Review

Thank you for sending me this paper which I think should be published with some minor revisions particularily in terms of reduction and the use of your website. The paper is original work and there is adequate cover of the literature. It embraces an important subject and is suitable for publication in the B.M.J.

The questionnaire was not piloted and there is no statement of any approval by the Health Authority or LMC.The response rate was remarkable. It is not clear whether the sample frame was just principals in general practice.

The exclusion of the 4 practice nurses because they did not respond to one particular question on giving advice to parents seems superficially to be odd particularily if they completed the remainder.

The method is adequately described and the results are clear although it would be nice if they could have been tabulated where possible as they do go on somewhat.It is unclear how the fact that GP's and HV's,who were confident of explaining the rationale and who also agreed with the policy on the one hand had a higher uptake(page 7) yet on the other hand (page 10) the final sentence indicates that agreeing completely with the policy was not associated with higher uptake of two doses.They should clarify the difference in these answers.

Page 9 final para.it is not clear whether or not a practice colleague means the same discipline or not. I have assumed it doesn't but perhaps they should be more specific.

Interpretation/Conclusions

I thought that the discussion was good as well as the recommendations although I am a little surprised that the authors have not discussed the possibility of releasing this information on NHS net or beyond that to the wider public via NHS Direct or Healthinfocus. It has the additional advantage of being readily updated to cope with further controversies.

It is a shame we do not know the proportion of the work that is being done by each of the categories of workers in this study. If there is an increase in the immunisations done by practice nurses and a reduction in those being done by health visitors then there is a specific training issue which needs addressing.

Finally, I think that some of the anecdotal comments could be included in the website.