The NHS has been given a severe flu warning from Simon Stevens at the NHS Expo conference. It is not too unexpected. Systems that calculate the probability of bad seasons have been issuing gentle warnings for a while, doubts about effectiveness of the last vaccine and the reports from Australia of a rapidly mutating virus add an additional worry.
I don’t need to explain the impact of flu and what might happen if we have a particularly bad season. The whole point of Simon’s warning was to ensure that the NHS was prepared, but there is still no plan.
I would like to mention that influenza is not a reportable illness. Public Health England does collect some surveillance data on influenza (ILI) like illness from General Practice and NHS England ‘may’ respond by allowing the prescribing of antiviral medication during the period of apparent high reporting of ILI. It all seems a bit hit and miss to me so I would like to suggest a way forward.
Vaccination – increase the campaign activity around vaccination. Stop petty arguments between community pharmacy and general practice by introducing an area wide reward based on joint achievement of vaccination. The more people that are vaccinated the better the community immunity.
Hospital triage – hospital A and E services have already started to purchase point of care tests for influenza A and B. The sensitivity and specificity of recently introduced tests are much improved at over 90% for influenza A. Patients coming through the door can receive a point of care test based on a nasal swab as they enter the system. More hospitals and out of hours services will join in.
General Practice triage – General Practice are waiting for CCGs to explain their preferred course of action. Patients coming into General Practice could be triaged using point of care tests and then managed through an appropriate pathway.
Community Pharmacy triage – Community Pharmacy are also waiting for CCGs to explain whether they will be included within flu triage. They are often the first stop for patients with ILI and it would seem sensible to start the triage process where most patients go. If excluded from the process Community Pharmacy could offer a private triage service to patients in association with anti-viral treatment via a PGD. The Community Pharmacist would be well placed to advise patients who have flu on how to look after themselves and when to seek additional help.
Treatment – although there are doubts about the absolute effectiveness of treatment, it could be employed as an immediate option following a positive result. A campaign using the strap line ‘get tested – get treated’ might be useful.
Surveillance – Public Health England could create a system based on both laboratory and point of care test reports to obtain a more detailed picture of influenza within England.
It could all work and it might reduce the impact on NHS service and minimise the expected increase in winter deaths, but if you were to ask me what I thought – I would answer:
- Warnings given to late
- Not enough thought about how to get Community Pharmacy and General Practice really working together to increase vaccination uptake
- Hospitals will introduce point of care triage – because they can
- Commissioners won’t get their act together to introduce locally enhanced services around point of care testing for influenza across primary care (General Practice and Community Pharmacy)
- A handful of community pharmacies will introduce a private service
- Public Health England would have to pull out all of the stops to redefine flu as a reportable illness and get the mechanisms in place
- It will be a bad flu season
Go on – prove me wrong…..