GP vaccine incentives could have ‘unintended consquences’ on other jab uptake, NICE warns

Incentive schemes that prioritise certain vaccinations could have ‘unintended consequences’ on the uptake of other jabs, a new NICE guideline has warned.

The guidance also recommended that GPs should update patient vaccine records within two weeks and ‘validate’ records ‘at least monthly’.

The new NICE guideline on vaccine uptake in the general population, published in May, said that regional and local commissioners of NHS vaccination services should ‘take into account’ the impact of any incentive schemes.

It said: ‘When designing incentive schemes for providers, take into account that using incentives to prioritise certain vaccinations could have unintended consequences on the uptake of other vaccinations.’

It added that the guideline committee ‘expressed concern that targets for some vaccinations may inadvertently result in those vaccinations being prioritised over other, non-targeted, vaccines’.

It said: ‘By highlighting these considerations, the committee thought that commissioners and providers should be able to develop ways to mitigate any reductions in the uptake of non-incentivised vaccinations that are detected using local uptake data. 

‘These could involve reminding professionals about the importance of other non-incentivised vaccinations.’

The guideline also recommended that there should be further research on ‘what is the effectiveness and acceptability of giving incentives to providers to increase immunisation rates in the UK’.

Meanwhile, the guidance also recommended that ‘GP practices should ensure that their vaccination records are updated within two weeks (or as specified in the GP contract if shorter) in response to new information about a person’s vaccination status’.

Child health information services (CHIS) should give GP practices a monthly update (or as specified in the CHIS contract if shorter) on children who are not up to date with their jabs, it said.

NICE added that its committee agreed that a two-week time limit was a ‘realistic timeframe for this work given the competing demands for time in GP practices’.

The guideline also said practices should ‘validate their vaccination records at least monthly against data sources received’, with a named vaccination lead to take responsibility for this.

‘Check registered populations and vaccine eligibility and status, investigate any discrepancies and correct the record accordingly,’ it said.

It added: ‘Regular validation of vaccination records against other sources by GP practices will lead to an increase in workload initially. 

‘However, once the current records have been checked, this workload would be expected to drop to a lower level because fewer discrepancies would be found.’

The guidance said: ‘Vaccination coverage needs to be actively maintained, and ideally increased, in the face of increasing vaccine scepticism and misinformation.’

It added: ‘Reasons for low uptake may include poor access to healthcare services; inaccurate claims about safety and effectiveness, which can lead to increased concerns and a reduction in the perceived need for vaccines; and insufficient capacity in the healthcare system to provide vaccinations. 

‘In addition, problems with the recording of vaccination status and poor identification of people who are eligible to be vaccinated may have contributed to low uptake.’

‘Additional or different’ measures may be needed to increase vaccination rates in certain groups with lower levels of uptake such as Travellers, Gypsy and Roma, refugees and asylum seekers, the guideline said.

The guidance does not cover seasonal vaccinations such as flu, Covid vaccinations, travel vaccines, selective immunisation programmes or areas covered by other guidelines such as on tuberculosis.

The NICE vaccine uptake guidance sets out that:

• GP practices should send reminders to those who do not respond to invitations or attend vaccination clinics and ‘confirm that the person has received the reminder’
• ‘Escalating reminders’ could begin with a phone call from a GP receptionist, then a practice nurse and finally from a GP, although this could be resource intensive and has not been shown to be more effective than other reminder formats
• Practices should consider sending invitations and reminders for different vaccinations together, such as the pneumococcal and flu jabs 
• Information, invitations and reminders should be in a format and language appropriate for the person and their family or carers if possible and as appropriate
• Compatible systems and processes should be in place to share and transfer vaccine records between healthcare providers ‘in a timely way’, such as to community pharmacies
• Vaccination services should be coordinated between providers to minimise waste where vaccine supply is limited
• Primary care providers should consider providing vaccination services during extended hours and extended access appointments in evenings and weekends
• Commissioners should set up a quarterly cycle of feedback and audits of vaccine uptake data that can be compared against similar providers at a local and national level
• Vaccination of secondary school-aged children and young people should be done in schools, if possible
• Practitioners working in GP practices who are in contact with people eligible for vaccination but do not administer vaccines should have ongoing education about vaccination
• Providers should offer people access to online systems or apps to allow them to view and check their NHS vaccination records or those of their child or the person they care for if appropriate. 

As previously published in our sister title, Pulse