UK to face swine flu preparedness test

Sanjay Tanday speaks to GPs on the swine flu outbreak frontline.

The DoH has repeatedly insisted that the UK is one of the best-prepared countries in the world to deal with a swine flu pandemic.

After all, a pandemic, albeit an avian flu one, has been expected by government scientists for many years now.

In anticipation, the DoH moved to produce pandemic guidance and stockpiled millions of doses of Tamiflu in secret warehouses across the country.

A swine flu vaccination programme will be launched this August, while a pandemic flu hotline is also expected to be up and running in time for the 'second wave' of swine flu that is expected this autumn.

But despite all the planning, the reality of a pandemic has left GPs in flu hotspots at breaking point as they battle to contain the spread of the virus.

Practices have warned of shortages of swabs and face masks, equipment that is essential to be able to follow the Health Protection Agency (HPA) algorithm.

But it is the role of the HPA itself that seems to be causing the most problems.

Dr Fay Wilson, a GP whose out-of-hours co-operative Badger has been tackling the outbreak in Birmingham, believes that their guidance 'just does not work' and requires 'a good rethink'.

'The guidance says that you should ask the patient to check their temperature but often they do not even have a thermometer at home to do this,' she says.

Birmingham has since moved away from the HPA algorithm and created its own guidance for GPs. It has also been distributed to GPs in London.

At the annual UK LMCs conference last month, the HPA came under fire from angry LMCs which criticised the agency for wasting GPs' time by making them do home visits for unnecessary swabbing.

Dr Paul Roblin, from Berkshire LMC, told delegates: 'The HPA website changes so frequently that information often disappears before it can be used.'

Dr Clare Gerada, vice-chairwoman of the RCGP and a GP in south London who helped tackle one of the first outbreaks of swine flu at Alleyn's school in Dulwich, agrees that the HPA needs to improve on the communication front.

'The HPA is always engaged when you ring for help. Far too much time is wasted.

'The HPA needs to look at modernising its methods of communication. It should use something akin to Facebook to communicate with GPs.'

A spokesman for the HPA insists, however, that the agency is working closely with the RCGP to ensure that accurate guidance is available.

Communication also appears to have broken down between the DoH and GPs concerning plans to suspend the QOF during a pandemic.

Dr Peter Holden, GPC lead negotiator for pandemic flu, believes that the QOF should be suspended in cities where GPs can no longer do their daily work in addition to dealing with swine flu.

But guidance from the DoH seems to suggest that QOF can only be suspended nationally. It is a message that does not appear to have filtered down to the LMCs.

Dr Robert Morley, executive secretary at Birmingham LMC, says that suspending the QOF is an idea that would be considered if the workload for GPs continues to rise.

'We will have to look at suspending normal activities. Guidance is unclear on this, but it can be suspended on locality.'

Local decisions
Dr John Cannning, secretary of Cleveland LMC, also believes that local decisions can be made. A worrying sign given that his LMC is involved in pandemic flu planning and was the first to pilot the buddying up system.

Come the autumn, the CMO for England Sir Liam Donaldson predicts that GPs could expect to see thousands of cases of swine flu every week rather than every month.

Dr Holden believes that when this does happen, GPs will 'roll up their sleeves and get stuck in'.

But unless the DoH can deliver on its bold promise that the UK is among the best-prepared countries in the world, GPs may be fighting a lost battle.

Tracking the spread of swine flu

2 April: First case of swine flu confirmed in Mexico.

27 April: Swine flu reported in Scotland, the first case of the virus in the UK.

15 May: Contracts are signed between the government and drug companies for up to 90 million doses of a pre-pandemic swine flu vaccine.

11 June: WHO declares a pandemic.

13 June: The number of swine flu cases in the UK rises above the 1,000 mark.

14 June: A statement from the Scottish government confirms the first death of a patient suffering from the (A)H1N1 virus.

1 July: Over 6,500 cases of swine flu and three deaths in the UK.

1 August: Swine flu vaccination programme expected to begin, starting with at-risk groups.


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