There is a point where we start to believe that the country is missing the point – and there are two points to make here.
Firstly we have missed WHO influenza immunisation targets for as long as I can remember. We should open up choice and convenience for people to be vaccinated. However, rather than creating competition, we should drive co-operation to achieve better results. Many GPs and Community Pharmacists are co-operating to share resources, identify patients, reach difficult to reach groups and get the job done. This should be the model – there are plenty of people who would benefit from vaccination to drive ‘community immunity’.
Secondly what are we going to do about surveillance? We operate a surveillance model based on a capture of influenza-like illness data. The definition is remarkably simple:
An acute respiratory infection with:
- measured fever of ≥ 38 C°
- and cough;
- with onset within the last 10 days.
Most community pharmacists would look at this and say that they see quite a few of these patients. As we drive patients with colds and flu more and more into community pharmacy, relieving pressure on hard-pressed General Practice what will happen to surveillance? OK – you may say that it is only looking at trends, but we have to have reports to do this. When the first GP says – no – I don’t see patients like this any more – then we lost.
If NHS England and Public Health England were both on top of their game, reporting from community pharmacy would be in the core contract – or at least being trialled. If they were innovative and advanced in their thinking, they would be asking the community pharmacists to offer a simple point of care diagnostic test that identifies people with influenza A or B.
I would be very interested in seeing what proportion of reported influenza like illness was actually influenza. Influenza is a dangerous condition, particularly for the young, old and those with existing medical conditions – patients can deteriorate quickly. I wonder if the healthcare response might be quicker and more targeted if the patient had a formal diagnosis of influenza A or B? There might be a different approach in Accident and emergency if you knew that the patient coming in had a confirmed diagnosis of influenza A infection?
I wonder if it is worth knowing that your condition is viral and likely to clear up in a week or two. Or your condition is really caused by influenza virus, perhaps might be more significant and likely to keep you off work longer?