Important Londonwide CEO message number 2 - 23 June 2009
We have been able to exert some influence on the London situation over the last 24 hours. The following is an extract from today’s Noon Brief from NHS London. It deals with the three issues of definition of fever, swabbing and prescriptions. It also covers school closures.
Please see the key messages from Dr Michelle Drage, which should help guide you through the next few days. As you can see, the next few days is as good as it gets! Don’t forget to keep us updated with your concerns on flu@lmc.org.uk and visit this website on a daily basis.
From NHS London, with Londonwide LMC Messages:
Following a meeting with DH and the HPA on Friday, NHS London has agreed some changes to the management of the flu response in London. The aim of this change is to ensure that local clinicians are empowered to prescribe antivirals for their population, according to local clinical judgement. Clinicians should use their clinical judgement in assessing the severity of symptoms and the vulnerability of patients; and, where necessary, prescribe antivirals. If clinicians have concern regarding clinical issues then they should contact the FRC in the usual manner. PCTs were asked to provide at least one ACP for their population to access, between 08:00 and 20:00 daily.
Michelle's message: Commonsense is needed here. Please read the Algorithm to mean a properly taken fever >38. If the temperature has not been taken properly, consider getting the patient to take it properly at home, and report the reading to the surgery the at the next session if above 38. Obviously this won’t apply if the patient is otherwise significantly unwell.
HPA and NHS London algorithm
The HPA and NHS London algorithm which was circulated on Friday 19 June 2009 made reference to the use of FP10s when prescribing AVs. This was a pragmatic solution at the time. Following discussion with the Department of Health, it is clear that this will not be an appropriate solution in the longer term, for legal reasons around the status of FP10s. Therefore GPs should move to other solutions as outlined in the Medicines and Pharmacy brief circulated yesterday, 22 June 2009 with briefing number 30.
Michelle's message: We are lobbying the GPC to get this changed and will update you on progress. We wish to see the simplest possible prescribing form used while FP10s are deemed unsuitable.
It is not appropriate to cease all swabbing in London as, despite reported high levels of influenza like illness, some PCTs are not yet affected by influenza A/H1N1v. Where an obvious cluster of cases is identified, eg in a school, it is not necessary to swab all patients, but instead to take a realistic and representative sample.
Michelle's message: This is small but far from perfect improvement, giving you a bit more flexibility within which to use your clinical judgement. Arrangements vary from PCT to PCT for the above reasons. We are trying to get the swabbing requirement reduced to a minimum and will keep you posted.
Clarity on actions around schools
The original rationale behind closing schools was to slow the spread of the virus in the community. Now that there is sustained community transmission in London of influenza A/H1N1v, the HPA will no longer recommend that schools close on public health grounds if there are cases amongst pupils. Schools may still choose to close for operational reasons, such as if there are insufficient teachers due to illness amongst staff.
Michelle's message: This is an improvement. Feel empowered to rebut unnecessary requests, and use the above as needed.