Prevention of infectious disease and the role of primary care clusters
Protecting the public from serious infections involves good planning and collaboration with others to provide effective prevention and response across Wales. There is a broad range of activity carried out across Public Health Wales (PHW) relating to prevention of infections that involve joint interests with primary care clusters. This activity is balanced across a once-for-Wales approach alongside local engagement and delivery across primary care.
The Health Protection Division in PHW has eight workstreams as follows:
Health Protection Team (HPT)
Lead Dr Graham Brown; Lead nurse Gary Porter-Jones
- Health Protection Team: Leads acute health protection response, based in premises strategically located across Wales. Contact HPT with details of any cases of infectious disease or to report any incidents/outbreaks.
- Integrated with Microbiology Services.
Communicable Disease Surveillance Centre (CDSC)
Lead Dr Christopher Williams
- CDSC protects the population from infection through surveillance of infectious disease, support for outbreak investigation, provision of health intelligence and applied research.
Vaccine Preventable Disease Programme (VPDP)
Lead Dr Richard Roberts
Healthcare Associated Infection and Antimicrobial Resistance Programme (HARP)
Lead Dr Eleri Davies
Environmental health protection
Lead Huw Brunt
Substance misuse (high-risk population) including alcohol
Theme lead Josie Smith
Theme lead Zoe Couzens
Custodial health and justice
Theme lead Stephanie Perrett
Why is prevention of infectious disease important to clusters?
It is in our collective interest to reduce the preventable burden of communicable disease and to support the acute response to outbreaks. The important role of vaccination is already well-recognised in many cluster plans and this reflects a national strategic context for prioritising improvement action in this area, including:
- A healthier Wales: our plan for health and social care 2018 (WG 2018; link) highlights the need for a shift towards greater prevention and early intervention.
- Uptake data for vaccination programmes are reported to Welsh Government as part of the NHS Wales Delivery Framework (link) and, reflecting the primary care contribution, via the Primary Care Measures quality improvement indicators (link).
- The Prevention and well-being workstream within the National Strategic Programme for Primary Care includes the aim of “Reducing variation between clusters and making overall improvements in vaccination and screening programme uptake.” Clusters are advised to review their vaccination uptake as part of their cluster IMTP and consider reasons for variation between practices within the cluster, learning from good practice and supporting those with lower uptake.
What are the improvement priorities?
- Public Health Wales and local health boards (LHBs) have co-ordinated activities aligned to National Improvement Programme priorities e.g. tackling inequalities in flu vaccine uptake among under 65s in at risk groups.
What can clusters do to help improve vaccination uptake?
Broad cluster-level improvement action may include one or more of the following for incorporation into the cluster IMTP:
- Make every contact count by opportunistically asking about vaccination intent
- Plan to support good practice within each cluster practice
- Learn from practices with high uptake and support practices with low uptake
- Improve local data quality
- For childhood vaccination, ensure follow up of preschool children who are outstanding routine immunisation
- Ensure immunisation of school age children is provided consistently
- Utilise e-learning resources to empower practice staff to advocate uptake
- For influenza vaccination, participate in the VPDP Cluster Support Scheme
- For influenza vaccination, identify and support the contribution of community pharmacies
- For influenza vaccination, identify and support the contribution of other local healthcare providers
- Ensure awareness and implementation of NICE guidance and quality standards
- Consider adopting learning from implementing vaccination-related improvement actions in other clusters or practices across Wales
- Engage with your cluster population to consider any community views on local barriers or facilitators to vaccination access
- Identify relevant local assets or partnership opportunities that may help promote vaccination
- Consider whether any additional local data might be needed to help inform a decision on best-value improvement action.
Many clusters share GP practice uptake data within their cluster in order to identify learning and best practice.
What support is available to clusters to make uptake improvements?
Support is available to help ensure that vaccination is considered for inclusion in all cluster IMTPs. The Primary Care Needs Assessment (PCNA) tool (link) provides uptake data and further detail/ signposting around the above improvement actions for uptake of influenza (link) and childhood scheduled vaccinations (link).
Local public health teams (LPHTs) are based within each health board and may be in a position to support clusters with access to public health advice; advice on developing plans; advice on implementing action; and evaluation advice around proposed improvement actions. LPHTs typically have a named immunisation lead. Links to LPHT information in the seven health boards are given below:
The PHW Health Protection Programmes offer clusters the following support:
- Analysis of vaccination uptake data: COVER (Coverage of Vaccination Evaluated Rapidly) reports provide cluster-level data on childhood immunisation and IVOR (Influenza Vaccine Online Reporting) provides data on cluster-level influenza vaccination uptake.
- VPDP co-ordinate improvement actions through a National Influenza Action Group (NIAG), with a comprehensive suite of seasonal influenza resources made available to clusters and GP practices every year e.g. videos, training, leaflets, etc.
- VPDP support immunisation co-ordinators based in health boards or LPHTs to promote uptake of influenza, childhood scheduled and other vaccination programmes locally through their work with clusters and GP practices.
- The refreshed antimicrobial resistance (AMR) strategy provides emphasis on primary care (including provision of cluster-level data) and the AMR Board oversee a primary care work stream.
PHW work with individual primary care contractors as well as at the cluster level. This includes:
- Provision of training and clinical guidance
- Provision of microbiology test results
- Sentinel GP practices for circulating flu levels
- Other vaccination programmes e.g. shingles, where practices invite patients to participate directly
- Weekly e-bulletins throughout the flu season
- HARP produce a comprehensive suite of resources e.g. video, posters, targeted treatment leaflets, etc. for primary care to help spread the message about making better use of antibiotics, including antibiotic guardians. HARP are also developing a web portal that will contain primary care data practices will be able to access (contact HARP@wales.nhs.uk)
- The 1000 Lives, healthcare associated infection (HCAI) and AMR teams collaborate with care homes on improvement projects.
Signposting to related learning/ other support resources
- For Making every contact count (MECC) e-learning (to level 1), see here (ESR or other login/ registration required). For MECC training contacts by health board, see here (intranet).
- FluOne: Information for all health and social care staff e-learning module (link; intranet).
- FluTwo e-learning module is a clinical update on flu and flu vaccination suitable for all healthcare professionals (link; intranet).
- A new CPD module Influenza vaccine has been created for primary care practitioners (link).
- Promotional resources such as posters, leaflets and stickers can be found here.
- AMR programme resources include the Antimicrobial usage in Primary care report, which contains cluster level data; antibiotic resistance resources for primary care (link); antibiotic awareness web portal (under development); and antibiotic resistance resources for general public (link).
- Audit and quality improvement work cluster resource for urinary tract infection (UTI) diagnosis and management, available (link) scroll down to Audit /QI tools
Acknowledgement: Input into this page was received from PHW Health Protection Division, Primary Care Division, and local public health teams based in health boards. Directors of Public Health and Directors of Primary Care were provided with an opportunity to review draft page content.