Have Your Say: Future of Vaccination Delivery

Please provide feedback by end of August.

NHS England is seeking feedback from providers to inform the future shape of vaccination services and identify potential opportunities to integrate the COVID-19 vaccination programme with other NHS-delivered immunisations.

This request for information will be conducted in line with NHS England policy and procedures along with the regional teams.

Over the coming months NHSE anticipates COVID-19 vaccination will move towards a seasonal service.  The precise details concerning future volumes of activity, quantities, and vaccine types are still, to a large extent, dependent on clinical and scientific direction, which is evolving.  However, NHS England has sufficient detail to enable it to consider its future requirements for COVID-19 vaccination and how best to align it to current immunisation programmes.

In addition, NHSE has responsibility for a wider set of 25 routine immunisation programmes and building on lessons from COVID-19 vaccination delivery, is now taking this opportunity to consider the future strategy for the delivery of all vaccinations. To support this, a draft vision for future vaccination delivery has been developed and is shown below in Annex A.

NHSE is interested in hearing from organisations that are capable and suitably qualified to manage, administer and deploy COVID-19 vaccinations and/or other vaccinations in a variety of settings (i.e every pharmacy that delivers flu vacs).

To help NHSE develop proposals, please complete the questionnaire below. Provide as much information as you feel appropriate.  You can complete all questions or just the ones that you feel are relevant.

From 24th August, NHSE will begin the analysis of responses received so far and use this, alongside other engagement feedback, to develop draft proposals for a future vaccination strategy.  It will, however, leave the questionnaire open until 30 September for further comments, which will be reviewed and reflected as appropriate in further iterations of the service model, vision and any eventual procurement.  

Please make it clear in your answer if any or all answers refers specifically to vaccinations such as flu rather than COVID-19.

For the avoidance of doubt, respondents to the questionnaire are not committing themselves to provide services in future, nor will they be formally expressing an interest in future service provision. The purpose of this questionnaire is only to seek information and opinions at this stage.

Clarification questions can be submitted via the portal link to NHSE. NHSE will not respond to specific questionnaire submissions unless they wish to seek further clarification. NHSE reserves the right to make available any response to clarification questions to all current and future participants in the process.

Questions for online QUESTIONNAIRE

Please note that each question is limited to 1000 words maximum using Arial and font size 11.

1. Do you agree with the proposed vision for a future vaccination offer to the public (annex A)? If not, why not?
2. What national, regional, or local barriers currently exist to achieving this vision?
3. What national, regional, or local enablers would support this vision? 
4. Across all immunisation programmes, what is currently working well at national, regional or local level (e.g.commissioning frameworks, workforce models, supply routes etc) that you would not want to be lost?  
5. What is working less well?
6. Based on your experience and knowledge, what delivery approaches drive the best uptake and coverage in all immunisation programmes, particularly amongst under-served communities? How could these approaches be scaled up, adapted, or applied to a wider set of immunisations?
7. What innovations are you aware of in the delivery of covid or other vaccinations, either through piloting or full implementation, that you would want to keep or see applied more widely?  Have any of these innovations been delivered despite barriers and, if so, could those barriers be removed to help the innovation to continue?
8. Are you aware of any improvements that are being considered or planned for existing immunisation programmes that you are involved in or otherwise?  What benefit are these expected to have?  What national actions would support these improvements?
9. What would be the critical elements of a future delivery model in your region/system/organisation, and what commissioning and contracting approach is best suited to the delivery of this model?
10. What are the additional activities/interventions that are currently, or could be, offered as part of or alongside a vaccination episode? 
11. What high level outcomes should we seek to achieve across immunisation programmes?  For example: levels of uptake and coverage within the population; avoidable morbidity and mortality; improvements in coverage for relevant under-served populations within that geography; reductions in avoidable outbreaks; etc.
12. Please highlight any other important issues which you believe we should be aware of when designing the delivery arrangements for future vaccination services, setting out: (a) why you think these need to be taken into consideration; and (b) any views you have of how these should be managed through appropriate commercial mechanisms?

