During 2014 London immunisation commissioners pondered how to improve uptake of vaccines in teenagers and adults, whilst trying to bring an efficiency.Most of our feedback, mainly from social media and patient-groups, suggested that busy teenagers and adults wanted to get several vaccines during the same appointment and so commissioner created the immunisation 'dovetail' model of delivery - giving several vaccines (obviously not any that might be contra-indicated to any other) in community-based and alternative providers.
When we drafted the cost-card with our community providers, we realised that the 2nd / 3rd vaccine given during the same appointment did not warrant the full £7.64 national tariff since most of the logistics were taken care of. We agreed a lower tariff of £4-£6 each later vaccine.
So what has our economic and outcomes evaluation shown?
1. If we were to have maintained single vaccines at separate appointments, in order to give all eligible Londoners all their NHS vaccines, we need to create 2.1M extra appointments each year. GP Practices simply cannot delivery this additional capacity alone. We needed to expand community provision into pharmacy, community nursing and outreach clinical services, especially if we are going to tackle inequalities and increase access to all vulnerable communities.
2. Survey Monkey survey shows over 95% of people prefer dovetailed vaccines, rather than single vaccination appointments.
3. We have saved £3 on the national tariff for every dovetailed-vaccine given by our community providers so we can invest in more alternative providers, such as Maternity Services for pregnant women or TB Outreach.
4. Londoners are looking for an expanded range of vaccine products which can be given at the same appointment - this will warrant changes in national procurement and logistics.