review conference, involving all key stakeholders, was held in March 2018 and priorities for additional focus during the the 2018/19 season, based on recognition of local needs, identified. As a result the following additional working groups have been established: Vaccines in Pregnancy: A successful Vaccines in Pregnancy workshop was held on 22nd June 2018 for NHS Trusts (maternity services), CCGs and other stakeholders. To build upon the good work of the group, and to continue to enhance the increased choice of setting for women in the South West to receive the flu vaccination, a Vaccines in Pregnancy network telecon for Trusts will be held monthly during the 2018/19 season and facilitated by the NHS England team. The telecon will enable providers to discuss

11 uptake, best practice and share learning, as well as providing an opportunity to review uptake and plan for the season. Offender Health: Flu vaccination in secure settings was identified as a priority during the 2017/18 season. To develop this workstream, a Secure Settings Group will be established. The group will meet via telecon monthly during the 2018/19 season with the aim of providing support, collaborating across localities and sectors and allowing facility for reporting uptake figures and issues as well as sharing good practice. The PHE Screening & Immunisation Team will be working with secure settings during the summer and autumn to provide training to prison staff to ensure those working in secure settings have a good understanding of the dangers of flu (for both themselves and patients) and the importance of flu vaccination. 2.5 Accountability Programme accountability is detailed in Diagram 1 11

12 2.6 Membership of the Strategic Oversight will include representation from the following stakeholders: NHS England Commissioning Public Health England Local Authorities/Public Health CCGs Local Pharmaceutical Committee Local Medical Committee PHE HPU NHS Regional Communications Health & Justice The north and South Strategic Flu Groups will meet monthly throughout the flu season (September to February). 2.7 Roles and Responsibilities Roles and responsibilities of group members are detailed in appendix A Appendix A South West Flu Planning Oversight Group Terms of Reference The aim of the NHS influenza immunisation programme is to protect those who are most at risk of serious illness or death should they develop influenza, and reducing transmission of the infection in the population, thereby contributing to the protection of vulnerable individuals with suboptimal response to their own immunisation and individuals who are unable to receive the immunisation directly. The purpose of the North and South Steering Groups is to: ensure that the seasonal flu programme 2018/19 is delivered effectively in line with the national flu plan monitor the progress of the seasonal flu 2018/19 action plan to agree actions to maintain and improve flu vaccination uptake to monitor and improve uptake for clinically at risk groups, pregnant women and children to support and oversee the extension of the flu programme to children to include school year 5 to be clear on flu outbreak strategy and national flu plan 12

13 Leadership Public Health England will provide leadership for the Flu Steering Groups. This will include: ensuring up to date and accurate partner representation on North and South groups agree Strategic Flu Group meeting dates including joint meetings between both groups prior to flu season ensure minutes of meetings circulated within one week of meeting maintain links with the NHS England Systems Resilience Group and Operations Directorate ensure that relevant groups feed in to the flu group (i.e. schools flu, FHCW, NHS England and PHE communications) Membership of the Steering Groups Membership and roles are detailed in the table below. Other representatives not part of the core membership may be in attendance should there be a specific item on the agenda. Role of representatives: NHS England: Public health Commissioning Team NHS England: Pharmacy Team NHS England: Medical Directorate NHS England: Medical contracting Public Health England: Screening & Immunisation Team a) Commissioning the flu vaccination programme under the terms of the Section 7A agreements b) Assuring that the NHS is prepared for the forthcoming flu season c) Monitoring flu vaccination services provided by GP practices, community pharmacies, school immunisation teams and other providers to ensure that services comply with the specifications d) Building close working relationships with Directors of Public Health (DsPH) to ensure that local population needs are understood and addressed by providers of flu vaccination services Implementation of the Advanced service contract, support via the main pharmacy contract, monitoring of participation, providing support to queries. Escalation of any issues Dealing with payment issues, monitoring and authorising payments Providing access to and advice on the NHS England PGD Professional impartial Meds Mgt advice to PHC team and SIT Implementation and monitoring of sign up of the ES, support via the wider GMS contract, monitoring of participation. CQRS, support and amendments linking in with the NHS commissioning team Escalation any contract issues. a) Planning and implementation of the SW seasonal influenza programme b) Monitoring and reporting of key indicators related to flu, including flu activity and vaccine uptake c) Maintaining oversight of local vaccine supply (including childhood) 13

