Guidance

Appendix 1: Examples of local practice

Published 1 October 2026

This appendix presents examples of local practice shared by colleagues through a case study collation exercise undertaken to support the development of this toolkit. The information included has been provided directly by local teams. It has not been formally critically appraised by the UK Health Security Agency (UKHSA). Additional relevant examples are likely to exist but are not captured here.

Integration of influenza vaccination offer with drug treatment services for people sleeping rough in Nottingham

Background

People sleeping rough are at increased risk of respiratory illness and often face significant barriers to accessing routine healthcare and vaccination services. In Nottingham, partners identified an opportunity to improve uptake of seasonal influenza vaccination among rough sleepers by offering vaccination alongside an existing respiratory health clinic that this population already attended. The initiative was developed in response to local winter pressures and the need to protect a vulnerable population from flu-related illness.

What local actors did

The pilot ran between October and November 2025 and involved collaboration between the local pharmaceutical committee, a local community pharmacist, Nottingham City Care, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham University Hospitals and Framework, a service supporting people experiencing homelessness. Outreach teams proactively invited individuals to attend a respiratory clinic within the local drug treatment service that was already familiar and trusted by the target population. A local community pharmacist attended the clinic and offered influenza vaccination to individuals immediately after their respiratory assessment.

To support delivery, partners identified a clinically appropriate environment that met vaccination requirements, including appropriate vaccine storage facilities. The pharmacist completed a risk assessment of the site and worked within existing clinical governance arrangements, standard operating procedures and service specifications. An application for off-site vaccination was submitted to the Integrated Care Board (ICB) and approved rapidly. No additional staff training was required, as the pharmacist was already trained and authorised to administer influenza vaccinations.

What was achieved

A total of 12 people sleeping rough received an influenza vaccination over the 2 clinic sessions conducted during a 6-week pilot period; every individual who was offered vaccination accepted it. The initiative supported local winter pressures planning by providing additional vaccination capacity outside of general practice (GP) and demonstrated the value of community pharmacy in supporting vaccination delivery for people experiencing homelessness. Partners also gained important learning that informed future planning and service development in advance of wider vaccination programme implementation. Furthermore, there has been a reduction in Accident & Emergency (A&E) attendance and admissions among people experiencing homelessness in Nottingham, and this is thought to be a direct result of this intervention. 

Key learning

The success of the pilot was underpinned by strong partnership working and a shared commitment to finding practical solutions.

Enablers:

• collaborative working between outreach services, City Care, community pharmacy and the ICB
• clear understanding of the professional and clinical frameworks within which different partners were operating
• an appreciation of the needs of people sleeping rough and the decision to provide vaccination in a familiar and trusted setting
• rapid support from the ICB
• a pharmacist willing to work flexibly
• robust clinical governance arrangements

Challenges:

• commissioning arrangements
• identifying a clinically appropriate room for vaccination
• communicating effectively with the people to be vaccinated
• operating without incentives, meaning that trust, communication and convenience were essential to achieving high uptake

The pilot highlighted that similar approaches can be implemented in other areas provided there is early agreement on governance requirements and delivery models. It also demonstrated the importance of considering the practical benefits for pharmacy providers involved in off-site vaccination delivery and of remaining open to different approaches for reaching underserved populations.

Next steps

Building on the success of the pilot, partners plan to work with outreach teams across Nottingham City and Nottinghamshire to expand the approach and increase access to vaccination for people experiencing homelessness. A multi-agency task-and-finish group is being established to coordinate planning and delivery. Future work will focus on identifying areas of greatest need, securing appropriate venues, understanding the number of people requiring vaccination and engaging community pharmacists early in the planning process.

Islington Health Outreach Team: Delivering vaccinations through trusted homelessness services

Background

The Islington Health Outreach Team (IHOT) was established to improve access to healthcare for people experiencing homelessness, including those with a history of homelessness, who are less likely to engage with mainstream primary care services, including vaccination.

What local actors did

In October 2025, IHOT began delivering influenza vaccination to people experiencing homelessness through its monthly GP and nurse outreach clinic at the Solidarity Hub in Islington, an established community venue that provides a range of support services for this population. This programme, which is ongoing, is delivered through a partnership involving Islington GP Federation, Islington Council housing teams including St Mungo’s, Streets Kitchen and the Single Homeless Project.

