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Covid-19 vaccines: GPs boost uptake by calling patients and teaming up with community groups

BMJ 2021; 374 doi: https://doi.org/10.1136/bmj.n2093 (Published 23 August 2021) Cite this as: BMJ 2021;374:n2093

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  1. Elisabeth Mahase
  1. The BMJ

An east London general practice that called every one of its patients to discuss covid-19 vaccination and any related concerns has reported vaccination coverage rates above those in the surrounding area.

Farzana Hussain, a GP who runs a practice in Newham, where levels deprivation and poverty are high, singlehandedly started phoning patients within a few weeks of vaccinations beginning in January 2021, after noticing that only about half of her patients were taking up offers the vaccine, all of them white British.

Hussain used her days off to ring patients who had not yet had the vaccine to explain that they were eligible for it and to discuss any questions they might have, having been spurred on by reports that people from ethnic minorities were more likely to contract and die from covid-19.1 “These weren’t just 10 minute calls—they took a lot longer than the normal 10 minute appointments,” she told The BMJ.

Hussain said that she had built good relationships with many of her patients over the past 18 years while running the practice, especially the older and more vulnerable groups, and this helped with these conversations. She noted three major themes that were prevalent among different communities.

“My black African and Caribbean patients were generally sort of mistrusting of the whole system,” she explained. “They thought about what had happened historically, that they had been experimented on, there was a lot of mistrust. With many of my South Asian patients, they were more concerned about animal products. So, whether it was Hindus for religious reasons or Muslims for religious reasons, there were some misunderstandings in terms of ingredients.

“My eastern European patients basically felt that [the vaccine] was rolled out very, very quickly and that their own home countries were not rolling it out yet, so they weren’t clear about the safety.”

Figures show that 91% of Hussain’s patients aged over 80 have so far received two vaccine doses, compared with 78% in Newham in general. Similarly, 87% of her patients aged 75 to 79 have been double vaccinated, compared with 79% in the borough overall.2

Hussain said that some patients called the surgery back to say that they had been vaccinated after the telephone discussion.

“I think that calling was really helpful in an area like Newham,” she told The BMJ. “We could have sent out a text message, but I think people were responding much better to that personal phone call from their trusted GP practice. I won’t lie and say it was easy. When I first started I was only getting a one in five rate in terms of agreeing to get vaccinated, but I planted a seed, and as the months went on and millions of people got vaccinated, I think people got more confident.”

However, it was not easy work. While Hussain took it upon herself to call the patients aged over 65 in her own time, she later trained another member of staff to take over with the younger groups.

“To keep it sustainable, I would say if you can do it within work time, do,” she said, adding that any GPs wanting to do the same should certainly seek funding, resources, and support from their clinical commissioning group.

Community action

Another GP network has boosted vaccine uptake by teaming up with local community groups to run pop-up and mobile clinics. The GP Federation Alliance for Better Care, which works with nine primary care networks in Crawley, Sussex, has been working with faith groups and homeless organisations, as well as catering for people who are reluctant to attend large vaccination centres and for housebound or less physically mobile patients.

Soon after vaccinations were launched the federation approached a local bus company, which agreed to help it run a mobile vaccine clinic. With help from faith groups they also set up pop-up clinics in mosques and temples.

The federation reported that around one in three of the people they saw through the clinics expressed a reason why they would not have gone to the main vaccination site.

Matt Cullis, a general practice manager, said, “In our practice we have some cleaning contractors who were cleaning up after our practice vaccination clinics every day. I was always trying to offer them vaccines, and yet they wouldn’t take them and wouldn’t explain why.

“Then one day I saw one of them being vaccinated at a local Hindu temple, and he said he had been waiting for religious reasons. It wasn’t always about religion, but certainly we were finding that there were all kinds of reasons why people were reluctant to attend a more traditional medical setting but in a more community based setting were very happy to come along.”

The federation staffed the mobile and pop-up clinics with vaccinators and administrators from the vaccination centres, as well as volunteers from the groups they had teamed up with.

Asked what advice he would give to other practices looking to do the same, Cullis said that the first step was to make contact with leaders in local communities to “start those conversations and build those relationships,” as this can help with future community health outreach work as well as the vaccination programme. “If you get those relationships, start to work on them now, then it will hopefully do a lot to address health inequalities in the future,” he said.

The federation is now working on ways to reach younger people in the community and people who will need a booster vaccination.

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