14 d) Advising NHS England on the commissioning of the flu vaccination programme in relation to supporting the development of a collaborative approach to deliver the flu plan e) Supporting the management and coordination of local flu outbreaks. Heading on investigating management of incidents within the programme. f) supporting the development of a collaborative apporoach to public communications to promote uptake of flu vaccination and other aspects of combating flu such as hand hygiene g) Supporting DsPH in local authorities in their role as local leaders of health and ensuring that they have all relevant expert input, surveillance and population data needed to carry out this assurance role effectively h) Support to providers to ensure access to flu vaccination and to maximise uptake among those eligible to receive it Public Health England: Health Protection Team Local authorities, through DsPH CCGs GP practices a)facilitating planning for use of anti-virals in and out of season. b)provide surveillance of incidents and outbreaks of influenza at regular periods through the season c)planning for management of outbreaks and incidents d)ensuring appropriate health protection response to outbreaks in collaboration with local stakeholders e)managing and co-ordinating the response to local incidents and outbreaks of flu f)management and oversight of POC testing g)support delivery of communications as appropriate a) providing appropriate advocacy with key stakeholders and challenge to local arrangements to ensure access to flu vaccination and to improve its uptake by eligible populations b) providing leadership, together with local resilience partners to respond appropriately to local incidents and outbreaks of flu infection c) promoting uptake of flu vaccination among eligible groups, for example older people in residential or nursing care, either directly or through local providers d)promoting uptake of flu vaccination among those staff providing care for people in residential or nursing care, either directly or through local providers a) Quality assurance and improvement which extends to primary medical care services delivered by GP practices including flu vaccination and antiviral medicines b) CCG holds the CQUIN for FHCW c) Business continuity and emergency preparedness d) oversight of the delivery of antivirals a) Educating patients, particularly those in at-risk groups, about the appropriate response to the occurrence of flu-like illness and other illness that might be precipitated 14

15 by flu b) Ordering the correct amount and type of vaccine for their eligible patients, taking into account new groups identified for vaccination and the ambition for uptake c) Storing vaccines in accordance with national guidance d) Ensuring vaccination is delivered by suitably trained, competent healthcare professionals who participate in recognised on-going training and development in line with national standards e) Maintaining regular and accurate data collection using appropriate returns f) Encouraging and facilitating flu vaccination of their own staff In addition, GP practices are responsible for: g) Ordering vaccine for children from PHE central supplies through the ImmForm website and ensuring that vaccine wastage is minimised h) Ensuring that all those eligible for the flu vaccine are invited personally to receive their vaccine ensuring that antiviral medicines are prescribed for appropriate patients, once the CMO/CPhO letter has been distributed alerting them that antiviral medicines can be prescribed LPC LMC NHSE Comms a) Statutory representative of community pharmacies. b) The LPC will advise the group of any pharmacy issues with the delivery of the flu programme c) Provide updates to pharmacies and communicate issues in order to support improvements in flu vaccination uptake a) Statutory representative of general practice b) The LMC will advise the group of any practice issues with the delivery of the flu programme Provide updates to practices and communicate issues in order to support improvements in flu vaccination uptake a) Development of a collaborative comms planlinked to SWTW b) Management and oversight of the flu vaccination campaign during the season c) Provision of reactive comms in response to incidents or outbreaks of flu d) Reporting on public comms etc 15

16 Frequency of meetings Meetings will be held monthly from September 2018 until February Quorum At least one member from each of the NHS England Public Health Commissioning Team and Screening and Immunisation Team and at least two out of the Local Authority Public Health organisation is required for decisions to be quorate. In the event that the group is not quorate, decisions can still be reached but would need to be ratified by all quorate members via within one week of the meeting and be endorsed at the next meeting. Standing agenda items 1. Accuracy of previous minutes 2. Update on actions from previous meeting 3. Childhood flu programme and extension to children in schools years reception, one, two, three, four and five 4. Seasonal Flu work plan 2018/19 update (Public Health England) a. Flu vaccination uptake data to be shared within the group only b. Primary Care update and issues c. Frontline Health Care Worker d. At risk groups and pregnant women 5. Local Authority Update 6. CCG update 7. LMC Update 8. LPC Update 9. Seasonal Flu communication update from NHs England and PHE 10. AOB 11. Date of the next meeting Accountability and reporting arrangements The group has no executive powers but will report NHS England Directors, NHS England Heads of Public Health Commissioning, PHE South West Centre Director, and Directors of Public Health (DsPH) Health Protection Committees or equivalent. 16