IHOT nurses, already trained and authorised to vaccinate under Patient Group Directions (PGDs), collect vaccines from Islington GP Federation and transported them to the clinic using appropriate cold-chain procedures. All eligible attendees are offered vaccination, either during consultations with the GP or nurse or while waiting in the communal area. The welcoming environment, where people can have a hot drink and a biscuit and speak with support workers, creates opportunities for informal conversations about vaccination and enables staff to address concerns and answer questions.

The programme has adopted an inclusive approach by offering vaccination to eligible keyworkers and support staff attending the clinic. Patient records and vaccine administration are documented using Community Egton Medical Information Systems (EMIS), enabling clinical records to be updated for people who could be identified through National Health Service (NHS) systems.

What was achieved

Overall, 21 people experiencing homelessness have been vaccinated through the outreach clinic. Vaccination is delivered in a trusted and accessible setting that reached individuals who might otherwise not attend routine primary care appointments. By integrating vaccination into an established outreach service, IHOT can engage some of the most marginalised and clinically vulnerable members of the community.

Key learning

This programme highlights the importance of taking services to where people are rather than expecting them to attend traditional healthcare settings. It also reinforces the value of working through trusted community and voluntary sector partners that already have established relationships with the target population.

Enablers:

• trust built on long-standing relationships between GPs, IHOT nurses and people experiencing homelessness
• convenience; vaccination offered opportunistically without the need for an appointment
• vaccination of staff alongside patients creating a sense of camaraderie and equality

Challenges:

• absence of a vaccine fridge at the Solidarity Hub required careful coordination to transport and store vaccines safely - surplus vaccines were offered to other eligible people present in the building to minimise waste
• information sharing across different areas remained challenging for individuals registered outside the borough
• concerns about vaccine side effects, which staff addressed through reassurance and practical advice

Next steps

This work is ongoing and will continue through IHOT’s community clinics, hostel in-reach and street outreach activities. Building on the success of influenza vaccination, partners plan to expand the offer to include pneumococcal, hepatitis B and potentially human papillomavirus (HPV) vaccination. Future delivery will continue to use flexible and opportunistic approaches tailored to different settings, including hostels, community hubs and outreach services for people sleeping rough. Continued collaboration with housing teams and voluntary sector organisations will remain central to the approach, while addressing practical challenges such as vaccine storage and cold-chain management. The overarching aim is to ensure that every contact with a person experiencing homelessness becomes an opportunity to offer appropriate vaccination and improve protection against preventable disease.

Guy’s and St Thomas’ Homeless and High-Intensity User Service: Embedding vaccination within inclusion health outreach

Background

People experiencing homelessness face significant health inequalities and are at increased risk of vaccine-preventable infections, yet vaccination uptake remains lower than in the general population. Barriers to accessing routine healthcare include transport difficulties, digital exclusion, competing priorities, previous negative experiences of services, stigma and challenges attending appointments. Mental ill health, substance use, trauma and mistrust of services can further reduce engagement with preventative healthcare.

What local actors did

The Homeless and High-Intensity User Service, part of the Health Inclusion Team at Guy’s and St Thomas’ NHS Foundation Trust, works across Southwark, Lambeth, Lewisham and the City of London to address these inequalities. The service provides nurse-led healthcare in homeless hostels, day centres, drug and alcohol services and through street outreach. Vaccination is embedded within routine health needs assessments and opportunistic clinical contacts, enabling people to access preventative healthcare within services they already use.

Nurse practitioners and community nurse specialists review vaccination histories, identify gaps in protection and offer vaccination. Where appropriate, vaccines are administered during the same contact, reducing the need for additional appointments. If an individual declines vaccination, the offer remains open and can be revisited during future contacts. Vaccines delivered through this service include hepatitis B, hepatitis A, seasonal influenza, measles, mumps and rubella (MMR), diphtheria, tetanus, polio, and pneumococcal vaccination (and in previous years COVID-19). Delivery is supported by strong partnership working with local GPs, substance misuse services, homeless accommodation providers and local authorities. Nurses receive immunisation training and supervision and administer vaccines through PGDs, prescribing pathways and collaborative working with GPs.

What was achieved

The team has been delivering vaccines to patients facing homelessness for many years, since the creation of the Health Inclusion Team. Between August 2025 and August 2026 in particular, the service administered 334 vaccinations. Hepatitis B accounted for almost 60% of vaccinations delivered, followed by influenza vaccination at around 25%, with hepatitis A, diphtheria, tetanus and polio, MMR and pneumococcal vaccines making up the remainder.

