Important Londonwide CEO message number 8 - 3 July 2009

Please see below the lengthy but helpful extract from today’s NHS London briefing which I advise every member of the practice team to read and familiarise. It reinforces the messages already circulated by Londonwide LMCs, and provides you with some more detail on which to base your workload priorities. At 1939 lab confirmed cases in London yesterday, the Capital now has approximately ¼ of the national caseload. I continue to work with my colleagues to explore ways of reducing demand on your practices, especially from those who are not ill. Please continue to feed back your concerns to flu@lmc.org.uk.

The announcement made by the Secretary of State for Health today, confirmed the national move from containment to mitigation. This will have a greater effect on those regions that have not already moved to outbreak management in the same way as London and Birmingham did on 19 June.

This move means that the NHS now provides ‘treatment only’ (ie no prophylaxis or contact tracing unless absolutely necessary) across the country. At this stage, that this will be ‘treatment for all’ rather than identified ‘at risk groups’, however as we continue to learn more about the virus this may change in the future.

In support of this the National Flu Service will be operational by mid-July to deliver the assessment component of providing antiviral treatment to symptomatic individuals.

At this time, providing front line staff are coping with demand, the current arrangements in London’s PCTs should continue. However, where there are significant local pressures or where GPs are unable to cope with demand, PCTs will need to consider activating local Antiviral Assessment and Collection Points. These should be enacted in response to local pressures.

ACTION:

• PCTs to be constantly monitoring demand on local services in order to be able to provide reactive support when and where necessary, and be prepared to activate Antiviral Assessment and Collection Point(s) at short notice should local services be over-whelmed.
• NHS London must be informed via incident@london.nhs.uk when Antiviral Assessment and Collection Points are activated
  

Yesterday’s COBR briefing provided further information around the national implications of the move to the treatment phase:

• Primary care will take the lead in patient assessment, as such clinical diagnosis will be used to confirm Swine Flu cases rather than laboratory testing (although we will continue to take tests from some patients in order to ensure we keep getting up to date information about the virus)
  
• Antivirals will continue to be offered to all those who have contracted the illness. However, it remains a matter of clinical discretion to decide whether antivirals should be prescribed in individual cases (many people will be able to recover from swine flu without the need for antivirals and may therefore choose not to seek treatment)
  
• Guidance will be issued to GPs to ensure that those in higher risk groups get early priority access to antivirals (see below)
  
• There will be an immediate end to contact tracing and prophylaxis in all regions
  
• Primary Care Trusts will now begin to establish antiviral collection points where necessary
  
• There will also be a shift from daily reported figures of laboratory confirmed cases from the Health Protection Agency to more general estimates of the spread of the disease
  
• Schools should not close because of individual cases of swine flu but they could close if the particular local circumstances warranted it. The HPA will advise on outbreak control issues as usual.
  
• The new arrangements will be communicated through a short guide that will be e-mailed to NHS staff, and will be available online for the public.
  

The science indicates that as we discover more about the virus and develop a more precise categorisation of risk groups, we are likely to reassess our approach and move to a more targeted use of antivirals. The CCC will keep this under review, with regular input from SAGE, to ensure the strategy continues to reflect the best scientific evidence available. If refinements to this approach are made, these will be cascaded through normal channels.

A letter from David Nicholson is being sent to all NHS staff along with a leaflet called ‘Swine Flu: from Containment to Treatment’.

Provision of antivirals to patients

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 stationery’ or using the tear off slip that accompanies each FP10, ensuring this does not include all other repeat medication information.

GPs no longer need to send routine emails or fax-back forms to the HPA about people they diagnose with swine flu – the disease will be monitored via the seasonal flu surveillance systems.

Clinicians need only inform the FRC regarding:

1. Patients in special schools, health care settings, care homes, other institutional settings such as prisons. These include vulnerable groups in institutions and health care settings
2. Severely ill and/or hospitalised patients
   

It is now unusual to close schools because of swine flu. Schools should have access to standard school letters via LEAs. Children can go back to school when symptoms resolve.

Healthcare workers can return to work once their symptoms have resolved.