Manchester: how a vaccine tracker and outreach work is helping follow-up with those who decline the vaccine first time round

Manchester developed a tracking system to identify the number of people who have declined vaccines to enable GP practices to recall eligible individuals.

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This is part of a series of case-studies published on 7 April 2021 

  • Council and CCGs have been working together since 2017 under a joint commissioning structure which has meant Covid vaccination programme run in tandem
  • A tracking system set up to follow-up those who decline vaccination first time round
  • Mobile clinics to offer vaccination to groups such as the homeless, while bespoke clinics being run for those with specific needs, such as people with learning disabilities and non-English speakers

Local context

Manchester is home to 550,000 people. There is a mass vaccination centre at the Etihad tennis centre and three hospital hubs along with eight primary care network sites and four community pharmacists. They form part of a network of 78 centres across the Greater Manchester region.

The council and CCGs have a close working relationship – since 2017 they have been working together under Manchester Health and Care Commissioning (MHCC). They are also part of the Greater Manchester Health and Social Care Partnership, set up as part of the devolution arrangements.

MHCC Medical Director Dr Manisha Kumar said: “The council and NHS have been working side by side for the past few years – and so when the Covid vaccination programme started it was only natural we would do it in tandem.”

Tracking those who do not get vaccinated

A number of joint workstreams have been set up as part of the vaccination programme covering issues such as equalities and inclusion and communication and engagement.

Manchester has developed a tracking system to identify the number of people who have declined vaccines and enable GP practices to recall eligible individuals who have declined a vaccination as well as capturing their reasons.  The system – developed in partnership between the council and local NHS and using data the Pinnacle software and tracking back through GP systems – is being used for the one to six vaccine priority groups. 

The social prescribing team and call centre team Gateway who normally manage outpatient appointments are also helping with follow-up calls.

Manchester Director of Public Health David Regan said: “It is allowing us to identify patterns in who is not coming forward for vaccination and why. It would be wrong to assume it is all because they definitely do not want. Some are saying maybe not now, maybe in the future. 

“You also have people who have health conditions who may want to check with their doctor first and you have others who have concerns and just need a little more time. We want to go back to these people to offer them a vaccine again. 

“We are not going to hound them, but we think it is important to follow up those who may be willing to have it in the future.  We know there are differences between ethnic groups and between deprived and wealthy areas – we see that each year with the flu vaccine. We need to keep doing this if we are not to see health inequalities widen further.”

Mobile vaccination and bespoke clinics

As part of this approach, Manchester is tailoring its offer to certain groups. For example, a dedicated clinic was organised in late February aimed at members of the South Asian population who did not speak English as a first language.

Vaccinators who were bilingual were brought in and people were able to make requests, such as asking for the jab to be given by woman. Each of the patients registered for that clinic were rung in advance to offer them a slot and to see what they may want. More than 100 came forward for vaccination – all had previously turned down the offer of a jab.

A bespoke offer is also being developed for people with learning disabilities. Dr Kumar said: “We are asked to provide a meaningful offer of vaccination. That is more than just a text or letter. We are working with learning disability nurses and the voluntary sector to organise vaccination clinics that are sensitive to the needs of people with learning disabilities. We are calling them calming or quiet clinics. 

“It will be done at a slower pace so there is more time to talk to the patients and where they can recover from the vaccine in the booth. Carers will be able to get their vaccinations at the same time. These vaccination clinics can be quite busy and that is not appropriate for all.”

Another initiative has involved using the city’s mobile clinics to target certain groups. This has already been done for homeless people with the mobile clinics taken to a hostel and day centre for homeless people.

The approach worked really well and over 350 people have been vaccinated. A similar model may now be used for the travelling community as well as to reach out to care workers who have not yet been vaccinated.

Dr Kumar said: “You have to do a lot of planning as part of this outreach work. You cannot just turn up on the day – you risk wasting vaccine and not getting good uptake. So we go in ahead of the mobile van turning up to engage with people.

This is where having the joint approach is invaluable – between the council, NHS and voluntary sector we have people who are working with these groups day in, day out, who are trusted.”

Mr Regan agrees. “We have had really good uptake so far – and we want that to continue. But naturally as you move down the age groups and out to more people there is a risk uptake could drop for a variety of reasons. We want to get on the front foot and identify some of the hurdles that could cause problems.”