For the Department of Health’s Week of Action we explore VACCSline, a nurse-led vaccination advice service in the Thames Valley
Immunisation remains one of most effective public health measures against disease and VACCSline aims to improve the quality and coverage of immunisation available to our population by supporting those delivering immunisation with proactive and reactive expert advice, guidance, training, and tools to improve performance.
The service which started in 2005, is a collaboration between the Thames Valley Public Health England Centre and the Oxford Vaccine Group (OVG), a leading vaccine research group within the Department of Paediatrics at the University of Oxford. VACCSline currently receives around 1,500 enquiries each year.
Advice is given by experienced nurses whose backgrounds include paediatric and adult vaccine research, travel medicine, general practice nursing and health protection. For complex enquiries the VACCSline nurses conduct literature reviews and other investigations as necessary as well as accessing further clinical advice through email discussion with the consultants in paediatric infectious diseases and other medical staff of OVG and the local CCDCs (Consultant in Communicable Disease Control).
Practice nurses are the largest group seeking advice and other healthcare professionals using the service include health visitors, school health nurses, GPs and paediatricians.
The infrastructures to support this service include: training and competency assessment resources for practitioners who will be delivering immunisation advice, established audit and quality improvement processes, a dedicated multi-user immunisation advice database with systems to collate, export, and exploit intelligence from recorded enquiries.
Snapshot of achievements
Immunisation advice as a specialist role
The service has identified the job role of “immunization advisor” as a specialist nursing public health role and established a competency framework to support this. This has allowed improved quality and efficiency in delivering this advice service within the wide PHE centre team.
VACCSline nurses use enquiries to work with the enquirer by sharing the information sources and approaches that have been used to answer their question. They aim to facilitate the individuals learning and support their use of information resources in their workplaces. VACCSline nurses also lead the development and delivery of training for NHS immunisers in partnership with the NHS England Screening and Immunisation team and NHS provider services.
Using intelligence from data
All enquiries are captured on a database which provides a continuously expanding resource of previous replies. This data assists in identifying local knowledge needs within the Thames Valley. These needs are then specifically addressed through immunisation training sessions and a quarterly VACCSline newsletter. The data is also used in joint work between the VACCSline team and the NHS England Screening and Immunisation team.
Snapshot of challenges
Immunisation programmes are largely delivered and promoted through the nursing workforce in primary and community care settings.
Since April 2013 an unprecedented number of new immunisation programmes, using new vaccines have been introduced, increasing the complexity of the programme. There are continued challenges with access to and the provision of quality immunisation training that is beyond the scope of this case study.
National immunisation policy is published in the Online Green Book and on the PHE website but requires interpretation, often by immunisers working in isolation. The provision of quality clinical advice to immunisers is sometimes considered by an over simplistic division of immunisation queries into:
- Questions that should be answered by reading the Green Book
- Questions that are more complex and are beyond just reading the Green Book.
Data from VACCSline suggests that questions fall across a spectrum rather than being as clearly defined as this simple division. Expert clinical support to immunisers is necessary to assure the quality and safety of immunisation programmes.
Learning, sharing and sustainability
The VACCSline database is designed to be used by different advising teams across England. It allows users to be grouped into advising teams with individual log-ins and a permissions system that allow teams to enter and alter only their own records and to be able to view selected teams data.
A policy of entering queries without identifiable patient details facilitates sharing between teams. Within the Thames Valley it has provided a useful shared resource for the VACCSline and NHS England area team. The system has also been piloted in areas outside of the Thames Valley for example in areas running childhood flu pilots.
Many of the tools that we have developed at VACCSline are available on our webpages for immunisers and other advisers. By sharing resources we hope to grow our communities of practice across all practitioners working in immunisation practice.