Exclusive: GP warning over swine flu diagnosis by phone

England's flu czar has defended the use of a swine flu hotline in the face of claims by GPs that serious illnesses will be missed as patients are assessed over the phone.

Nine out of out 10 GPs believe that diagnosing flu over the phone will mean other diseases may be missed, a GP survey of 251 GPs has found.

Asked about these concerns in an exclusive interview, Ian Dalton, England's director of NHS flu resilience, said that the clinical algorithm used for the pandemic flu service had been planned on a ‘precautionary principle'.

‘The algorithm has been designed in such a way that, as best as we can predict, people who have serious conditions, be that meningitis or MI, or anything else, will be taken to the point of need,' he said.

The advantage of an algorithm was, he said, that it was 'intrinsically appropriate' to use non-clinically qualified people to operate it, he argued.

‘What we're not asking those people to do is to exercise clinical judgement - that's what GPs do, and that's why we need to protect their time.'

Mr Dalton praised the ‘fantastic response' of GPs to the pandemic.

'We always expect the best of our GPs and we've certainly not been disappointed,' he said. ‘I know that the number of consultations, the out-of-hours calls and the telephone contacts have required GPs to work very, very hard. I think they've responded magnificently.'

GPs have acknowledged that the introduction of the hotline has released pressure on them.

Our survey found that most have seen their swine flu-related workload fall since the pandemic flu service was introduced, although a third have seen no reduction in work.

In addition, most GPs want to see specialist flu centres introduced, to assess patients and provide vaccinations.

Mr Dalton said that the DoH was not currently working on plans for such centres.

'Our hope is that the vast bulk of people with flu will be treated through the national pandemic flu service and that's the basis of the strategy,' he said.

'That will save GP time to see patients who need particular clinical judgement and to deal with any complications of flu that do tend to occur.'

However, Mr Dalton is keen to keep ‘a very close eye' on the pressures on general practice. ‘I will be out, I will be listening and we will be doing all we can to keep primary care acting in an effective manner,' he said.


Anonymous comments from GPs:

'Saw a case today of measles which was diagnosed over the phone as swine flu.'

'Without question. The symptoms are so vague and wide ranging, swine flu can masquerade as a vast array of other diseases.'

‘A death will occur from meningitis.'

‘Patients are making up symptoms in order to get Tamiflu and for example meningitis or tonsillitis or bronchitis/pneumonia may be missed.'

‘Blindingly obvious that a telephone diagnosis will very rarely, but very significantly miss an alternative diagnosis which could lead to severe morbidity or mortality.'

‘Chest infections or tonsillitis may be missed.'

‘I have already seen two patients with severe tonsillitis and one with a knee infection, given Tamiflu over the phone from the hotline.'



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