Facilitating GP registrations among children by linking with Child Health Information Services (CHIS)

Wescott, Molly and Isba, Rachel (2025) Facilitating GP registrations among children by linking with Child Health Information Services (CHIS). Archives of Disease in Childhood. ISSN 0003-9888

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Abstract

Background Lack of access to primary care services, by not being registered with a general practitioner (GP), is a source of health inequality.1 Unregistered children are at risk of missing healthcare activity, including routine vaccination.2 NHS England has emphasised the importance of ensuring no child misses out on vaccination invitations and has sought to explore solutions for those not registered with a GP. NHS South, Central and West (SCW) currently provides Child Health Information Services (CHIS) coverage for 32% of the 0–19-year-old population in England.3 Approximately 1% (n=8000) of those aged 0–6 years within the areas covered are not registered with a GP. SCW CHIS maintains health records for all children aged 0–19 years who live in, attend school in, or are registered with a GP within one of its areas. CHIS is notified when a baby is born or moves into the area, when they register with a GP, and about their vaccinations and screening. The aim of this pilot was to facilitate GP registrations among children aged 0–6 years resident in Bath and North-East Somerset, Swindon, Wiltshire and Gloucestershire, so that families could access childhood vaccination and other healthcare services. Methods CHIS worked with NHS England South-West commissioners to develop a letter reminding parents/carers of the importance of registering their child with a GP. The letter was in plain English, written at a level below the average adult reading age, and included symbols to support accessibility. It outlined how to register, emphasising the process was quick, free and did not require a fixed address or identification. In September 2024, the letter was sent to the households of 807 children aged 8 weeks to 6 years who were not registered with a GP and had one or more missing routine vaccinations. A second letter was sent out the following month to all households where the child was under the age of 1 year (n=89). Results Within 2 months of the initial mailout, 77 children (9.5%) were newly registered with a GP in the area and 52 (6.4%) became up to date with their age-appropriate vaccinations.2 The cost of postage (the most expensive item at £0.86 per letter) for both mailouts (896 letters in total) was £770.56, which equates to just over £10 per new registration or just under £15 per child catching up with their vaccinations. Discussion and conclusion In recent years, there has been a rise in vaccine-preventable diseases such as measles, alongside widening health inequalities. It is therefore more important than ever that children are registered with a GP. CHIS providers are well positioned to identify non-registered cohorts and send simple and low-cost mailouts, resulting in increased registrations and an associated increase in uptake of routine childhood vaccination. Future work A planned project will expand the area covered and will look to identify indicators associated with uptake, for example, ethnicity, index of multiple deprivation. Related projects will look at the optimum number of reminders for vaccination appointments, moving to digital-first invitations and making reminders more accessible.