17 Appendix B1 South West Flu Oversight Group Action Plan 2018/19 Item/Issue Action Document / Evidence 1 Regional Flu Insert feedback conference feedback 2 Promoting flu Check with CCGs insert letter ahead of season: that invitation letter templates for all eligible populations to be available. Send links to flu Gp toolkit letter to GP practices. Timeline / End Date 21 st March 2018? 30 June nd week of August National flu letters: develop local actions Send links to flu letter toschool providers. GPs providers to ensure a process for data returns via imm form is in place School vaccination providers to insure a process for collating and returning information regarding vaccinations contact comms team re messages school vaccination providers and GP practices send out early season Flu bulletin to GP's re pre planning flu clinics and vaccination ordering link with comms to develop a local comms toolkit, identify case studies develop a pilot project for outpatients and secondary care 17 August

18 (ICN's). 3 GP toolkit to be updated Local universities - ensure flu immunisation is on the curriculum for nursing and midwifery courses. Share lesson plans developed for teachers to use in schools with 4-8 yr. olds Need to agree format. As ongoing work review results of last seasons poor performers against last seasons performance. 4 Care home toolkit Care homes support to LAs re updates. Ensure care home pack (when updated is circulated). 30/06/2018 End of July 30/06/ GP questionnaire Send out 19/5/18 6 Social care questionnaire send social care survey to LA leads Attach DCIOS/BNSSSG questionnaire and BGSW one Send out 19/5/18 7 Create Webex update for all providers 8 Ensure access to training provision for all providers Develop the WebEx; distribute flyers/notice to providers 1 x maternity & 1 x general practice PDI international has agreed to provide this across all provider groups if required there is a cost Complete by end July send out by end August 30/06/ /06/

19 10 Ensure we have representation from all key stakeholders for strategic group meetings 11 Strategic flu meetings: Agree ToR send out monthly reminder to group with minutes to update any staffing changes At 1 st strategic meeting 22/06/ Confirm agreement to the stakeholder template reporting documents Include in LA template: Health promtion send letter to relevant partners to request support with targeting at risk groups add section to LA template, seek assurance that they have mechanisms in place to promote carer uptake Send out reporting template to strategic group members Annette please include template document At 1 st strategic meeting August 13 set up and jointly chair the Prison Flu Strategic Group, agree ToR 14 Undertake an evaluation of the 2017/18 provider FHCW programmes 15 Pharmacy Flu service: review the national service specification 16 School aged flu programme: Work with Rachel Campbell, PHE Lead for SW set up monthly FLHW telecon during flu season explore ways to improve Collaboration between GPs and Pharmacists to improve uptake (inc all adult patient groups) Support engagement with schools and parents 30/06/

20 Review contracts with special schools 30/06/ Maternity based flu delivery: Seek assurance that the providers have robust plans to maximise uptake in place, including identifying and individually call all eligible children, including those not at school, ensure that the consenting process is effective, appropriate supply of vaccine Update table of maternity providers Jane to update for BGSW 30/06/2018 training provision for community midwives send training details for PDI Identify heads of midwifery asap asap Vaccinations in pregnancy - workshop for maternity providers review of midwifery based models 22nd June /06/2018 initiate monitoring telecons for maternity providers 22/06/ Ensure all providers are aware of the definitions for carers, and patients with learning disabilities, housebound, obesity (BMI 40+) Put definition of carers and L&D in a newsletter request what arrangements are in place for house bound patients 20

