MMR letter template instructions

Crown Copyright 2010

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CONTENTS Background

3

Introduction to the material

3

The 2010 research

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The new vaccination schedule

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Adapting the letters

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Example best-practice immunisation journey

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Letter A

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Letter B

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Letter C

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Letter D

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Letter E

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Letter F

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Factsheet for parents

15

Questionnaire

17

Case study 1: Joanna and James

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Case study 2: Simon and family

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BACKGROUND The combined MMR vaccine, which protects against measles, mumps and rubella, was introduced in the UK in 1988. By the mid 1990s, MMR vaccination levels had risen to above 92% – almost the level required to protect the entire population. But in 1998, The Lancet published a paper (Wakefield et al.), which was interpreted as suggesting a possible link between the MMR vaccine and autism. Numerous studies around the world (see www.nhs.uk ) have since shown no such link. This research and the resulting media coverage led to a drop in vaccination levels to about 70% in London – and these levels have still not totally recovered. Because measles, mumps and rubella had been almost eliminated, many families do not realise how dangerous they can be. In 1967, the year before the single measles vaccine was introduced, 99 children died from the disease. In 2009, the number of children in London who had had two doses of MMR vaccine by the age of five was 68%, which is still well below the level needed to ensure protection for the whole population. (In 2009, 86% had one MMR dose by the age of five.) In October 2010, the Department of Health in England simplified the vaccination schedule so that the 12-month vaccinations and the first MMR are now given within the same appointment between the ages of 12 and 13 months; these may be known jointly as the 12-month vaccinations. The second MMR and pre-school booster are also given within a single appointment at about three years and four months. The change in schedule is to maximise vaccination uptake by reducing the number of appointments that parents and carers need to attend with their children. Increasing vaccination uptake is complex – and is shaped by a number of factors, including the public discourse about vaccinations, the provision of objective information, practical issues (such as attending appointments) and accurate recordkeeping. INTRODUCTION TO THE MATERIAL Working with the Central Office of Information (COI), Commissioning Support for London (CSL) has developed six letter templates (pages 8-14) for you to adapt when inviting children to their 12-month and the pre-school booster / 2nd MMR vaccinations. We have also written a factsheet (pages 15-16) that you can give to parents/carers to answer any questions that they may have. There is also a questionnaire (page 17) for you to gather feedback from parents/carers about their vaccination experience and use it to develop your service. And for press use and to give context, there are two case studies (pages 18-19) about parents’ experiences with the MMR. The material has been designed to maximise uptake of the vaccinations. It builds on good practice across London, and we have based it on recent research into the causes of low uptake of the MMR.


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THE 2010 RESEARCH Research with parents carried out for CSL (Linguistic Landscapes and COI, 2010) confirms previous research showing that some parents feel that some NHS staff do not understand their perspective on MMR and vaccinations. • The MMR debate is still heated The research found that, despite the fact that the 1998 Lancet paper is discredited, the debate about the MMR is still heated, albeit less heated than before. The research confirms previous recommendations that healthcare professionals should be aware that child vaccinations in general – and the MMR in particular – are still worrying for parents/carers and they should follow best practice of listening to parents/carers and empathising with them. • Parents make decisions In general, parents treat the decision about vaccinations like the dozens of other important decisions they take on behalf of their children. They consider the issues carefully; they talk to other parents – either face-to-face or using social media such as Mumsnet – and they look at websites online. They also ask the experts, although some may mistrust healthcare professionals. Significantly, most parents believe that the decisions they make about immunisation are right for their children. • Autism is still a worry Although extensive research has not shown a link between autism and bowel disease and the MMR vaccine, it is still a worry for many parents. Some parents choose not to vaccinate because they are more frightened of autism then they are of their child developing complications from measles, mumps and rubella infections – many parents don’t realise how dangerous measles, mumps and rubella can be. The research recommended that when healthcare professionals are talking to parents about the MMR, they should not ignore the fear of autism; they should empathise with them and respect their concerns. • The vaccination experience can be distressing The research found that the vaccination experience can occasionally be more distressing than it needs to be. There are some pockets of poor practice, where healthcare professionals hurry parents/carers and can be patronising – instead of being professional and respectful. • Having a conversation A key recommendation of the research is that healthcare professionals should view discussions about vaccinations as an ongoing conversation – rather than a one-off decision based on a letter or on an instruction. Therefore, we suggest that, in any letter, you refer parents and carers to further sources of information about vaccinations, and if need be, invite them to further appointments to discuss their vaccination decisions. If all communications about vaccinations – including letters, discussions, press releases and leaflets – are viewed as a conversation, they should say the same thing in the same tone of voice. In this way, messages will be reinforced and parents/carers are more likely to accept vaccinations.


