Agenda item

1.               Minutes of the meeting held on 20 June 2013

The Board agreed the minutes of the meeting held on 20 June 2013 as a correct record. 

2.               Matters Arising

2.1           Immunisation (Item 4 – 2.19)

Alison Frater (NHS England) provided a verbal update to the Board on immunisation following the discussion at the last formal meeting and the request that more information be provides for this meeeting. 

·       Responsibility for Immunisation had recently been transferred to NHS England.  The transition had gone relatively smoothly and investment was continuing.

·       All commissioning was carried out, working closely with the CCG.

·       As part of the Health and Social Care Act, Public Health England had been given ownership of all the immunisation data: there had been delays in receiving data from them.  NHS England was unable to share any data until it had been published by Public Health England.  Publication had been delayed.

·       However informally, Enfield’s Quarter One data looked encouraging and there had been some improvement in MMR uptake in the 2-5 age group. 

·       Three main action plans were being put together to improve the services: 

·       The first to establish a better set of information – much of the current data was inaccurate – and to invest in local systems creating a better engagement strategy.

·       The second to target local communities where immunisation rates were low.

·       The third to look at different work force models – currently a large proportion of immunisation is carried out by GPs - this would include looking at the feasibility of establishing a taskforce made up of health visitors to work with schools and nurseries for example while relying on the core GP delivery model. 

·       More could be done if GPs could improve the sharing of information on immunisation.  Peer reviews between practices could improve uptake. 

·       More work to support the uptake of the seasonal flu vaccines, widening access to community pharmacies perhaps, would be undertaken.

·       Immunisation uptake amongst health professionals themselves was poor and needed to be increased: they were at greater risk of infection.

·       They would also be seeking to support work with, and raise awareness amongst at risk groups.

2.2     Questions/Comments

2.2.1   Ray James noted the reassurance that long established local schemes would continue and that possible risks during transition seem to have been overcome. 

2.2.2   Data from Q1 was due to be published on 17 September 2013 and is now scheduled for mid October.  In the past this had been provided in June. 

2.2.3   It was suggested that Public Health England should be encouraged to issue data more quickly.  Local Public Health could co-ordinate work to generate a better understanding of immunisation uptake practice by practice by asking GPs to send through copies of the data that they sent to Public Health England. 

2.2.4   In general there has been a poor uptake across London, due to the high proportion of the population who were mobile and unregistered.  But the reporting and data recording system was not working well.  During the recent MMR campaign the level of immunisations was significantly under reported.  If the level had been as poor as records indicated, there would have been a measles outbreak.  A recent evaluation had indicated an uptake rate of 95%.

2.2.5   With improvements in technology reporting should become more reliable. 

2.2.6   During the recent MMR campaign, GPs were asked to interrogate their systems and write to families who were not recorded as being immunised, they found that many were.

2.2.7   Including the MMR within the school leaver booster was being considered. 

2.2.8   Providing more immunisation through Children’s Centres was also a possibility. 

2.2.9   There have been issues within the Traveller and Somali communities and some other hard to reach groups which need some targeted interventions. 

2.2.10An average of 95% is not enough to provide herd immunity.  The rate does need to be increased. 

2.2.11Dr Mo Abedi said that there was a problem with the validity of the data and that he would urge greater collaborative working. 

2.2.12 Doctors would welcome more information on the new flu campaign. 

2.2.13The Over 50’s Forum had welcomed the new Shingles Vaccine which was being offered to the over 70’s, but were disappointed that it only seemed to be available to 70 and 79 year olds.  This was due to a shortage of vaccine. 

2.2.14Doctors did have difficulty with the recording system.  It would be more effective if the surveillance data was linked to the payment system.

2.2.15Enfield had invested heavily in the immunisation and there was a concern that NHS England would not be able to provide as much resource. Enfield had been able to employ a full time borough level co-ordinator enabling them to make good progress. 

2.2.16Once the data from Public Health England was available, it would be possible to target support where it was needed, and improve uptake.