Coronavirus (COVID-19) vaccine inclusion: vaccination programme - phase one

3. Flexible delivery models

Programme objective:

Everyone who wants to take up the offer of vaccination is able to.

Examples of national programme support:

Initially mass vaccination clinics were set up and people were asked to attend by appointment only.

Early on in the rollout, the national programme worked with partners to identify certain groups within the population which may not engage with the programme or wish to attend a mass clinic. This included groups such as: those experiencing homelessness, Gypsy / Traveller communities; refugees and asylum seekers; and those from deprived areas. All health boards were asked to consider whether assertive outreach for these groups should be undertaken. Home appointments were also available for those who were housebound.

As the Delta variant became more prevalent, the national programme responded to this, alongside evidence of uptake and feedback from people's experiences. A need for a change in approach to include drop-in, pop-up and mix model delivery was identified. Health boards were supported to adapt their delivery approach by national initiatives and support from partners including the Scottish Ambulance Service (SAS), resource from the Armed Forces and British Red Cross' National Volunteer Coordination Hub.

The national programme responded to new groups becoming eligible for the vaccine by ensuring delivery was suitable. For example, identifying unpaid carers for sending appointment letters was a challenge therefore an online self-registration service was set up to allow them to come forward. Use of this was extended for 18-29 year olds and then for the wider population, who had not yet come forward for vaccination.

Examples of health board approaches and activities:

We saw vaccines administered in community venues, places of worship, food banks, homeless shelters, Fisherman's Missions, on farms and at Gypsy / Traveller sites. This type of outreach is most successful when fully planned out and in partnership with relevant community representatives and in trusted locations. Some health boards operated mass vaccination sites in city centres to deliver vaccinations as close to communities as possible (with accessible transport routes). All offered drop-in and pop-up / mobile facilities to make the vaccine as accessible as possible.

Some examples of flexible delivery models include:

• NHS Ayrshire and Arran: Mobile unit taken to primary school in Ayr. The location was chosen to enable the vaccine to be offered to those accessing the food bank there. The clinic was run in partnership with the primary school, Violence Reduction Unit, Community Link Worker, South Ayrshire Alcohol and Drugs Partnership, Homeless Service and NHS. Those attending were also offered additional health advice and naloxone kits (which can reverse the effects of an opioid overdose) to take away.
• NHS Borders: Attended agricultural workplaces to reach seasonal workers and a local tup (male sheep) sale to reach farmers who may not have had the time to attend a clinic.
• NHS Dumfries and Galloway: Held pop-up clinics at the larger supermarkets in areas of lower uptake.
• NHS Fife: Held clinics within college and university campuses to reach younger people when term started; drop-in located within Kingsgate shopping centre to reach people who may not be able to attend due to working unsociable hours; clinics held on a large farm to reach seasonal workers and a football club to reach a range of age groups.
• NHS Forth Valley: Worked closely with local authority colleagues and Scottish Ambulance Service to deliver vaccination and carry out home visiting to homeless accommodation and Gypsy/Traveller sites. Increased local drop-in opportunities targeted at college campuses to reach younger people.
• NHS Grampian: An African Church provided a venue for a vaccine clinic and the Pastor supported community engagement. This initial relationship resulted in further positive contacts with African Pastors for other health boards; pop-up clinics held in other churches, community centres, sexual health clinics, universities, the Tour of Britain cycle race and food banks.
• NHS Greater Glasgow and Clyde: Held clinics in places of worship (such as Mosques and Gurdwaras) in areas of high case prevalence; pop-up clinics attended schools, car parks, sports and leisure centres and football clubs to be as accessible as possible.
• NHS Lanarkshire: Mobile clinics attended large workplaces; pop-up clinic attended Clyde Football Club to reach younger people; more local satellite clinics were made available on a rolling basis for easier access to vaccination.
• NHS Lothian: Mobile drop-in vaccination units were made available at various central locations across Edinburgh and the Lothians in conjunction with Scottish Ambulance Service and Lothian Buses to make it easier for people working in retail, hospitality or those who are out and about to get their vaccine; drop-in clinics were available at local mosques and pop-ups attended football matches. Lothian vaccinated people at risk / experiencing homeless using outreach clinics at substance misuse services and at home visits to supported accommodation.
• NHS Orkney: Provided clinics on the Outer Isles to reduce the need for people to travel to the mainland.
• NHS Highland: Used two mobile clinics to go out to rural communities (named 'Jagger-naught' and 'Test-a-lot'); community pharmacies and Superdrug were used on a trial basis.
• NHS Tayside: Ran out of hours clinics, opened between 7-8pm to allow people to attend after work with most drop-ins open until 7pm; took mobile units with translators to farms to reach seasonal workers; drop-in clinic attended football ground with St Johnstone Football Team and at homeless service in Perth and Kinross; the Scottish Ambulance Service bus attended locations in Perth and Dundee in areas of lower deprivation.