Public Health England involving GPs in Flu outbreak management, for both cases and well contacts of cases

Date sent: Thursday 4 January 2018

To All BBOLMC Practices

Issue date: 04.01.17

My last email on this issue can be found at https://www.bbolmc.co.uk/email5610

NHSE have now agreed that prescribing Tamiflu prophylactically to well contacts of flu cases is not a GMS obligation.

Managing symptomatic flu cases is covered under GMS, and GPs should use their clinical discretion on using Flu antivirals in these circumstances

Guidance can be found at

https://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/648758/PHE_guidance_antivirals_influenza_201718_FINAL.pdf

http://www.cebm.net/blog/2014/04/10/tamiflu-relenza-how-effective-are-they/ 

Beginning on 12/6/17, David Geddes (NHSE) has sent 2 letters on the Tamiflu issue to all CCGs (Gateway references 06880 and 07402)

These can both be found at https://www.england.nhs.uk/publication/localised-community-outbreaks-of-influenza-in-the-out-of-season-period/

Essentially his letter of 12/6/17 instructed CCGs to commission a service for prescribing Flu antivirals prophylactically outside the CMO flu season.

His letter of 20/11/17 clarified that such a service needed to operate all year round.

However, I am getting increasing reports of an inadequate CCG response to these letters and GPs continuing to receive requests from PHE to prescribe Tamiflu prophylactically to well contacts of flu cases

It seems several CCGs have not commissioned an antiviral prophylaxis prescribing service despite it now being 6 months since the first letter.

This as a serious omission especially as:

1) this year’s flu was predicted to be bad and

2) current non-adjuvanted vaccines had been assessed a providing poor cover for the over 65s.
(see pages 10-12 of JCVI minutes of 4/10/17 at https://app.box.com/s/iddfb4ppwkmtjusir2tc/file/247634612957).

CCGs and PHE generally underestimate the workload involved in prescribing Tamiflu prophylactically to what can be large numbers of patients at very short notice. Renal function needs assessment (for dosing purposes) and obtaining individual informed consent can be difficult and time consuming in the care home setting

This workload burden was what the new service was meant to solve.

Some CCGs still seem to expect GPs to search large numbers of patient records for recent renal function results and provide medical summaries on the cohort of well contacts of cases to the contracted prescriber of prophylaxis. (all un-resourced but not part of GMS)

This is time consuming and takes GP away from what we would have been doing for booked ill patients ie there is an opportunity cost.

My view is that CCGs should not be involving GPs in this way but using modern record sharing IT to obtain the information necessary to prescribe safely

If you are asked to get involved in the management of a possible flu outbreak, I think the resources requested of your CCG should take account of the real workload involved. The unexpected workload bulge will be added to all your other winter pressures and comes at a cost

Recent reports I’ve received suggest PHE has not been liaising well with CCGs over outbreaks in their area and practices have not been informed of the funding mechanism or name of the outside provider of prophylaxis. If PHE contacts you requesting your involvement in outbreak management please ask them what contact they have had with your CCG

If you are asked to do more for cases than you would normally do under GMS (eg take case confirmation swabs for PHE) then given all your other winter pressures, declining such requests and asking PHE to swab would be considered reasonable by LMC

Please contact me if you experience difficulties that you think LMC can help with

Paul Roblin

CEO of BBOLMC

www.bbolmc.co.uk

07799116597

 

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