Coronavirus (COVID-19): vaccine deployment plan: update - July 2021

Invitations, appointments and digital solutions

Appointment letters

The National Vaccination Scheduling System (NVSS) is the system we use for appointment scheduling in Scotland. We have worked closely with Health Boards, National Services Scotland (NSS), National Education Scotland (NES) and PHS, to provide the data and digital solution for creating clinics, appointments and the generation of letters which are printed and sent to Royal Mail for delivery.

One of the successes of the appointing process to date was the introduction of blue envelopes which clearly identify that the letter contains an invite for a vaccination. From the 1 February 2021 to 23 July 2021, nearly 4.5 million individuals in Scotland received a blue letter with their appointment details.

In order to help us reach the population of Scotland as quickly as possible, it is important anyone who has recently moved house, or due to move house in the near future, ensures their details are correct with their GP. We are proactively engaging with Health Boards to communicate the importance of updating details with the GPs to ensure that individuals do not miss their appointments. 

As part of planning for the next phase of our COVID-19 vaccination programme, it has been agreed the NVSS will be used, including the option for people to book appointments online. The use of blue envelopes and letters will also continue for people who do not come forward – or are unable to – to confirm their preferred choice of digital communication.

Our approach to missed appointments

Uptake is one of the key measures of success for the national vaccination programme and the data shows high uptake across all cohorts, with an overall 89% uptake for first doses for those aged 18 and over as of 23 July. We understand not everyone will be able to attend their vaccination appointment and, indeed, not everyone will choose to be vaccinated. It is important to recognise what can be learned from the intelligence we gather when people did not attend appointments (DNAs).

We scrutinise all the data available on vaccinations, including DNAs, as it can offer an indication of the level of vaccine hesitancy and refusal and the effectiveness of our lettering based appointment system. But as mentioned earlier, DNAs cannot be viewed in isolation as a measure of productivity of the programme. The DNA rates relate to those who have not attended a scheduled appointment but that does not mean those people have not been vaccinated. Younger people may have attended ad-hoc or drop-in vaccination clinics which have recently been established, which could result in a DNA against their scheduled appointment. We have seen high levels of overall uptake due to a combination of health boards overbooking and using any unmet capacity with drop in and outreach activity. DNA figures from 1 February 2021 to 6 June 2021 are included in PHS’s COVID-19 Statistical Report published on 16 June.

We have taken steps to try to make the vaccination programme as accessible to all as possible. The national helpline allows people to rearrange their appointment to suit them and there is help available for anyone who is unable to leave their home. We introduced an online appointment checker to help reduce the number of DNAs. We also introduced a self-help guide on NHS Inform for people to find out how they rearrange their appointment in their local area, or opt out.

We are aware there may be some vaccine hesitancy in some communities and we are working alongside third sector and community groups to address this by developing and targeted messages to address any specific barriers people may face.

We have also created a platform for people who may have missed appointments to schedule a vaccine and this can be done through the missed appointment form on the NHS website.

COVID-19 vaccine national helpline

We launched our COVID-19 vaccine national helpline in December 2020 as an alternate channel to digital services for patients without access to the internet or who could not use our digital products available. The helpline provides access to the same content and services as on NHS Inform, such as rebooking, DNA letters and registration services. Some services, such as rebooking of a historic DNA appointment, registration of 16 and 17 year olds who are unpaid carers, adult household contacts of shielding adults, or patients who need a Community Health Index (CHI) number and are not registered with a GP practice, are currently only available on the helpline.

The helpline was initially intended to support vaccine queries only, however we soon expanded its scope to include appointment re-bookings, missing letters/appointments, registrations and other ad hoc services. An example of this is when we responded to the Glasgow surge vaccination initiative in May 2021.

Since going live, we have answered more than two million calls through the helpline, and successfully rescheduled more than 400,000 appointments.

The helpline operates 7 days a week from 8am to 8pm and is on an 0800 number free for anyone to call. At its peak, the helpline was regularly answering nearly 30,000 calls per day. Average wait times during June have varied between 10 seconds and 2 and half minutes.

As the programme has developed, the helpline has adapted and continuously added new services and capabilities. For example, we have provided an option for translation services. As the programme progresses, the commission of the helpline will require to be reviewed not only to take account of the inclusion of the flu programme but also if this single point of contact role is required. If so then the scope and resourcing of the helpline will require modification in order to meet these new and increased service asks.

Self-registration portal

In order to make vaccinations more accessible for unpaid carers, we opened a self-registration service for this group. This enabled around 200,000 people to identify themselves as carers, who are included in priority group 6 due to the risk of passing on COVID-19 to the person or people for whom they provide care.

Building on the success of unpaid carers, we decided to roll out self-registrations for under 30s. This self-registration service enabled those aged 18-29 to identify themselves in that age category and offered them the choice of how they were contacted.

On the 28 June 2021 we opened the self-registration system to all adults which enables anyone, for example, those new to Scotland or did not have an up-to-date registered home address, to come forward for a first appointment.

Those who sign up will receive a text or email with details of their appointment which they can change if the time or location is unsuitable. For those who have previously received an appointment and could not – or decided not to – attend, the portal provides the opportunity to now take up the offer of a vaccine and ensure protection against COVID-19.

Improving the digital offer

Our long-term aim is to move to a model based on individual preference, which includes digital and traditional non-digital routes.

We have scheduled and delivered millions of appointments through the NVSS and other digital solutions early on in the programme, whilst achieving exceptionally high vaccine uptake rates and positive feedback from both Health Boards and the public.

A priority area for development for the next phase of the vaccine programme is the improvement of the digital processes and systems to enable people to book appointments at vaccination clinics and centres based on their preference and choice. We will also work to ensure our systems are as inclusive and accessible as possible so as many people as possible can access them.

One of the benefits of moving to an online booking system is the ability to quickly contact individuals with appointment details as well as being able to send out public health information. The current paper based system takes about two weeks. This time can be reduced and give people the option to choose an appointment at a time which suits them, rather than having to change it or not attending.

The roll-out of a digital solution provides an opportunity to capture missing data with the potential for a significant digital legacy from the COVID-19 pandemic. As people engage with our digital products, it minimises the risk of a person’s details not being up to date, leading to DNAs. It also provides an opportunity for us to collect important additional characteristics to support our inclusion work, such as ethnicity and disability. This is vital to the ongoing research into rapid COVID-19 responses and helpful for wider public health planning, information and service offers.