Closing the gap in nurseries: flu vaccination for two- to three-year-olds in North Tyneside

The School Aged Immunisation Service from Northumbria Health Care NHS Foundation Trust worked with North Tyneside Council, North East and North Cumbria Integrated Care Board (NENC ICB) and other stakeholders and expanded delivery of seasonal ‘flu vaccinations beyond GP practices to include nursery-based sessions and community clinics. 

The pilot demonstrated that this mixed delivery model is operationally feasible, well-supported by parents, and improves access and convenience. Over 650 children were vaccinated in nursery settings alone, with strong parental feedback highlighting improved accessibility. The approach shows clear potential to reduce health inequalities, increase uptake, and support delivery of the NHS Vaccination Strategy through more flexible, community-based services.

Seasonal ‘flu vaccination uptake among 2-3-year-olds has historically struggled to achieve national targets, particularly in areas of deprivation. Traditional delivery through GP practices created barriers including limited appointment availability, working parent constraints, and inequitable access. Local data showed significant variation across the cohort, with uptake as low as 37 per cent in some localities compared to over 60 per cent in school-aged cohorts. 

The traditional single delivery route did not meet the needs of families, many of whom faced logistical challenges in accessing appointments or managing vaccinations across multiple children. It was recognised that 4-year-olds in nursery can slip through the net. This is due to SAIS and GPs working to different criteria with SAIS working to year group and GPs working to age.  The programme aimed to reduce inequalities and improving early childhood immunisation uptake particularly for working families.

Utilising funding from NENC ICB, aimed at addressing inequalities in children and young people, North Tyneside Council commissioned the School Age Immunisation Service (SAIS) to pilot an expanded delivery model between September and December 2025. A structured Plan–Do–Study–Act methodology was used to develop and deliver a programme of ‘flu vaccinations in mainstream nursery settings alongside a programme of delivery in community clinics, complementing existing GP provision. 

Using established school immunisation infrastructure, including digital consent systems and communication channels, the programme was delivered with existing workforce capacity and minimal disruption. The approach focused on accessibility and choice, ensuring families could opt for vaccination in settings most convenient to them. This approach aligns with the NHS England Vaccination Strategy (2023), through the delivery of integrated, community-based models to improve equity and uptake.

The pilot demonstrated that expanding vaccination delivery into early years settings is safe, feasible, and effective. A total of 653 children were vaccinated in mainstream nurseries, achieving 41.9 per cent uptake within that cohort. Parental feedback was strongly positive, with 80 per cent reporting nursery-based vaccination as more convenient. Community clinics were well attended with evaluation showing that they provided an important flexible alternative for working families and those unable to attend nursery sessions. 

The pilot improved access and reduced barriers, with evidence of reduced unmet need and progress toward addressing inequalities. The pilot was delivered using existing workforce and infrastructure, demonstrating scalability and sustainability.

The pilot confirmed that access, rather than hesitancy, is a factor that was driving inequalities in uptake, with parents prioritising convenience and flexibility. Earlier mobilisation was identified as critical. Limited lead-in time resulted in reduced opportunities to engage families before GP appointments had been arranged. Uptake was also lower where on-site delivery was not possible, particularly in private nursery settings. The use of existing infrastructure, and flexible delivery options were identified as key to maximising uptake.

Ken Ross, Head of Health Improvement and Promotion, North Tyneside Council