21 20 Ensure arrangements in place to:- monitor performance of providers for each cohort of the vaccination programme at monthly intervals feedback data to providers, CCG and LA 21 Ensure that PGDs are disseminated to all providers when available 22 Public engagement Contact LMC's regarding data sharing with practice on a monthly basis Prepare a form of words for provider dashboards to indicate uptake and potential earnings create reports via mail merge for each GP practice detailing last years income and uptake review data sources (immform) re individual practice reports prepare template for GP level monthly data comparisons preparation of performance documents across the extended region identify high and low uptake for 2 and 3 year olds and target practice visits accordingly share the link via GP comms Identify PPI links August August August August August August 23 Dorset Identify CCG plans for Dorset 21

22 Appendix B2 South West Flu Strategic Action Plan 2018/19 Key area Objective Lead organis ation Timescale Pre-season planning and information sharing Stakeholders provided with up-to-date information as required in advance of flu season (separate pre planning checklist) Sept 2018 Processes in place for GPs and School vaccination providers to collate and return information regarding child vaccinations as appropriate Any pre-season required intelligence is collected from providers i.e. surveys to maternity, GP and social care providers Processes in place to remind providers of responsibility for completeness of offer to all eligible patients Contact address provided for flu vaccination related queries to the SIT Monitoring uptake Process in place to review immform monthly data at the strategic flu group meetings and identify any actions 3. Monitoring arrangements: 3 (a). mechanism in place to monitor performance of providers for each cohort of the vaccination programme at monthly intervals 3 (b) Member of SIT responsible for preparing data overviews for South West using monthly Immform data 3 (c) Members of SIT responsible for ensuring GP practice data is as complete as possible NHSE Sept 2018 Sept Rag rating North North updates Sept 2018 Via GP toolkit in bulletin Sept 2018 England.swscre eningan et Sept 2018 / NHS England / NHS England / NHS England Sept 2018 Sept 2018 Throughout season To seek missing practice figures Rag rating South South updates Via GP toolkit in bulletin England.s wscreenin To seek missing practice figures

23 3 (d) regular feedback of data to providers, CCG and LA with clarification of with whom the data can be shared Processes in place to monitor GP practice uptake for FHCWs Agreement attained from Local Authorities to provide independent scrutiny of the programme through Health Protection Committee groups Review uptake data to identify issues with completeness of offer Improving identification and uptake All Tailored support to areas providers for flu planning and implementation (to be focused on those with lowest performance if capacity does not enable Learni ng disabil ities 2,3, year olds uptake ambiti on at least 48% support to all) Processes in place to improve identification of patients with learning disabilities in order to make reasonable adjustments to improve uptake (e.g. Easy Read letter) Process in place to review uptake by CCG and take remedial action in line with ambition targets / NHS England NHS England / LMC Strategic group meeting dates Oct 2018 LAs Sept 2018 / NHSE LMC / / NHSE Throughout season Throughout season Sept 2018 Throughout season Schoo Processes in place for Throughout 23 before Immfor m submissi on closure First data due to be submitte d early Nov and availabl e mid- Nov First data due to be submitte d early Nov and availabl e mid- Nov before Immform submissio n closure First data due to be submitted early Nov and available mid-nov First data due to be submitted early Nov and available mid-nov

24 ls Clinica l atrisk under 65s uptake ambiti on at least 55% Pregn ant wome n uptake ambiti on at least 55% Over 65s - uptake ambiti on 75% Carers House bound Patien ts Care Home s ongoing monitoring of providers to ensure increased uptake across all age cohorts & seek assurance about completeness of offer Mechanisms in place for supporting engagement with schools and parents as required Process in place to review uptake in children aged six months to two years old Pregnant women, clinical at risk groups, under 65s (analysis presented to strategic flu groups) Implementation of midwifery-based model (with inclusion of pertussis in some localities) Mechanisms in place for monitoring of uptake in pregnant women and developing actions to improve uptake where required Providing access to training to community midwifery teams Identification of poor uptake at CCG and GP practice level. Actions developed to support providers. Communications sent via carer networks Agreement achieved for provision of flu (and where relevant, shingles and PPV) vaccination to housebound / long-stay residential patients Processes in place to monitor activity and uptake (amongst staff and residents) Independent and NHS/LA care homes and home carer organisations / NHSE season LA / Oct 2018 Throughout season NHSE Sept 2018 NHSE / Sept 2018 Aug 2018 Comms / LA NHS England contract s team Throughout season Oct 2018 Oct 2018 LA Sept 2018 LA Sept