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Healthcare professionals should therefore, when talking about the vaccinations, use the same language and tone of voice as in the leaflets and letters. For that reason, it’s essential for healthcare professionals to understand the research and how best to talk to parents and carers about vaccinations. You can get copies of the research from CSL. It is outlined briefly above and also in our tone of voice guidelines. THE NEW VACCINATION SCEHDULE The new MMR vaccination schedule at 12-months and at three years and four months offers the opportunity to turn down the heat on the debate by not focusing on the MMR. As of December 2010, the new schedule is not causing much concern. There is limited evidence from social media of some parents/carers being worried about the number of vaccinations given in a single appointment. The research recommendations are to empathise with parents/carers about their concerns and to explore them. The Department of Health suggests that nurses offer to give the three vaccinations in two separate appointments if parents/carers are worried. You should also reassure parents and carers that the new schedule is completely safe and has been clinically tested.


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ADAPTING THE LETTERS The letters on pages 8-14 are in Arial 11 point. Simply cut and paste them into your standard letter template and adapt them as necessary. For each letter, you will need to: • • • • • •

Fill in the date (please do not write ‘Date as postmarked’) Fill in the parent or carer’s name at the beginning Fill in the child’s name throughout and ‘he’ or ‘she’, ‘his’ or ‘her’ as appropriate Fill in a healthcare professional’s name throughout that you can refer parents and carers to; Fill in a named individual who is responsible for keeping your records up to date; and Remove the page numbers, letter title and the Crown copyright information.

Letters to parents/carers about the 12-month vaccinations Letter A: 12-month vaccinations invitation letter Use letter A to invite children for their 12-month vaccinations once they have reached the age of one. Some practices send the letter together with a first birthday card. Once parents/carers have made an appointment, it is best practice to remind them about the appointment by text. Letter B: 12-month vaccination initial non-responder letter Use letter B if you get no response to letter A after four weeks. The family could still be thinking about it, the letter could have gone astray, the family could have moved or gone away or they could simply have forgotten about the first letter. The letter contains more information about some of the worries that parents may have. Letter C: 12-month vaccination supplementary non-responder letter Use letter C if you haven’t received a response to letters A and B after a further four weeks. The letters could have gone astray or it’s possible that the child could have had their vaccinations elsewhere. As suggested in the letter, you may want to phone them if they still haven’t responded to any of the letters after a few weeks. Letters to parent/carers about the pre-school booster and the second MMR Letter D: pre-school booster and 2nd MMR invitation letter Use letter D when inviting children for the pre-school booster and the second dose of the MMR from the age of three years and four months. Letter E: pre-school booster and 2nd MMR initial non-responder letter Use letter E if you haven’t had any response to letter D after a couple of months. Letter F: pre-school booster and 2nd MMR supplementary non-responder letter Use letter F if you haven’t received a response to letters D and E. As suggested in the letter, you may want to phone the family if they still haven’t responded to letters D and E after a few weeks.


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EXAMPLE BEST-PRACTICE IMMUNISATION JOURNEY The immunisation journey below has been developed based on examples of best practice across London for use with letters A-F on pages 8-14 in this document.


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LETTER A: 12-month vaccination invitation letter [insert date]

Dear [insert parent or carer’s name] Your child’s 12-month vaccinations Now that [insert child’s name] is one, we are writing to offer [him / her] an appointment for [his / her] 12-month vaccinations. The 12-month vaccinations protect against measles, mumps, rubella (sometimes called German measles), meningococcal C and Hib diseases, as well as some pneumococcal infections. These vaccinations are part of the routine programme that the NHS recommends for all children. As part of the programme, [insert child’s name] has probably already had injections to protect [insert him or her] from other serious diseases – such as polio and diptheria. Although some people think these six diseases aren’t serious, they can all be very dangerous – for example, measles can lead to deafness, pneumonia and swelling of the brain. These vaccinations will help protect your child against all these diseases. Making an appointment for the vaccinations As your family doctors, we strongly recommend these vaccinations for your child. Please get in touch to make an appointment for [insert child’s name]’s injections. Or if you’d like to discuss the vaccinations, talk to [insert named individual] or visit www.nhs.uk for more information. If you think you’ve received this letter by mistake – or if your child has already had these injections – please contact [insert named individual with responsibility for records]. This is so that we can keep our records up to date. We look forward to hearing from you. Kind regards


