Table 4 Organisation of responsibilities for processes involved in routine vaccination at the included practices

1. Pre-clinic administration (receiving info; generating patient list)

The PM runs searches and allocates tasks to the R staff.

An AD runs the searches and manages the list.

The PM runs searches and the PN has a role in allocating tasks.

The PM runs searches and allocates tasks to the R staff.

The APM is responsible for running searches and allocating tasks.

The PM runs the searches and then tasks allocated to the PN and AD.

An AD generates the list and allocates tasks, with some support from the PN.

An AD generates the lists of eligible patients, from info from CHIS and local records.

An AD is responsible for generating the list of patients.

2. Patient contact, appointment booking and reminder/recall activities

The R staff are responsible for booking appointments and reminder recall activities, which involve letters and phone and text messages. Occasionally the PN will phone parents.

An AD is then responsible for all the reminder and recall activities, which primarily involves letters, but with some follow-up phone calls.

An AD has a large role in contacting patients, including calling patients and sending letters and SMS reminders, with some support from a R.

The R staff undertake all appointment booking and reminder recall activities and have a role in clinic preparation. Initial invite is by letter, followed by phone calls. Adult vacc is opportunistic.

This is split between the APM and the R staff and primarily involves sending letters, with some follow-up phone calls.

Some initial letters sent, then an AD books appts during the PN’s clinic (below). The PN and PM both also have a role here in phoning patients who do not respond or DNA.

The R staff are responsible for sending out letters and SMS reminders and booking appts. An AD and PN also call parents who DNA or do not respond.

This is undertaken by an AD who sends letters to parents, or will phone or send a SMS in the case of no response. Adult vaccines are booked ad hoc, especially during flu season.

The AD also sends the letters and manages the reminder recall activities, and the PN phones non-responders and DNAs.

3. Vaccine ordering, stocking and fridge maintenance

The PN primarily manages vaccine stock levels although with some support from the PM.

An HCA undertakes the vaccine ordering, which stock audit, and fridge maintenance is done by the PN.

Ordering is done by the PN and stocking and maintenance is split between the PN and an AD.

Ordering, stock management and maintenance is undertaken by a PN.

The PN does the fridge maintenance and an AD vaccine stocking and ordering.

Vaccine ordering and fridge maintenance are all undertaken by the PN.

Stocking and ordering is undertaken by an AD with some maintenance from the PN.

Stocking and ordering is done by an AD. Fridge maintenance is split between an AD, a PN and HCA.

Stocking, ordering and maintenance are all undertaken by a PN.

4. Vaccination appointments

Vacc takes place in general clinics with a PN.

Childhood vaccines are allocated 20 min, with some adult vaccs having 10-min appts.

All vacc takes place in general clinics within 15-min appts with a PN.

Most primary imms are given in a specific baby clinic with a PN in a 15-min appt, although some are also done in general clinics. All adult imms are done in general clinics and sometimes 10-min appts are used.

Almost all vacc takes place in a dedicated baby/child clinic with 10-min appts.

Although rarely 20-min general appts are used.

A mixture of 15- and 20-min appts are used in general clinics with a PN. Rarely 10-min appts are used.

There is a dedicated clinic for the 8-week appts with 2 PNs working 5 min per patient. All the others in general clinics with 10-min appt with a PN.

All childhood and most adult vacc take place in 15-min appts with a PN. Some PCV and shingles vacc are done in 20-min appts with an HCA.

A specific vacc clinic is run that involves 2 PNs with 5-min appts and 2 HCAs undertaking data input. A few 15-min general appts with PN and 20-min appts with an HCA are used. Adult vaccs take place in general clinics and are often given by HCAs.

Almost all vacc are given in 15-min appts in a general clinic with a PN.

5. Post-clinic data collection and submission, including Open Exeter and CQRS.

This is entirely undertaken by the PM.

This is primarily done by the AD, with some support from the PM.

Some data collection is undertaken by the PN immediately after the appts, then an AD is responsible for upload and submission.

This task is split between the PM and the R staff, with a small amount of support from the PN.

This is undertaken by an AD staff member and however is primarily automated.

An AD is in the clinic with the PN to undertake data collection and submission simultaneously. The PM has a role in the financial submissions.

A member of the R team has a large role in this, supported by a specialist AD.

Aside from the data entry undertaken in the clinics, the remainder is done by the AD.

An AD has a large role in data submission, with some time spent by the PN, particularly on CQRS.

6. Professional tasks and activities (training, reading updates, PGD administration)

Reading the vaccine update and training are undertaken by the PN.

Reading the vaccine uptake is done by both the PM and PN, with the PN also doing training.

Reading the vaccine update and training are undertaken by the PN.

Reading the vaccine update and training are undertaken by the PN.

Reading the vaccine update and training are undertaken by the PN.

Reading the vaccine update and training are undertaken by the PN.

Reading the vaccine update and training are undertaken by the PN.

The PN undertakes annual training.

The PN undertakes annual training.