015A Childhood Vaccination Recall

015A Childhood Vaccination Recall

Overview 

The 015A Childhood Vaccination Recall folder helps Practices to manage identification of children for routine NHS childhood vaccinations, ensuring that all children are invited at the scheduled age, and any overdue doses are followed up promptly. 


It is structured to clearly separate: 

  • Routine call invitations – sending first invites at the correct age milestones 

  • Recall – identifying children under 5 who are overdue and targeting follow-up by age group 

  • Missing vaccinations - identifying children aged 5-17 who are overdue and targeting follow-up by age group


Folder 015A actively complements Primary Care IT’s 015B folder by highlighting the patients who should be invited for vaccinations as opposed to displaying vaccination coverage and requiring a member of the team to identify the gaps. 


Warning
Before using the recall folder it is essential that this support article is understood, in particular the preparation section. 

Vaccinations covered

Routine childhood vaccinations are included for the childhood schedule up to the age of 5 years. For teenage vaccinations normally administered by the schools teams, Primary Care IT currently only provides the overview of vaccination coverage in 005B.
  1. 6in1
  2. Pneumococcal
  3. Meningitis B
  4. Rotavirus
  5. MMR(V)
  6. Hib/MenC
  7. DTaP/IPV pre school booster

Preparation 

All searches are only as good as the data they are interrogating. For a recall system such as vaccinations, it is imperative that some basic rules are understood to minimise the possibility of patients being invited when they do not require vaccination. 


Users running the searches, or those involved in reviewing the data must understand the limitations of searches, and how these pitfalls can be mitigated. 

Searches can only look at coded data 
Each vaccination should be coded at the point of administration. If a patient has been registered with the same Practice their entire life it is likely that all vaccinations will have been recorded uniformly and not present many issues.  
The most likely reasons for vaccinations not being recognised are in patients who have moved surgeries with their medical record being transferred electronically. See Vaccinations given in other systems. 

Previous vaccinations must have been coded correctly 
Each vaccination has one or more codes that can be used, and each of those allows for ‘qualifiers’ that allow more detailed information such as manufacturer/brand, batch number and expiry date. A human may read the qualifier information and understand what was given despite an incorrect code. 

Warning
Do not use a pneumococcal polysaccharide code (PPV) for a child receiving the conjugate vaccine (PCV)
Do not select a code for Td/IPV for a child receiving a DTaP/IPV pre-school booster

Some concessions are built into the searches, meaning a 5-in-1 primary immunisation could have been accidentally coded instead of a 6-in-1 immunisation. 

Coding the same dose twice is not a problem for these searches (eg: First rotavirus vaccination coded for both the 1st and 2nd doses). It should be noted for payment purposes that some vaccinations coded out of sequence may not be recognised for payment. 

Alert
All searches in folder 015 only look at codes 
Prescriptions are ignored.

Info
Staff using these searches are expected to be familiar with the current routine childhood immunisation schedule, as well as understanding previous schedules when reviewing overdue vaccinations.


Vaccinations given in other systems

TPP SystmOne uses a different approach to recording vaccinations which functions effectively within that clinical system, but when a patient moves to an EMIS Practice many of the vaccinations arrive degraded. A vital operational process when a patient arrives is to review degraded codes from GP2GP. This should happen as soon as possible after the patient registers, and all degraded vaccinations replaced with EMIS recognised vaccinations. 

 

Cegedim (INPS) Vision used another different approach whereby each vaccination is coded by its component. It affects compound vaccinations such as the 6-in-1 or MMR which is coded as 3 separate measles, mumps, and rubella vaccinations, meaning EMIS interprets this as individual injections. The Vision clinical system is no longer used in England, but potentially affects any patient who once registered with a Practice using Vision in the past. For Practices who migrated to EMIS from Vision, a lot of vaccinations may be impacted and cause problems for the recall. 

 

Data Quality 

There is no single approach to locating and fixing data quality issues. One approach is to have a big project to find all patients with degraded information, while the other is to review each list of patients that 015A searches identify to invite. 