25 Frontli ne Health care Worke rs mapped in each local authority Plan developed to improve uptake amongst social care staff, care home workers and residential care workers employed by the LA and privately PHE (SIT) to arrange and facilitate monthly FHCW stakeholder telecon monthly (during flu season) meetings Reporting process in place to ensure information from FHCW telecon is shared with strategic flu group Communications Integrated communications plan developed (to include FHCW in acute and community providers, GP practices and local authority staff) Plans in place to ensure timely, collaborative and local comms are provided (proactive and reactive) Targeted comms activities developed alongside partners as required Stay well this winter campaign supported Health & Justice Mechanisms in place to ensure access and promotion for eligible patients through support from prison health and secure settings Reporting processes in place from Secure Settings flu group with any issues identified and actions developed LA / Oct 2018 Throughout season Telecon dates arrange d Sept 2018 Standin g agenda item NHSE / PHE comms NHSE / PHE comms PHE / NHSE / comms / LA NHSE / PHE Health & Justice Team / PHE Health & Justice Team / Sept 2018 Sept 2018 Throughout season Sept 2018 Sept 2018 Throughout season Telecon dates arranged Standing agenda item 25

26 Appendix C Example of Monthly update reports provided by each stakeholder for review at the Strategic Flu Group Meeting: Flu Group Monthly update report for Strategic Flu Group Meeting on: To: All members of the Strategic Flu Group From: S(SW) Screening and Immunisation Team Date: Insert date of meeting Contact: Annette McHardy / Charlotte Cadwallader england.swscreeningandimms@nhs.net Reporting Insert month period Local Authority: Enter name of LA name & job title of person providing report 1. Progress report 1.1 Employee vaccination rates / updates and issues 1.2 Care Homes Staff 1.3 Campaigns, Comms and Health Promotion 1.4 Promotion with hard-to-reach groups 2. Issues to report 2.1 Insert details of issue Insert commentary on key issues and developments 3. Any challenges or requests for support from the Flu Group Insert details of Insert comments challenge 26

27 Appendix D Flu Vaccination Update for GP Surgeries Surgery and code: Insert Field Version number: V1.0 Date: September 2018 Prepared by the Southwest Screening and Immunisation Team england.swscreeningandimms@nhs.net Dear Practice Manager As you will be aware, each year NHS England sets ambitions around uptake of the seasonal flu vaccination for eligible patients. The data below indicates how many of your patients remained unvaccinated during last year s flu season and therefore potentially did not benefit from being protected against Flu. Each vaccination given in practice has an Item of Service (IoS) fee of 9.80 and so we have also indicated for you the total amount of additional income that could have been generated per group had these additional patients been vaccinated. The following immunisation data is sourced from immform and is not to be shared widely: Targeted Group Number unvaccinated Missed income Over 65s Pregnant women Under 65 at Risk 27

28 Carers Age 2 Age 3 We are sure that you will wish to work with us to increase uptake to ensure that more of your practice population are protected this year. We recognise that many individuals and practices working on flu are very familiar with best practice for encouraging uptake of vaccination, however, there are a number of ideas below, that might help to do this: Identify a named lead individual within the practice who is responsible for the flu vaccination programme and liaises regularly with staff involved in the programme. Ensure that your practice list is up-to-date and that you have accurate details for patients including their eligibility and personal details and contacts. Send patients individual and personalised invitations. All eligible patients should receive an individual invitation to attend for vaccination and this should be followed by recalls for patients who fail to attend scheduled clinics or appointments. Ensure that you have suitable availability of clinics or appointments for your patients including considering those who work and those who have young children. To see full details of the NICE Guidance We recognise that the 2018/19 flu vaccination programme is different with the introduction of a new flu vaccine for over 65s. We would encourage you to explain the benefits of the adjuvanted trivalent vaccine and ensure that all of your eligible patients aged over 65 are enabled to access it to ensure optimal protection. We would recommend sharing these figures and information with your nursing team. Kind regards Annette On behalf of the South West Screening & Immunisations Team england.swscreeningandimms@nhs.net 28