Beyond the number of vaccines delivered, the service creates opportunities for prevention among individuals who may otherwise have limited contact with healthcare services. Vaccination provides a mechanism for building trust, strengthening engagement and maintaining connections to wider health and support services.

Key learning

Vaccination services should be taken to people rather than expecting people to navigate complex healthcare systems. Building trusting relationships, maintaining flexibility and revisiting offers of care over time are essential components of successful vaccination delivery for people experiencing homelessness.

Enablers:

• nurse-led, flexible delivery alongside clinical care and outreach, without requiring a separate appointment
• continuity and relationship-based care
• strong partnership working between hostel teams, GPs, substance misuse services and wider clinical colleagues

Challenges:

• unpredictable engagement as people may be unavailable, decline interventions or have competing priorities
• practical and system barriers such as limited access to telephones, digital exclusion, difficulty navigating services and challenges attending appointments
• competing priorities of both patients and clinical teams managing complex and sometimes urgent needs

Next steps

Vaccination will remain an integral part of the Homeless and High-Intensity User Service’s ongoing outreach and clinical work. The team will continue to embed vaccination within health needs assessments, street outreach and opportunistic healthcare contacts, while maintaining the governance, training and vaccine supply arrangements required for safe delivery. Future work will focus on strengthening partnerships, monitoring uptake and identifying gaps in coverage to inform targeted approaches. Alongside improving vaccination rates, the service aims to continue building trust, reducing exclusion from healthcare and creating repeated opportunities for prevention among people experiencing homelessness.

Peer-led mobile outreach vaccination for people experiencing homelessness and other inclusion health groups in London

Background

People experiencing homelessness and other inclusion health populations face some of the poorest health outcomes in society. Chronic and infectious diseases are often undiagnosed or untreated, while barriers, such as unstable housing, difficulties navigating services and previous negative experiences of care, can limit engagement with services. These challenges can reduce access to preventative interventions such as vaccination, increasing the risk of serious illness from infections. To address these inequalities, Find&Treat, based at University College London Hospitals NHS Foundation Trust (UCLH), developed a peer-led outreach vaccination programme that takes healthcare directly to people in the settings they already access and trust.

What local actors did

Find&Treat delivers seasonal and opportunistic vaccinations alongside a wider integrated infectious disease service that includes tuberculosis, blood-borne virus and syphilis testing and treatment. The service operates across London in a range of settings, including homeless hostels, day centres, soup kitchens, street outreach locations and accommodation for people seeking asylum.

The service is delivered by a multidisciplinary team. A dedicated nurse leads vaccine consent and delivery and supervises trained outreach workers who administer vaccinations. Peer workers and interpreters play a central role in engaging people, building trust, overcoming language and cultural barriers and supporting informed decision-making. Outreach teams work closely with hostels and community organisations to identify opportunities for delivery, raise awareness and encourage uptake. Vaccination services are commissioned annually and supported by strong partnerships with homelessness and voluntary sector organisations. Find&Treat has designed a secure, General Data Protection Regulation (GDPR) compliant web-based electronic patient record platform to support data collection and reporting requirements.

What was achieved

Between April 2022 and March 2024, Find&Treat administered a total of 8,500 doses of respiratory vaccines, including COVID-19, influenza and pneumococcal. However, the programme’s impact extends beyond these vaccination numbers alone. By offering vaccination through peer-led outreach in trusted community settings, Find&Treat has improved access to preventative healthcare for people who may otherwise remain excluded from mainstream services. Each contact provides an opportunity to build trust, address concerns about vaccination and strengthen links with healthcare services. The integrated model also supports engagement with wider health interventions, helping individuals access screening, treatment and ongoing care while promoting longer-term involvement with health services. 

Key learning

Peer-led outreach can improve engagement and vaccine uptake among groups who may be reluctant or unable to access traditional healthcare services. Integrated delivery maximises opportunities for prevention, allowing vaccination, screening and treatment services to be delivered in a single encounter.