 

Search Structure 

A) Routine call childhood vaccinations

Search Name
Purpose
🔍 Invite for 1st primary imms 
Children now due their first set of primary immunisations (around 8 weeks old) 
🔍 Invite for 2nd primary imms Children now due their second set of primaries (12 weeks)
🔍 Invite for 3rd primary imms Children now due their third set of primaries (16 weeks)
🔍 Invite for 12 month immsChildren turning 12 months, due MMR + Hib/MenC boosters
🔍 Invite for 18 month imms
Children due their 18-month booster set (depending on date of birth) 
🔍 Invite for 40 month imms Children due preschool boosters at around 3 years 4 months 

Each invite search is paired with a report to provide a list of patients for batch messaging or mail merge. 

B) Recall under 5 vaccinations 

Search Name 

Purpose 

🔍 Overdue 1st primary imms 

Children aged under 1, 12–24 months, or 2–4 years who have missed their first immunisation 

🔍 Overdue 2nd primary imms 

Same breakdown by age – allows targeting of catch-up invitations 

🔍 Overdue 3rd primary imms 

Patients with incomplete primaries at different age bands 

🔍 Overdue 12 month imms 

Children overdue MMR + Hib/MenC booster by age group 

🔍 Overdue 18 month imms 

Overdue 18-month vaccinations – stratified by age 18–24 months or 2–4 years 

🔍 Overdue 40 month imms 

Preschool booster overdue – separated into 3-year-olds and 4-year-olds 

IdeaThe age-banded structure helps you prioritise younger patients (to keep them on track with schedule) while still capturing older children who are behind. 

C) Missing 5-17 vaccinations 

Search Name 

Purpose 

🔍 Missing Primary imms 

Children aged 5-11 years, or 12–17 years who are missing any coded primary immunisation.

🔍 Missing 12 month imms 

Children aged 5-11 years, or 12-17 years who are missing MMR + Hib/MenC booster 

🔍 Missing 18 month imms 

Overdue 18-month vaccinations – stratified by age 18–24 months or 2–4 years 

🔍 Missing 40 month imms 

Children aged 5-11 years, or 12-17 years who are missing Children Preschool booster

Info
There is no "Missing 18 month imms" search yet since this new part of the vaccination schedule impacts on younger children who have not yet had their 5th birthday.

How to Use Childhood Vaccination Recall 

  1. Run the “Routine Call” folder weekly to generate fresh invite lists as children reach age milestones. 
  2. Use the “Recall” and "Missing" folders monthly to capture anyone who appears to be overdue a routine childhood vaccination, split by age groups for prioritisation. 
  3. Use the reports (table versions) to review the missing vaccinations and to generate call/recall letters, SMS lists, or mail merges. 
  4. Integrate these searches with your vaccination recall workflow (admin or automated system). 

Search principles

  1. Patients begin to appear in the Invite reports (folder a) when they are approaching the scheduled vaccination age, and remain for approximately 2 months. This provides sufficient time to identify, invite, book, and vaccinate a child before the next schedule milestone.
  2. If a patient is a non-responder or delayed for any reason for more than 2 months after they first became eligible for the age, they appear in the Overdue reports (folder b).
  3. The upper age limit for folder b is 4 years 11 months, when unvaccinated children appear in the Missing reports.
  4. Progression through primary imms is dependent on the previous set being completed, or coded declined or contraindicated.
    If the 1st primary (8 week) imms were partially done without rotavirus, the patient will not appear in the 2nd primary (12 week) imms without a code for Rotavirus declined. Nurses and admin staff should be aware of this to ensure that patients are not inadvertently missed off subsequent rounds of invitations. In this scenario the patient would continue to appear in "Invite for 1st primary imms" and the report would show the vaccinations which have been given.
  5. 12 month, 18 month, 40 month imms search independently of the previous milestone. Patients missing a previous routine vaccination will stand out by having a gap in their coverage on the report.
​

Reasons for not being picked up

The searches have been structured to ignore certain groups of patients so they are not identified for invitation/recall too frequently.
  1. A vaccination of the same type in the previous 3 weeks will exclude a patient from being picked up.
    Multi-dose vaccinations typically have a minimum 28 day interval between doses, so this rule prevents patients from being called too soon, especially those patients who are running behind in their schedule.
  2. The most recent code for the vaccination is declined or contraindicated
  3. The patient is too old for the vaccination.
    Some vaccinations have an upper age limit meaning it would be inappropriate to invite a patient for a vaccine that they are not indicated for.