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LETTER B: 12-month vaccination initial non-responder letter

[insert date]

Dear [insert parent or carer’s name] Reminding you about your child’s 12-month vaccinations I am writing to remind you about [insert child’s name]’s 12-month vaccinations. The 12-month vaccinations protect against measles, mumps, rubella (sometimes called German measles), meningococcal C and Hib diseases, as well as some pneumococcal infections. These vaccinations are part of the routine programme that the NHS recommends for all children. As part of the programme, [insert child’s name] has probably already had injections to protect [insert him or her] from other dangerous diseases – such as polio and diptheria. Although some people think these six diseases aren’t serious, they can all be very dangerous – for example, measles can lead to deafness, pneumonia and swelling of the brain. Measles, mumps and rubella are also highly infectious. Even though your child is not yet at school, [he or she] could still come across them at playgrounds and toddler groups. These injections will help protect your child against all these dangerous diseases. About the vaccinations The 12-month vaccinations are given as three separate injections in a single appointment. It’s completely safe to have these injections on the same day, but if you’re concerned, [insert named individual] will be happy to give your child the injections on two different days. The 12-month vaccinations include the first of the two MMR injections. Last year, 86% of London children had their first MMR injection. The NHS recommends that children have their first injection soon after their first birthday and a second dose – together with the pre-school booster – at the age of about three years and four months. Getting in touch with us Like any parent or carer, you want to be sure that you’re taking the right decisions for your child. As your family doctors, we strongly recommend the 12-month vaccinations for your child. Please get in touch to make an appointment for the vaccination or, if you have any worries, [insert named individual] is always very happy to discuss them with you. You can also visit www.nhs.uk for more information.


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If you think you’ve received this letter by mistake – or if your child has already had these vaccinations – please contact [insert named individual with responsibility for records]. This is so that we can keep our records up to date. We look forward to hearing from you. Kind regards


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LETTER C: 12-month vaccination supplementary non-responder letter

[insert date]

Dear [insert parent or carer’s name] Making an appointment to discuss the 12-month vaccinations I am writing to remind you that [insert child’s name] is overdue [insert his or her] 12month vaccinations – and to ask if you’d like to make an appointment to discuss them. The 12-month vaccinations protect against measles, mumps, rubella (sometimes called German measles), meningococcal C and Hib diseases, as well as some pneumococcal infections. The 12-month vaccinations are part of the routine programme that the NHS recommends for all children. As part of the programme, [insert child’s name] has probably already had injections to protect [insert him or her] from other dangerous diseases – such as polio and diptheria. Getting in touch with us The 12-month vaccinations are given as three separate injections in a single appointment. It’s completely safe to have these injections on the same day, but if you’re concerned, [insert named individual] will be happy to give your child the injections on two different days. If you have any other worries about the vaccinations, [insert named individual] is always very happy to discuss them with you. If we don’t hear from you, [insert named individual] will call you to check that you’ve received our letters and ask if you’d like an appointment to discuss the vaccinations. If you tell us that you don’t want [insert child’s name] to have the vaccinations, we’ll document it on [his or her] records. But it’s never too late to have them – if you change your mind, you can contact us to make an appointment at any time. If you think you’ve received this letter by mistake – or if your child has already had their 12-month vaccinations – please contact [insert named individual with responsibility for records]. This is so that we can keep our records up to date. Thank you for your help. Kind regards


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LETTER D: pre-school booster and 2nd MMR invitation letter [insert date]

Dear [insert parent or carer’s name] The pre-school booster and the second MMR Now that [insert child’s name] is three, we are writing to invite [him or her] for the preschool booster and the second dose of the MMR. The pre-school booster protects against polio, diphtheria, whooping cough and tetanus, and the MMR protects against measles, mumps and rubella (sometimes called German measles). Although some people think measles, mumps and rubella aren’t serious diseases, they can all be very dangerous – for example, mumps can cause meningitis and, in some cases, deafness. The pre-school booster and the second MMR are part of the routine vaccination programme that the NHS recommends for all children. [insert child’s name] has already had earlier vaccinations against these diseases, and [insert he or she] should now have these injections to ensure maximum protection. Making an appointment for the MMR As your family doctors, we strongly recommend these two vaccinations for your child. Please get in touch to make an appointment for [insert child’s name]’s injections. Or if you’d like more information about the vaccinations, talk to [insert named individual] or visit www.nhs.uk. If you think you’ve received this letter by mistake – or if your child has already had one or both of these vaccinations – please contact [insert named individual with responsibility for records]. This will help us to keep our records up to date. We look forward to hearing from you. Kind regards


