PRIMARY AND PRESCHOOL IMMUNIZATION IN GRAMPIAN - PROGRESS AND THE 1990 CONTRACT

Objective - To examine changes in immunisation performance in Grampian region after the introduction of the 1990 contract for general practi tioners. Design - Retrospective descriptive study using data held on t he Grampian immunisation record system's computer. Setting - All 95 ge neral practices in Grampian region (313 general practitioners). Patien ts - All children in the primary immunisation and preschool booster ag e groups. This formed two groups of children for each of the four cale ndar quarters of 1990 and first three quarters of 1991 analysed as (a) those aged 2 years on the first day of the relevant quarter and (b) t hose aged 5 years on the first day of the relevant quarter, with an av erage population of 6600 and 6400 respectively. Main outcome measure - Percentage immunised by practice. Results - For primary immunisation the number of practices achieving immunisation rates of at least 95% i ncreased from 29 (31%) to 76 (81%), and practices achieving 90% rates rose from 69 (73%) to 87 (93%). For preschool boosters, the number of practices achieving at least 95% immunisation rates increased from 22 (23%) to 61 (64%). By the end of September 1991, 76 (80%) practices we re achieving at least 90% levels compared with 36 (39%) at the beginni ng of 1990. Since the beginning of 1989 the proportion of immunisation s not given by general practitioners declined from 14% to 2%. Conclusi ons - Primary and preschool immunisation rates for preschool children in Grampian showed a sustained improvement during 1990 and consolidati on in 1991. Although overall trends were unchanged, 18 months after th e introduction of the 1990 contract only one practice failed to meet l ower target levels of 70% for both primary and preschool immunisation. By September 1991 more than three out of four practices had reached l evels of at least 95% for primary immunisation.