Enablers:

• involvement of people with lived experience to build trust, increase engagement and ensure the service remains responsive to the needs of the target population
• flexible outreach model to enable vaccination delivery in locations already used by inclusion health populations, with multiple opportunities to engage over time
• strong partnerships with hostels, voluntary sector organisations and community services

Challenges:

• overcoming barriers to healthcare access associated with location, service availability and reliance on building-based healthcare settings
• addressing mistrust of healthcare services among some individuals, requiring sustained engagement and a peer-led approach
• managing complex commissioning, reporting and administrative requirements across multiple geographical areas and commissioners

Next steps

To sustain and expand the programme, there is a need for coordinated, long-term commissioning arrangements that reflect the mobility of inclusion health populations and reduce duplication in reporting requirements. More consistent funding across wider geographical areas would support workforce stability, strengthen partnerships with community organisations and enable longer-term engagement with service users. Expanding integrated, peer-led outreach approaches has the potential to improve equitable access to vaccination and other preventative healthcare services while helping to reduce health inequalities among inclusion health populations.

Seasonal influenza vaccine delivery through outreach nurses working in homeless hostels in Camden

Background

The Camden Adult Pathway Partnership (CAPP) Team, an Inclusion Health service based at University College London Hospitals NHS Foundation Trust (UCLH), provides community healthcare to around 1,000 people experiencing homelessness across Camden. Through regular outreach to homeless hostels, nurses have developed trusted relationships with residents and identified an opportunity to improve access to seasonal influenza vaccination by incorporating it into their existing outreach model which consists of basic observations, (blood pressure, heart rate, respiratory rate), phlebotomy and linking patients with healthcare services, as well as Groundswell for further support.

What local actors did

During winter 2025 to 2026, the CAPP team explored how seasonal influenza vaccination could be delivered through its established hostel outreach service. The team worked closely with Find&Treat, UCLH’s specialist peer-involved mobile outreach service, which provided support with service development, governance arrangements and vaccine supply.

Existing outreach nurses were trained to deliver influenza vaccinations through completion of an internal online course, with competencies signed off by senior nursing staff. Nurses were added to the existing PGD, enabling them to administer influenza vaccines safely and consistently. Additional preparation included training in vaccine recording systems and ensuring all staff were competent in basic life support and the management of anaphylaxis.

Vaccine stocks were supplied through Find&Treat and UCLH Pharmacy, with robust arrangements in place to maintain the cold chain during transport and delivery. Outreach nurses worked closely with hostel staff to promote the vaccination sessions in advance, estimate likely uptake and minimise vaccine wastage. These existing relationships helped increase awareness of the service and supported effective planning. Vaccinations were then delivered directly within hostel settings, allowing residents to access immunisation in a familiar environment without needing to attend another healthcare appointment.

What was achieved

Approximately 200 vaccines were delivered during winter 2025 to 2026. This service demonstrated that seasonal influenza vaccination could be successfully integrated into an established hostel-based outreach service. By building on trusted relationships and existing clinical contacts, the programme created a practical and accessible vaccination pathway for people experiencing homelessness. Monitoring arrangements were established using the NHS Record a Vaccination Service (RAVS) platform, enabling vaccine delivery activity and demographic information to be recorded and reviewed.

Key learning

Building on established relationships, using familiar settings and leveraging existing organisational expertise can reduce barriers to vaccination and improve access for people experiencing homelessness.

Enablers:

• strong existing relationships between outreach nurses, hostel staff and residents supported engagement and vaccine uptake
• support from Find&Treat provided access to established governance arrangements, vaccine supply, training and clinical expertise
• advance planning with hostels helped raise awareness, estimate demand and minimise vaccine wastage

Challenges:

• ensuring all staff completed the required training and competency assessments before delivering vaccination
• maintaining vaccine cold-chain requirements
• coordinating vaccine supply, administration records and monitoring processes across outreach settings

Next steps

The CAPP team established processes for ongoing monitoring through RAVS, including monthly reviews of vaccination activity and demographic data. The approach provides a foundation for continuing seasonal vaccination through hostel outreach and demonstrates how existing Inclusion Health services can incorporate preventative healthcare into routine practice. The vaccination service will continue in winter 2026 to 2027.

Childhood immunisations for families in temporary accommodation in Manchester

Background

Families experiencing homelessness and living in temporary accommodation often experience disruptions to healthcare access. Relocation away from their usual GP and support networks, combined with the challenges of unstable housing and competing priorities, can make it difficult to access routine services such as childhood immunisations.

What local actors did

Hawthorn Medical Centre in inner-city Manchester partnered with the Shared Health Foundation to improve healthcare access for homeless families living in temporary accommodation. As part of this partnership, a clinical psychologist was embedded within the GP to work alongside primary care staff and support vulnerable families.