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LETTER E: pre-school booster and 2nd MMR initial non-responder letter

[insert date]

Dear [insert parent or carer’s name] Reminding you about your child’s vaccinations I am writing to remind you about [insert child’s name]’s pre-school booster and second MMR. The pre-school booster protects against polio, diphtheria, whooping cough and tetanus, and the MMR protects against measles, mumps and rubella (sometimes called German measles). They are part of the routine vaccination programme that the NHS recommends for all children. [Insert child’s name] has already had earlier vaccinations against all these diseases. Although some people think measles, mumps and rubella aren’t serious, they can all be very dangerous – for example, measles can lead to convulsions, pneumonia and swelling of the brain. Now that your child is three, [insert he or she] should have these injections to ensure maximum protection. As [insert child’s name] mixes with more and more children, [insert he or she] is more likely to come into contact with diseases such as measles. Getting in touch with us Please get in touch to make an appointment. As your family doctors, we strongly recommend these vaccinations for your child. If you have any worries, [insert named individual] is always very happy to discuss them with you. You can also visit www.nhs.uk If you think you’ve received this letter by mistake – or if your child has already had one or both of these vaccinations – please contact [insert named individual with responsibility for records]. It’s important for us to keep our records up to date. We look forward to hearing from you. Kind regards


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LETTER F: pre-school booster and 2nd MMR non-responder letter

[insert date]

Dear [insert parent or carer’s name] Making an appointment to discuss your child’s vaccinations I am writing to ask if you’d like to make an appointment to discuss [insert child’s name]’s pre-school booster and second MMR. The pre-school booster protects against polio, diphtheria, whooping cough and tetanus, and the MMR protects against measles, mumps and rubella (sometimes called German measles). They are part of the routine vaccination programme that the NHS recommends for all children. [Insert child’s name] has already had earlier injections to protect against all these illnesses. Now that your child is over three, [he or she] should have the booster and the second MMR to ensure maximum protection. You can find more information about these vaccinations and the diseases they protect against on www.nhs.uk Getting in touch with us Like any parent or carer, you want to be sure that you’re making the right decisions for your child. If you have any worries, [insert named individual] is always very happy to discuss them with you. If we don’t hear from you, [insert named individual] will call to check that you’ve received our letters and to ask if you’d like to make an appointment to discuss the vaccinations. If you tell us that you don’t want [insert child’s name] to have the vaccinations, we’ll document it on your child’s records. But it’s never too late to have them – if you change your mind, you can contact us to make an appointment at any time. If you think you’ve received this letter by mistake – or if your child has already had one or both of these vaccinations – please contact [insert named individual with responsibility for records]. This will help us to keep our records up to date. Thank you for your help. Kind regards


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12-month vaccination factsheet for parents 1. What are the 12-month vaccinations? The 12-month vaccinations protect against measles, mumps, rubella (German measles), whooping cough, meningococcal C and Hib diseases, as well as some pneumococcal infections. 2. What are measles, mumps and rubella? Measles, mumps and rubella are all infectious viral illnesses that are spread very easily and quickly. They usually affect children and symptoms include high temperature, rashes and swollen glands, and a general feeling of being unwell. 3. Are measles, mumps and rubella dangerous? Yes. Although most children will get better without any side effects, these infections can lead to serious conditions such as deafness, brain damage and, in rare cases, death. That’s why the NHS recommends these vaccinations. 4. What are meningitis C, hib disease and pneumococcal infections? Meningitis C, hib disease and pneumococcal infections are all potentially very serious bacterial infections. They can lead to anything from ear infections to pneumonia, blood poisoning and meningitis. 5. What do vaccinations do? Vaccination is a way of protecting against serious diseases by stimulating the immune system. Once we have had an injection to protect against a disease, our bodies are better able to fight the disease if we come into contact with it again. The measles and the MMR vaccinations have probably prevented more than 25 million cases of measles in the UK since the introduction of the measles vaccine in 1968. 6. Can’t these injections be left until children are a bit older? It’s best if children have these injections as soon as possible. In particular, measles, mumps, pneumococcal diseases and rubella are all highly infectious, and children could catch them anywhere, from a toddler group to the playground or the supermarket. 7. How do you give the 12-month vaccinations? The 12-month vaccinations are given as three separate injections in a single appointment. The NHS has found that if a child has several injections within a single appointment, it is less distressing for both the child and the parent/carer than attending several appointments. 8. Three vaccinations at once sounds a lot. Can’t children have the vaccinations one at a time? Your child’s immune system can handle a lot, and it’s perfectly safe to have all these vaccinations at once. Also, the three injections are just as effective when given together in one appointment as they are when given in separate appointments. If you’re concerned, the practice nurse should be happy to give your child the three injections on two different days. 9. What about children with an egg allergy? Children with an egg allergy should still have these vaccinations. Research has shown that severe reactions to vaccinations are not linked to the egg in the vaccine – rather to other ingredients. However, if your child has a history of severe allergy to anything, you should talk to your health visitor, practice nurse or doctor before having any vaccine or medicine.


