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DH Week of Action

Using local experts to cascade immunisation knowledge

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For the Department of Health’s Week of Action we explore a partnership between an immunisation manager and an immunisation nurse from a nurse-led advice service

Successful immunisation programmes rely on a well trained workforce. This case study describes a novel approach to immunisation training led by a partnership within the Thames Valley PHE centre between an immunisation nurse from VACCSline (a dedicated immunisation advice service) and a screening and immunisation manager.


Across the Thames Valley region, immunisation training had historically been delivered by VACCSline nursing staff from within the HPA and the immunisation leads from the PCTs. With the NHS organisational restructures, the introduction of new immunisation programmes and the extension to existing ones, Autumn 2013 posed a particular challenge in meeting the training needs of immunisers.

The session was aimed at training leads within provider organisations on influenza, pneumococcal and shingles vaccines. Prior to the study day delegates were asked to access and read the relevant disease chapters in the Online Green Book and the resources for each of the programmes on the PHE immunisation website. They were informed that the study day would be aimed at a level which assumed the pre-reading was undertaken.

The session was aimed at training leads within provider organisations on influenza, pneumococcal and shingles vaccines

An emphasis was placed on developing skills, not just immunisation knowledge but in considering how training is delivered. Trainers modeled different educational approaches to teaching and learning such as quizzes, lectures, learning needs assessments using post it notes, small group work encouraging dialogue between delegates and sharing practice between learners.

Delegates were encouraged to consider the context of their organisation/workplace and to decide the best educational approaches for their context including who might need to be included in any training. 

The train the trainer event was at capacity with 60 delegates attending from across primary, community and secondary care services. All the training resources used on the day were circulated and onward support offered via phone or email as training began at a local level. Two months after the session all delegates were invited to participate in a survey investigating; if training had been delivered, to whom, what the enablers or challenges were to this and if cascade training was a sustainable model.

Snapshot of achievements

The delegates were mainly nurses with just one GP attending. Delegates engaged well with the different activities throughout the morning and the interaction between delegates supported learning and provided insight to practice based issues to the trainers.

The survey response rate was 65%; 19% from community services and 78% from general practice.

Of those who responded to the survey, 97% had delivered training following the event. In community services there was evidence of nurses working together to deliver training at both organised formal sessions and smaller localised events.

Local resources such as PGDs (Patient Group Directions) were used in conjunction with the train the trainer resources. In general practice settings, training was largely done at individual practice level with almost 60% of this cohort training GPs as well as practice nurses.

A small number of trainers in primary care also extended training to receptionists who are often overlooked. Local training materials were reported to have been developed to suit individual contexts.

Snapshot of challenges

When the idea of the train the trainer first came about we envisaged training CCG (Clinical Commissioning Group) leads who may cascade across their patches, but the reality was much more health centre/practice based. While this practice-based model worked in terms of onward training it does require a larger number of trainers to be trained.

In the survey there was a consistent theme noted of time afforded to immunisation training within general practice. Some delegates also referred to a lack of willingness of some members of the team to undertake any training so took different approaches such as emailing across the team.

Time was also cited as a factor in those who did not complete the pre-reading. Some of the nurses were attending the session in their own time. Only one delegate stated that they had attended for a personal update.

Learning, sharing and sustainability

This cascaded training model, using local experts utilising a range of teaching approaches has been successful in reaching a wide audience evidenced through the onward training of the delegates.

Undertaking a survey two months following the cascade training provided a valuable insight into the impact of the session and will inform the development of future cascades.

The response from those trained in 2013 was that this model was sustainable and that they would be keen and enthused to do it again.

As more immunisation programmes are being introduced in 2014 this model may offer an opportunity to move beyond just offering pre-prepared slide sets to immunisers that are often delivered by didactic teaching methods.

A cascade model with an active learning focus provides an opportunity to address real concerns and encourage co-construction of knowledge between learners. There is perhaps an opportunity to share such a model wider across those who are developing immunisation education.


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