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What's behind a simple letter?
David Ibbotson, Operations Director for the Vaccine Programme at NHS South, Central and West (SCW), a key partner in the NHS-wide vaccination programme, shares what he has learnt about what is required to deliver a ‘simple’ letter inviting someone for a jab.

Friday 18 June was a watershed moment for the NHS vaccination programme. We successfully completed sending letters and texts to the entire adult population through the Call and Recall service, inviting people to have a COVID-19 vaccination within our NHS Immunisation Management Service (IMS).

It seems a long time since the programme dispatched our first national invite letters for COVID-19 on 7 January 2021, and since then we’ve gone on to send out a total of 47 million letters and 29 million text messages.

Collage image of people receiving their letters inviting them to get a vaccination.

Where did we start?

In order to send out a letter or a text message you’ve obviously got to have the basic contact details of every individual so we needed to work with various NHS organisations and our partners to identify the population and build the supporting infrastructure. This meant establishing the required data flows to access the much-needed demographic and geographical information.

To underpin this, we ensured all the significant information governance and clinical safety elements were in place to flow the right data for the right purpose.

Once we got the data, we then needed to overlay the Joint Committee for Vaccination and Immunisation (JCVI) Green Book guidance to identify the cohorts, establishing who was in which age group, who was at risk etc., so we knew who to contact first.

In parallel to all of this we needed to stand up new teams, services and processes to deliver an end-to-end service. Our team had a lot of help here – working with our trusted partners – System C & Graphnet who provide and support the backbone platform to the service, and Synertec who provided the hybrid mailer service. 


Matching supply and demand

What I learned early on, was that this was not a linear process, and very much an integrated service with the national vaccination tech and data products and services, plus other third parties.

One example of the complex integration was the introduction of an application programme interface (API), to enable Point of Care (PoC) systems and the national booking service to perform checks against eligible individuals. Is this person in an eligible cohort and/or have they already had their vaccination event captured? This gets used up to an astonishing 3 million times per day and is a vital part of the infrastructure to book and capture vaccination events safely.

Another area requiring our specialist help was to identify and invite individuals at the right pace and timing to match the waves of vaccination centres and community pharmacies being stood up at the start of the year.

This was quite significant as we couldn’t just select the ‘all over 80s’ and issue an invite letter in case there was insufficient vaccine supply. We also wanted to avoid people having to make 3-hour car journeys specifically.

To meet this need, we introduced another piece of new tech and service, with the help of our own expert GIS team, who provided accurate drive time mapping capability using specialist software.

This enabled us to issue invite letters to people within a 45-minute drive time radius of a particular site and expand the footprint as more and more vaccination centres were being opened across the country. This level of precision enabled the national data modelling team to manage effective supply and demand across the vaccination centres.


Fine tuning

As the national vaccination programme gained momentum throughout January and February, our invitation mapping processes became even more complex. We needed to fine tune invite volumes per region given that not all vaccination centres had the same capacity, coupled with the variances of population density across the country.

New processes were put in place to select individuals by Sustainability and Transformation Plan (STP), by Clinical Commissioning Group (CCG), by Primary Care Network (PCN) and even by postcode. And key to this was introducing the right assurance checks to make sure invites weren’t incorrectly sent out or that people weren’t being left behind.


The blues....

One of things that we did introduce in conjunction with the national team and Royal Mail, was to introduce blue envelopes instead of the standard white ones with an NHS logo. The rationale being that the envelopes would clearly stand out in Royal Mail sorting and delivery offices. I have to admit I wasn’t sure of the impact this would have on both the programme and the recipient, but I was definitely willing to give it a go.

Sometimes, in these heavily process-driven programmes, it is dangerously easy to lose sight of the people that we are ultimately serving.

This posed a significant challenge to our team, from agreeing the re-design, sourcing materials, testing them through machines ….and then you learn things such as ink reduces the integrity of an envelope, so when loaded up with a leaflet and other inserts, we started to see failures with the envelope edges and ink transfer. But, it was all sorted, and from start to finish we were sending out blue envelopes in just over a month, which was an impressive turnaround with everything else going on.

Sometimes, in these heavily process-driven programmes, it is dangerously easy to lose sight of the people that we are ultimately serving. I make sure to remind myself of putting ‘patients first’ and being focussed on the end outcomes that we are trying to achieve.


It's how you say it

And finally, just to touch on the content of the letter and text message. If you’ve received a letter from the NHS, you’ll note that it’s two A4 sheets, plus language translation, plus a Public Health England (PHE) public health guidance leaflet. Wording on the letter goes through constant change as it has been tweaked for the various cohort groups and PHE leaflets are continually updated. Also, working with the Department for Health and Social care (DHSC), we have conducted text message variance testing, to ensure we use content that leads to the greatest response to encourage someone to go and book their vaccination.


So, what's behind a simple letter? Quite a lot!

It’s been a tough journey on a rocky road, but one that has been very rewarding in that it really does feel that we are doing our bit to help the health of our nation.

We have had to significantly evolve to support a fast-moving programme that was reaching out to the nation.

It continues to be a humbling experience, working with partners and stakeholders who have had and continue to have a great ‘can do’ and ‘in it together’ attitude to their work.


Next chapter

We will continue to invite eligible people and encourage uptake across all cohorts and ensure we vaccinate all types of people. We fully expect to send invites for the COVID-19 booster that is due in the autumn, focussing on digital first but still sending out letters if necessary and integrating our services with the NHS App.


Related subjects

The national booking service is helping millions of people schedule their life-saving COVID-19 vaccinations. James Higgott, Lead Product Manager, gives an insider’s view on how we created the staff-facing products that make up this service and solved some teething problems along the way.

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Last edited: 28 July 2021 8:53 am