It is all go – the Chief Medical Officer and the Chief Pharmacist have issued the Central Alerting System saying that surveillance data indicates an increase in the number of influenza cases in the community so GPs and other prescribers in primary care can now start prescribing anti-virals at NHS expense.
OK – I didn’t think that PHE data actually identifies cases of influenza rather than ‘influenza like illness’, and it is only reported through GPs, but I won’t worry about that. I go to the PHE guidance and well – “GPs may only prescribe antiviral medicines for the prophylaxis and treatment of influenza at NHS expense when the Chief Medical Officer (CMO) has confirmed that influenza is circulating in the community. The CMO announcement is issued to the NHS through the DH Central Alerting System (CAS)”.
Hang on a minute – what about the community pharmacist?
So every poster or communication from the DH/NHS tells patients to go to their pharmacy first for winter illnesses. But only GPs are trusted to make a diagnosis and report the PHE and then issue prescriptions for treatment at NHS expense. So, put simply, if you think you have flu you had better see your GP.
So what is the strategy? Ask all patients with influenza like illness to sit in a crowded GP waiting room – see the GP – who does not have point of care testing – and get the GP to issue a prescription for a suitable medicine and then send them to the pharmacy to have it dispensed at NHS expense. Seems a bit dumb to me, particularly when GPs are already overworked and there is extreme pressure on appointments and their waiting rooms bulge.
How about letting the community pharmacist play a part. Patients would walk in – no wait. Pharmacy teams can make a provisional diagnosis of influenza. The Pharmacist could confirm and offer a point of care influenza test on the NHS. If positive then the Pharmacist could manage the supply of anti-viral medicines through an NHS PGD for all uncomplicated patients and just refer the complicated ones to the GP. And PHE might have a better grasp on actual influenza patient numbers if they allow pharmacists to report.
So what might be the result? It isn’t coughed and sneezed around a busy GP waiting room full of ‘at-risk’ patients. GPs only get to see 5% of the patients with influenza like illness that might need their expert care. Patients get a more accurate diagnosis and rapid access to anti-viral medicines.
What is the problem with a little innovation in the NHS?