The clinical psychologist and a GP from the practice carried out weekly outreach visits to local temporary accommodation settings. These visits provided opportunities to identify and address unmet health needs, build relationships with families and encourage engagement with healthcare services. Through regular contact, clinicians were able to discuss childhood immunisations, provide information and reassurance, address concerns and misconceptions, and directly book vaccination appointments at the practice.

What was achieved

Over 5 years, the Infant Parent Service and GP outreach model improved engagement with healthcare among vulnerable families living in temporary accommodation. Stronger relationships between clinicians and residents led to increased trust and greater willingness to access healthcare services. This contributed to improved childhood immunisation uptake within the practice population. The programme also supported earlier identification of wider health and social needs, including early cancer diagnosis, safeguarding concerns and mental health issues.

Key learning

This work demonstrates the value of taking healthcare directly to families experiencing homelessness and building relationships over time.

Enablers:

• charitable funding from the Shared Health Foundation
• embedding a clinical psychologist strengthened engagement with vulnerable families and supported relationship-based care
• strong partnerships with housing teams and temporary accommodation providers facilitated access to families

Challenges:

• building trust and effective relationships with staff working within temporary accommodation settings
• addressing suspicion and mistrust among some families regarding the role and intentions of outreach healthcare teams
• engaging families facing complex social circumstances and competing priorities that can make healthcare attendance difficult

Next steps

The programme remains ongoing and continues to support families experiencing homelessness. Future plans include developing more robust quantitative evaluation methods to better measure the impact of the service on immunisation uptake and wider health outcomes. This evidence could support further development and wider adoption of the model in areas seeking to improve healthcare access for homeless families and children living in temporary accommodation.

Vaccination through Beacon House Ministries in Colchester

Background

People experiencing homelessness often face significant barriers to accessing mainstream vaccination services. Beacon House Ministries, a specialist homelessness charity in Colchester, Essex, developed an integrated model to make vaccination more accessible by delivering it within a trusted homelessness support setting.

What local actors did

Beacon House Ministries operates a specialist day centre for people experiencing homelessness (including all recognised forms of homelessness such as rough sleeping, emergency hotel accommodation, temporary accommodation and insecure housing), alongside a Care Quality Commission (CQC)-registered clinic providing ICB-funded primary care services. The service offers a broad range of vaccinations, including influenza, HPV, pneumococcal, MMR, hepatitis B, shingles, tetanus, diphtheria and polio (Td/IPV) and meningococcal vaccines, directly to people experiencing homelessness.

Vaccination opportunities are identified during routine clinical appointments and through engagement with the wider support services. This enables opportunistic vaccination in a setting that patients already know and trust, reducing the need to attend separate healthcare appointments.

The service is delivered by a trained clinical team supported by the wider Beacon House workforce. Delivery is underpinned by appropriate governance arrangements, including vaccine storage and cold-chain management, patient records systems, vaccination documentation and staff training in vaccine administration, consent, record keeping and management of adverse reactions. Access to electronic patient records also helps staff review vaccination histories and identify outstanding vaccines.

What was achieved

The success of the service is measured through vaccination uptake and the number and range of vaccines delivered to patients experiencing homelessness. During 2025 to 2026, approximately 400 vaccinations were delivered through the service. Vaccination activity is reported to NHS England on a monthly basis and reviewed through regular contract monitoring meetings, enabling performance to be monitored and opportunities for improvement identified.

Key learning

Beacon House combines a homeless day centre with a CQC-registered clinical service, allowing the delivery of NHS-commissioned vaccinations services within a specialist setting.

Enablers:

• delivering vaccination within a trusted and familiar homelessness support setting
• strong partnership working and commissioning arrangements with NHS England
• close integration between clinical staff and the wider Beacon House team enabled vaccination opportunities to be identified through day-to-day engagement with patients
• £5 incentive vouchers to encourage uptake and engagement

Challenges:

• encouraging uptake among people who may have other immediate priorities or be reluctant to engage with preventative healthcare
• supporting completion of multi-dose vaccination courses when patients move accommodation or leave the area
• maintaining engagement and follow-up with people whose circumstances can change rapidly and unpredictably

Next steps

The service will continue to provide opportunistic vaccination through its clinic while seeking to increase uptake among people experiencing homelessness. Future plans include exploring outreach delivery in locations where patients are living, including hostels, supported accommodation and temporary accommodation settings. Beacon House will continue working closely with NHS England and local partners to sustain the service, monitor outcomes and identify opportunities to further develop and expand the model.