New Pandemic guidance for Doctors announced

The guidance says sensible preparation now will make the difference between just ‘getting through’ a pandemic and maximising the number of lives that can be saved. There were three pandemics in the last century which caused public health emergencies and many experts believe another one is overdue.

It is, however, impossible to predict its timing. The BMA/RCGP guidance is intended as a practical guide for GPs and practice managers. It details how GP surgeries will be expected to adapt from their usual method of working and gives information and guidance on the following:

• Every practice will have to follow “command and control arrangements” which will be monitored and co-ordinated by Primary Care Trusts to ensure there is a robust, uniform response.

• GP surgeries will be expected to ‘buddy up’ with neighbouring practices to share resources and exchange staff as necessary. The guidance recommends that practices should ensure these contingency plans are in place by 31 March 2009.

• There will be changes to the death certification process, including bringing in retired doctors to ease the pressure on local services.

• Patients with flu will get access to antiviral medicine via a new National Pandemic Flu Line Service, not via their GP surgery.

• Additional capacity in the health service will be created by prioritising services and patients in a systematic and ethical manner.

• How practices can minimise the spread of infection, for example by setting up separate waiting areas for patients with flu.

Dr Laurence Buckman, Chairman of the BMA’s GP Committee, said: “We've seen over Christmas how seasonal winter pressures put strain on the health service but this is in a situation where the system is still operating on a normal basis.

During a pandemic the NHS would have to work differently - it’s a major health emergency and as such requires a totally different way of helping patients. Family doctors need to be prepared for this and this guidance has been produced to help them with their planning.

During a pandemic many people will get flu and a few will be very poorly, but there will still be people suffering from other illnesses and they will also need our full attention. So plans are being put in place now to make sure general practice and the health service not only copes during the crisis, but does the best it can do to minimise the spread and impact of a flu pandemic in the UK.”

Dr Maureen Baker, Honorary Secretary at the RCGP said: “General Practice is a critically important service which needs to be able to function as well as possible during a flu pandemic. This guidance provides practices with clear instructions on the steps they need to take now and during the pandemic, so that they can look after people with flu, and other emergencies, as well as can be done in very difficult circumstances.”

Continuity Forum Comment

This guidance addresses one of the regular questions we have asked over the course of the past few years “Are our primary care providers (GP’s) prepared?” It is clear from the guidance issued that that the RCGP’s shares our concern on the pressure our health care providers will face over the course of a pandemic with the warning being made that without proper adherence to the command and control system and the effective implementation of the local and national support mechanisms there will be chaos.

The report also highlights the pressure on hospital beds and other vital resources and states that a prioritisation will have to be used. The set up of a National Flu Hotline and the principal of ‘self care’ features prominently throughout the guidance and this is seen as a way of reducing the pressure on the Health System.

However, experience gained elsewhere tends to suggest that people do not necessarily follow guidance under times of stress or indeed during a crisis. A strong communication and education message will feature heavily from central government of course, but how effective this will be remains a cause for concern. The guidance does state the importance of establishing a BCM process and sets a target for the completion of planning within all GP’s (March 2009).

We would like to hear from any involved in the planning in this area either within a Primary Care Trust or GP level to hear directly your thoughts on the guidance: In particular:

• Will it be possible to maintain practice services with 25% fewer staff

• Are adequate arrangements in place to support Primary Care personnel with the challenges of childcare, possible school closures and extended working hours

• Is there adequate cover for key continuity and management personnel in key positions within your area? (many plans seem to have just one ‘BCM lead’ acting as a co-ordinator with apparently little in the way of cover)

• The lower levels of infection used for the calculation of the likely increase in GP visits suggest significant increases, do you believe these estimates are realisitic?

• How confident are you that sufficient Antivirals and Antibiotics will be available for all the key workers and patients?

• What are your thoughts what the effects of prioritisation will be?

• Strong emphasis is wisely made on the need to separate those with flu-like symptoms from both practice staff and other patients.

Pharmacies are also detailed to play an important role through the dispensing of prescription and ‘over the counter’ medicines.

Yet it appears to us that it is FAR more difficult to sustain this role in a retail environment. What are your thoughts?

• Reference is made to ‘Flu Buddies’ … this concept means having a friend or family member in place ahead of time to acquire medicines etc … is this a role an employer could realistically fulfill?

• Has your PCT conducted a realistic rehearsal for a Pandemic? Did it consider the supply chain fully? What lessons were learnt? Please do pass on your thoughts and experiences in complete confidence to us at the email address below

NOTES from BMA/RCGP

1) It is expected very similar guidance will be issued in Scotland, Wales and Northern Ireland A pandemic is associated with much higher rates of illness and death than an ‘ordinary’ seasonal epidemic of flu, which every year affects on average 10-15% of the UK population and kills approximately 12,000 people. The worst flu pandemic of last century - the 1918 ‘Spanish Flu’ - caused around 250,000 deaths in the UK (Explaining Pandemic Flu: A guide from the Chief Medical Officer October 2005).

Though the severity and timing of any pandemic is impossible to predict, it is estimated that up to half of the UK population (approximately 30 million) could catch flu during a pandemic. While most will be asked and able to self-treat at home, up to a third may need to be assessed and treated by a GP or other health professional and around 4% may need to be admitted to hospital. 

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