Important Londonwide CEO message number 4 - 25 June 2009

Working with NHS London we have now managed, in addition to yesterday’s decision to use modified FP10s, to reduce the need for swabbing to an absolute minimum. Please read the extract from today’s Flu Briefing below.

Michelle’s message – As we have been saying, use your clinical judgement, prescribe when clinically necessary within the algorithm on FP10s as modified by annotating the words ‘Convenient Stationery’ (not that NHS London spells this with an A for some peculiar reason), and swab only if you are in an area where sustained community transmission is not yet demonstrated. You may do this immediately. If this causes difficulty with your PCT, or if you have other concerns, please let us know via flu@lmc.org.uk.

Managing the response to pandemic influenza in London

WHO has advised each country to consider their own situation and decide whether to continue with containment or move to mitigation. The current view in the UK is to continue with containment, albeit in a more measured manner.

Ministers have agreed the following with regard to handling ‘hot spot’ areas around the country, which recognises and expands on some of the actions we are already taking in London:

• cases of swine flu may be determined by clinical diagnosis as opposed to swabbing and laboratory testing
• it is recognised that GPs who are under severe pressures will use their clinical judgement on how best to prioritise their workload
• swabbing need only be conducted on a small sample of representative cases to support HPA surveillance; this is particularly important in those areas of London where sustained community transmission is not yet apparent
• appropriate antiviral treatment should continue to be offered to all symptomatic cases
• contact tracing of symptomatic patients and the prophylactic use of antivirals can cease, except in circumstances where it is clinically indicated
• PCTs should ensure that communications and support to GPs are strong and ensure that support for the ‘hot spot’ strategy is secure as far as possible over the coming weeks.

HPA and NHS London algorithm

For legal reasons around the status of FP10s, GPs should move to other solutions for providing antivirals to patients as outlined in the Medicines and Pharmacy brief circulated on 22 June 2009 with briefing number 30. This can include using an FP10 that has been clearly annotated ‘convenient stationary’ or using the tear off slip that accompanies each FP10, ensuring this does not include all other repeat medication information.