Intended for healthcare professionals

Rapid response to:

Research

Differences in risk factors for partial and no immunisation in the first year of life: prospective cohort study

BMJ 2006; 332 doi: https://doi.org/10.1136/bmj.332.7553.1312 (Published 01 June 2006) Cite this as: BMJ 2006;332:1312

Rapid Response:

Working smarter - improving performance

You state partial or no immunisation status can be attributed to
deprived, ethnically diverse or education of populations. I suggest that
this is a popular myth that is often quoted (Baker, MR, Bandaranayake,
R,Schweiger, MS,1984) and one that I wish to dispel.

Heart of Birmingham Teaching Primary Care Trust (HOB) has extremely
high levels of ethnic diversity with 7 out of 10 being Asian or Black. We
also have the highest levels of deprivation with populations living in the
lowest 10% nationally. Until recently, HOB had the worst coverage for MMR
(2004 = 80% aged 24 months) and influenza (2004 = 49%). We now have the
best coverage that ranks in the top ten nationally (MMR = 95%) and
(Influenza = 78%).

Hitherto, our attempts to improving immunisations coverage, we
assumed myths that inequalities in immunisation uptake are persistent and
result in lower coverage in poorer families. Recently, our focus has been
providing support for underperforming General practices by implementing a
variety of failsafe activities.

To resolve the issue of partial or non immunisation, an active
patient management system should be implemented. This should include:

• professional leadership and commitment to good performance

• an accurate, up to date list of registered patients

• a personalised system of call up e.g. letter signed by GP

• a schedule of dedicated clinics

• active follow up and direct contact with defaulters

• a system of “opportunistic visits”

In summary, gross poor performance should not be attributed to
culture, education or deprivation. Three things matter; Organisation,
organisation & organisation.

The good news is that 2/3 of poor performance is artefactual (ghost
patients or non reporting; and easy and cheaply addressed)

We would like to invite you and your team to Birmingham to discuss
the detail of our innovations and see the systems that we utilise.

Competing interests:
None declared

Competing interests: No competing interests

16 June 2006
Janice Nelson
Immunisation Coordinator
Heart of Birmingham Teaching Primary Care Trust, 142 Hagley Road, Birmingham B16 9PA