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10. Will they have any side effects after they have had the 12-month injections? Some children get a raised temperature and flu-like symptoms a day or so after the injections. A few children get a mild attack of measles between five and ten days after having the MMR. Fewer children get a mild case of mumps or rubella after two or three weeks. None of these are infectious. 11. What should I do if my child has a high temperature? You can help to reduce a fever by: • making sure that they don’t have too many layers of clothing or blankets on; and • giving them plenty of cool drinks. Call the doctor immediately if your child has a temperature of 39°C or higher, or if they have a fit. If you can’t get to the doctor, go to your nearest Accident & Emergency department. 12. Should I give my child infant paracetamol or ibuprofen? If your child has a fever and appears uncomfortable or unwell, you can give them a dose of infant paracetamol or ibuprofen liquid. It is not recommended, however, to give these drugs before or after vaccinations in anticipation of a fever. 13. Do the measles, mumps and rubella injections cause autism or bowel disease? No. The question was first raised following a paper published more than ten years ago, which implied a link. That paper has since been discredited. A considerable amount of scientific research has since shown that no link exists between the measles, mumps and rubella vaccinations and autism or bowel problems.

December 2010


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CASE STUDY 1: JOANNA AND JAMES

Malaysian-born Joanna David and her husband Paul live with their son, James, in Walthamstow, north-east London. ‘I researched the MMR really thoroughly. Because there was so much in the press about it, we wanted to be sure that it was safe. I talked to healthcare professionals, I went on all the mother and baby websites, and I read research on the internet. I also discussed it with other parents: all my siblings chose the MMR for their children – as did most of our friends. ‘We thought quite hard about whether the vaccination was necessary. There was a measles epidemic in Malaysia when I was a child – I had it and was fine but a friend of mine was left deaf in one ear because of complications from measles. We didn’t feel we wanted to risk it. ‘Eventually, we decided to have the MMR. I was more anxious about it than I had been about the other injections, but it was fine. We watched James like a hawk for any side effects – but there weren’t any. Then, because the first injection had been OK, we weren’t worried about the second MMR. ‘We definitely don’t regret choosing the MMR for James. To set your mind at rest, do your research on the internet, talk to other parents and think about the issues. All the scientific evidence shows no link between it and autism. But ultimately you have to make up your own mind about the MMR.’


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CASE STUDY 2: SIMON AND FAMILY

Simon and Dorcas de Deney have two sons, Jack and Harry, and live in Stoke Newington, north London. ‘Jack was born in 1998 around the time of the MMR controversy – when people first started talking about a link with autism. We had no problems with any of the other injections, but for us, the MMR was different. ‘It was very difficult to make up our minds about the MMR at that time. The press coverage was overwhelmingly against the MMR and when we researched it on the internet, there didn’t seem to be a clear picture at all. ‘We couldn’t have forgiven ourselves if Jack had become autistic due to a decision that we’d made. But we still wanted him to be protected from measles, mumps and rubella. So we found a private doctor who was willing to give Jack the three separate jabs. It was an expensive and inconvenient option – but it was what we felt we had to do at the time. ‘In 2003, Jack was due his second injections. We researched it all again and this time, the evidence was much more strongly in favour of the triple MMR. So Jack had the MMR, and we chose the MMR and the second MMR for our younger son, Harry, as well. ‘It’s sad that so many people – ourselves included – were misled by the 1998 paper and the resulting press coverage. The whole thing caused a lot of people a lot of anxiety and worry. I think we made the right decisions given the facts that were available at the time.’