Once completed, please upload to the portal link:

•  https://uk.eu-supply.com/login.asp?B=UK

Project reference Quote/tender  56405 - and follow any on screen instructions.

Annex A: draft vision for a future NHS vaccination strategy

Why is this important?

Vaccination is amongst the world’s most effective public health interventions, second only to the provision of clean water.[1]  Vaccinations prevent up to three million deaths worldwide every year and prevent many more people from needing a stay in hospital. High rates of vaccination help prevent the spread of infectious disease, its complications and early death among individuals.

Our mission

Building on the success of and the learning from our existing covid, flu and routine immunisation programmes, we will support local systems to deliver responsive, community-focused NHS vaccination provision that continues to save lives and puts vaccination firmly at the heart of prevention and broader healthcare delivery.  The delivery approach should improve public health, help people to stay well and protect themselves and those around them, and leave no-one behind. 

Platform for change

Over the coming months, contingent on advice from the JCVI, we anticipate covid vaccination will move towards a seasonal service and we can take this opportunity to explore how to integrate covid vaccination with other vaccinations offered to similar groups of people at similar times.  Over the longer term, we must build on the success of routine immunisation programmes, drawing on national and international learning to further improve our approach and our reach into under-served communities.  We need to:

• Improve uptake and coverage and reduce variation, prioritising programmes such as MMR that have seen a decline in uptake in recent years, as well as vaccination programmes impacted by the pandemic such as school age vaccinations. 
• Address health inequalities relating to vaccine uptake, increase vaccine equity, and reduce the burden of avoidable morbidity and mortality, proactively searching out those areas where there are gaps in uptake between different parts of the population and finding locally-tailored solutions to meet those needs. 
• Make every contact with an individual count, including identifying opportunities to co-administer vaccines, co-promoting other immunisation programmes, and potentially encouraging wider health and wellbeing interventions.
• Build on the raised public and workforce awareness of the importance and benefits of vaccination, so clinicians across primary and secondary care routinely use other healthcare interventions as a route into promoting vaccination.

Features of the vaccination offer

We want to support local systems to build sustainable, responsive, NHS vaccination provision that:

• Is convenient and responsive to the needs of local communities
• Supports people to understand the benefits of vaccination and how and when they can access the offer
• Maximises uptake and coverage, reduces variation and addresses health inequalities by using a range of flexible delivery models that meet the needs of communities and minimise impact on other services
• Is flexible to embrace change and innovation and, for those vaccinations where it is required, can deal at scale and at pace with surge
• Supports wider public health and prevention initiatives by aligning with or signposting to other health interventions
• Is delivered by an agile, efficient and trained workforce that reflects the communities it serves
• Benefits from a technology and data infrastructure that continually improves the experience for users and staff and puts control into the hands of citizens
• Is supported by supply chain and procurement routes that, together with the delivery approach, deliver best value for the NHS and the taxpayer. 

Developing a framework

We will work collaboratively with a range of stakeholders to test this vision and design a framework that enables systems to make it a reality for their populations, building on what is already working well.  The framework should provide national infrastructure and enablers where it makes sense to do so - for example tech and data solutions and workforce models.  It should also support local innovation in delivery, so that regions and systems can tailor their delivery model to meet the needs of their populations, using the Core20PLUS5 approach, and deliver agreed outcomes.  Any commissioning framework needs to be supported by a contracting and payment approach that offers best value for the NHS overall.  

Implementing changes

We will produce headline recommendations in autumn 2022 to enable us to put the building blocks in place for the potential implementation of some changes in or from 2023/24.  Some parts of the model may take longer to implement, but for some changes that have a strong evidence base and widespread agreement we may be able to start making improvements earlier.  In some areas we may want to test new approaches in specific systems or regions.  We will also use the development of the strategy to inform wider discussions about the future role of ICBs in commissioning of NHS vaccination programmes.