Reaching the immunosuppressed for Covid vaccinations in Somerset

In 2021, the Joint Committee on Vaccination and Immunisation (JCVI) recommended that people who were immunosuppressed have a third primary dose of a Covid-19 vaccine, followed by a booster, then an additional booster during the Spring 2022 programme.

Clinical teams across the county worked together to develop a unique comprehensive and reliable central list of immunosuppressed people. The list helped people in this group to get access to the vaccination, leading to a higher than average take up.

Immunosuppressed people have a weakened immune system due to a particular health condition, such as a blood cancer, or because they are on medication or treatment that is suppressing their immune system.

A team of senior clinical leaders from Yeovil District Hospital NHS Foundation Trust and Somerset Foundation Trust worked together with health teams and practitioners across the county to identify immunosuppressed patients in primary and secondary care before any national advice was available. As later guidance came out, we incorporated those recommendations into the original process.

How we did it

First, we set up a booking team using colleagues from the Covid vaccination centres under the leadership of Somerset Foundation Trust’s outpatient manager.

Our first challenge was identifying our immunosuppressed patients. There was no single list when the Covid-19 vaccination programme started.

Working closely with various health teams, we solved this in the following ways:

• Establishing search terms and clinical coding for secondary care patient information records at both trusts.

• When a national list of medications linked to immunosuppression was released to help identify patients, chief pharmacists from our two acute hospitals ran searches for patients taking these medications and we added them to our list.

• GP practices submitted their searches to the programme to combine with the secondary care list, ensuring all eligible people were on one central list.

We then created an effective and efficient system for contacting people and booking their appointment:

• We sent out a consultant’s letter to everyone on our list explaining that the vaccination was offered on JCVI advice.

• Then we regularly checked attendance via our clinic lists against electronic records, automatically rescheduling new appointments and contacting those who failed to show up three times to address any concerns they may have.

• Any concerns raised by members of the public via the Somerset Clinical Commissioning Group Patient Advice and Liaison Service (PALS) were shared with Somerset NHS Foundation Trust for assessment and where appropriate, individuals were added to the patient list.

• Our list was updated regularly to include newly eligible patients. Secondary care then refreshed their list so NHS Somerset could run a search covering all practices, removing the need to ask individual practices to search and submit patient data.
• GPs are also able to email the Somerset Foundation Trust team with details of newly eligible patients to add to the list.

This collaborative list management reduced the chance of duplication between the booking team and the opted-in Primary Care Networks.

Our approach has resulted in high uptake since the beginning of the programme, thanks in no small part to the customer service skills of the team.

Working together

The Somerset COVID-19 vaccination programme is delivered in partnership with:

• Somerset NHS Foundation Trust (lead organisation)
• Eight Primary Care Networks (PCNs)
• NHS Somerset
• Community pharmacies
• Public health colleagues from Somerset County Council, with support from colleagues in Yeovil District Hospital NHS Foundation Trust and the voluntary sector.

Bringing together the individual knowledge and insights of each partner was invaluable. Working together, we were able to develop a coordinated response to the vaccination programme across Somerset’s health and social care system.

Briefing and engagement sessions were held monthly for representatives from local councils, public health and the voluntary sector, to discuss our plans and performance.

All hospital consultants and GPs were informed of our process to identify and contact immunosuppressed patients. We also set up a dedicated mailbox for clinicians to refer patients directly and raise any clinical queries. Queries were then passed to senior medical leaders in primary or secondary care for response.

Measuring Success

Our joint working approach to identification and engagement led to Somerset consistently being the highest performing system in the country for protecting this vulnerable group of patients.

The outcome was a 98% success rate, protecting over 14,000 of the most clinically vulnerable in our county.

The national team has recognised our identification of patients as robust and innovative, and our achievements have been used as an exemplar both regionally and nationally.

Sharing success

Our collaborative and innovative Somerset response to the mass vaccination programme, from identifying eligible patients to leading nationally in vaccination uptake, is completely replicable and scalable.

Our experience and knowledge of how to produce vast lists of people from specific target groups can and has been applied in different scenarios and contexts since the pandemic.

The tactics we have learned are also useful in our day-to-day work and puts us in a stronger position to be able to respond to crisis situations in the future.

Knowing how to do this quickly and having the right partnerships in place across our local integrated care system has long-term benefits that will reach beyond the Covid-19 vaccination programme.