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Increasing uptake of child vaccinations Tone of voice guidelines for NHS staff

December 2010

Vaccinations: the context

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Increasing vaccination uptake • Increasing vaccination uptake is complex and shaped by factors including: – – – –

accurate record-keeping; access issues – such as time and location of appointments; the provision of objective information; and The press’s, parents’ and carers’ attitudes towards vaccinations.

• These tone of voice guidelines and templates were written in response to research, which showed the following: – Many parents were worried about child vaccinations; – Some parents reported that the vaccination experience is more distressing than it needs to be; – Some parents reported being confused by the lack of consistent information about vaccinations.

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Communicating consistently • Research suggests a need for all NHS staff to adopt messages and a • • •

consistent tone of voice – and to act in a consistent way Communications about vaccinations are not one-off events – they are always part of a conversation This document is based on existing good practice across London It gives guidelines for conversations and communications about vaccinations – so that all NHS staff can talk about it consistently and act in a consistent way

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Understanding parents and carers (1) Parents and carers make decisions • Every day, parents/carers have to make decisions on behalf of their children • In making these decisions, many parents/carers consider the issues carefully • They talk to other parents – either face-to-face or on parenting websites such • • •

as Mumsnet – and they search online for information They also ask the experts – but some may mistrust healthcare professionals Most parents/carers believe that the decisions they make about vaccinations are right for their children Some parents feel that not all NHS staff understand their perspective

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Understanding parents and carers (2) Vaccinations are a distressing topic • • • • • •

The vaccination experience can be distressing for parents and children There is still some heat in the MMR debate Even now, the press still occasionally links autism and the MMR Some parents/carers choose not to vaccinate with the MMR because they are more frightened of autism than of their child developing complications from measles, mumps and rubella There is some concern about the number of vaccinations children are given at any one time So when we are talking to parents, we need to empathise with them and respect their concerns

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Guidelines for talking about vaccinations

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About these tone of voice guidelines • These guidelines are based on an understanding of parents/carers, and their • • • •

beliefs about vaccinations They bring all the best practice into one place – many NHS staff already work in this way But we need to encourage all NHS staff to adopt these behaviours, messages and tone of voice consistently There is also a set of letters to parents/carers which can be adapted as required – as well as case studies and a factsheet Read on to find out more about our tone of voice

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Tone of voice Recent and previous research shows that, whether we’re creating communications or having a discussion with a parent/carer, everything that we say about vaccinations should be:

• • • • •

Respectful Empathetic Supportive Informative, and Part of a conversation

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Be respectful of parents’ concerns • Understand and value parents’/carers’ past experiences and perspectives • In a conversation with a parent, ask questions about their past experience • Acknowledge, in all our communications (without seeming to apologise for immunisations) that we understand they’re trying to do the best for their children Did Daniel have all his injections when he was a baby? Like many parents, you want to be sure you’re making the right decisions for your child.

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Be empathetic

• Put ourselves in the position of parents when we’re talking to them or writing a • •

leaflet Listen to what parents say and reflect it back to them Talk about the child by name if possible

Even though Daniel had all the other injections when he was a baby, the MMR is different in your view. Like a lot of parents, you want more information. So you’re here for Baby’s injections?

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Be supportive • Be open to discussion and avoid judgemental language • Even though parents’ views may be based on incorrect information, don’t •

railroad them – persuade them gently Don’t unwittingly alienate parents by criticising their opinions

What you’re doing is wrong You don’t have to make a decision now. I read up on all the research and decided to get my own children vaccinated.

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Be informative • Don’t lead on fear – give the facts but in an empathetic way • Write or speak warmly – we’re friendly medical experts not faceless government bureaucrats As your family GP surgery, we strongly recommend these vaccinations for your child. Lots of people are surprised to learn that the year before the measles injection was introduced, 99 children died of measles. Once your child has had their 12-month injections, they will have excellent protection against all these diseases.

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And finally … be part of a conversation • Don’t forget that the decisions about vaccinations are frequently part of a • •

conversation that could well last some weeks – and not a one-off decision based on an instruction. Don’t worry if parents don’t decide there and then. Refer parents to sources of more information Invite them back for more conversation

For more information about the MMR, visit www.nhs.uk and search for MMR. If you’re not yet sure, we can talk some more next week – until you’re completely happy. I’ve got a queue of other mothers waiting for the vaccination outside.

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