1. Workshop 1 - Report ‘The Broughton Believers’ V2

2. ‘The Broughton Believers’ Kirstine Farrer - Head of Innovation and Research (Senior Academic Sponsor) Tina Dixon - Senior Manager Innovation & Improvement Team Leader Anna Cowley – Operations Manager Hayley Hart - Senior Innovation and Research Officer Frazer Meadowcroft - Innovation & Improvement Manager V2

3. What are we trying to accomplish? Aim- To improve patient engagement by 15% from 2015-16 baseline by 31 st March 2017 across the Broughton neighbourhood with the following service: Influenza vaccination programme for at risk adult patients (>65yrs/<65yrs at risk/pregnant women/Carers) Objective- To understand the barriers to engagement with the Flu Vaccination programme for “hard to reach” adult groups (defined as 2 or more consecutive non attendances for Flu Vaccination in previous season) Use a QI methodology to conduct tests of change to identify the best way to work with hard to reach patients to improve uptake of Flu vaccination. Take “lessons learned” and apply to other areas of non-engagement, identified by the neighbourhood as Cervical Cytology & Long Term Condition Reviews. V2

4. Why Flu Vaccination? Immunisation has been shown to reduce the incidence of severe disease including bronchopneumonia, hospital admissions and mortality (Wright et al., 1977; Mangtani et al., 2004). Flu is a key factor in NHS winter pressures (Public Health Flu Plan, 2015) Influenza vaccination reduced the likelihood of prematurity and smaller infant size at birth associated with influenza infection (Omer et al., 2011). Pregnant women should be offered inactivated influenza vaccine as the risk of serious illness from influenza is higher in pregnant women (Pebody et al., 2010). V2

5. Why Flu Vaccination? Broughton neighbourhood below both CCG and national average for all at risk adult flu vaccination, with a downward trend overall in 2015-16 season: – Broughton 38% – CCG average 47% – National average 52.8% Risk of lack of sufficient staff resource if increase uptake, and shortage of Flu vaccine. V2

6. Expected Outcomes Quality Improvement Facilitator to work alongside practices to understand demographics and previous culture of flu vaccination attendances Baseline data to be used to inform progress, with measurement at monthly intervals during flu season (Sept 2016-Feb 2017) Increase in uptake from baseline across all groups (>65,<65yrs at risk, Pregnant women & Carers) by 15% More appointments needed to vaccinate more people- may be less of an issue as difficult to quantify staff time taken to chase hard to reach groups in previous years. Monthly monitoring of uptake from beginning Sept 2016 – February 2017. V2

7. Baseline Data 2015-16 65 and oversAt Risk (<65)Pregnant WomenCarers Neighbourhood Practice Code Practice Name 2014/152015/16Trend2014/152015/16Trend2014/152015/16Trend2014/152015/16Trend Broughton Neighbourhood66.7%64.7%È42.9%33.6%È28.3%26.8%È33.0%26.9%È Salford CCG75.3%73.8%È50.2%42.8%È40.4%37.7%È40.4%34.4%È National72.7%71.0%È50.3%45.1%È44.1%42.3%È V2

8. How do we know change is an improvement? How do we know that change is an improvement? 15% Increase from 2015-16 baseline data across all adult at risk groups by end March 2017 Better patient engagement with the service (obtain patient feedback) Monitor monthly vaccination rates & monthly invites across the neighbourhood Risks-Insufficient vaccine available/lack of sufficient resource to vaccinate patients/adverse publicity/Influenza outbreak triggering uptake. V2

9. What changes can you make? Initial Activities: To understand reasons for non-engagement in last Flu Vacc season To establish any commonality across the various groups e.g. Language/cultural barriers Boundaries: Need to recruit a QI Facilitator to work in the neighbourhood to undertake tests of change Project encompasses neighbourhood of 9 practices which will be challenging operationally V2

10. To improve engagement with Flu vaccination programme of “hard to reach*” groups across Broughton neighbourhood by 15% from 2015-16 baseline by March 2017 *defined as >2 consecutive invites in last Flu vacc season Service delivery Admin systems Communication across organisations and within practices Locations Timescales Appropriate staff Patients/Families/Carers Primary drivers Secondary drivers Primary Outcome Call & recall tailored to patient need Coding Admin workflow Info from other agencies Broughton Believers Driver Diagram CAPABILITYBUILDINGCAPABILITYBUILDING Education Patient Families/carers education/awareness Self Management GP staff education Admin Staff training V2

11. Key activity Project assessment score (0.5 - 5.0) (see next slide for criteria) V2 MayJunJulAugSepOctNovDecJanFebMarApr Score1.5

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