Interpreting reports

The reports are all derived from the same source to help users understand what they show. The data is best viewed when exported from EMIS Web and viewed in Excel, but remember to export as a CSV file.
All reports begin with patient details including their contact details which allow users reviewing the data to filter and pick certain patients for contacting directly. The whole report is built to sort patients from oldest to youngest. We recommend keeping with this order as it helps to see the bigger picture of vaccinations, especially in younger patients. When sorted by date of birth, a pattern of vaccinations may be visible based on the schedule for that patient. Missing gaps in older patients (higher up the list) suggest a patient is not keeping to their schedule, while entirely empty lines show a patient who has either declined all vaccinations or data has not been transferred from their previous Practice. 
Idea
A patient's registration date can be a very helpful indicator of why vaccinations may be missing. If the date is more than 10 weeks after the date of birth, and particularly in older children, it is likely the patient has been registered with another Practice before, so consider that there are degraded vaccinations.
The order of vaccinations is tied to the typical order of the schedule when the child was a baby. The rearranging of MenB and Pneumococcal during 2025 means that some vaccinations may appear out of order in younger children. 

Some tables do not appear at all - such as 1st MenC - except for older children, and additional Pneumo doses in children born in the 2020s.
Notes
Two types of vaccination, Rotavirus (24 weeks) and Meningitis B (2 years) have upper age limits set which means that despite a gap in the report, the patient cannot have the vaccination. In the case of Overdue and Missing reports, a gap in these fields will not be the reason as to why a patient has been included. The searches have been written in a way that ensures any patient older than the upper age limit has that 'overdue' vaccination ignored. 

Unlike the reports in 015B these reports include both a date and a code term for each vaccination, intended to help pinpoint specific vaccinations in the record which may have more complex names that make finding entries harder.

At the right hand end of each report are 3 tables which show any relevant coded Declined or Contraindicated vaccinations, plus the "Latest admin note". If a user identifies a gap in the vaccination record, but there is a corresponding declined code show, they may be less concerned about chasing the vaccination.

Staff maintaining the reports may choose to record information in the patient record against the code Child immunisation administration [714761000000109]. The most recent comment will be shown on the report, which may be a note indicating that a delayed schedule has been discussed, or perhaps attempts to contact the child's family have been unsuccessful.

Declined and Contraindicated

Whilst not a recognised component of childhood vaccination enhanced services, adding declined and contraindicated codes is a helpful way of managing a recall. If a particular vaccination has been declined on behalf of the child, it is still helpful to code the decision so the patient does not continue to be invited regularly when a clear decision has been made. The admin note code can be helpful in this regard, but still means that a child will appear in the searches.
Adding a declined or contraindicated code means that the patient will not be picked up for that type of vaccination again unless they recommence vaccination (eg: refuses 1st 6in1, but 18 months later chooses to have the vaccination).
Searches in the zSubs / Individual vaccinations folder will list anybody under the age of 18 whose most recent code relating to a particular vaccination is contraindicated or declined. This can be used as a list of target patients if the Practice chooses at a later date to chase vaccination uptake. 

Hints & Tips 

    • Always record invitations using the appropriate SNOMED invite codes – this provides an audit trail. 

    • Use batch messaging or recall templates to reduce admin workload. 

    • Prioritise younger patients in overdue searches, as delaying early vaccines increases risk. 

    • Regularly check data imports from Child Health Information Systems (CHIS) – sometimes discrepancies arise if vaccines are given elsewhere. 

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