Pandemic Preparedness, United Kingdom. Preparing for pandemic influenza - Guidance for GP practices. What to do now and in a pandemic. (Excerpts)

[Giuseppe]

Pandemic Preparedness, United Kingdom. Preparing for pandemic influenza - Guidance for GP practices. What to do now and in a pandemic. (Excerpts)

Preparing for pandemic influenza - Guidance for GP practices. What to do now and in a pandemic

[Original full PDF Document available at LINK. EDITED.]

Foreword


This guidance is for GPs and their staff in general practice. Practice Managers in particular should find it helpful. It will also be of use to Primary Care Organisations (PCOs) and is relevant to patients. It tells practices what they need to do now and in the future in order to prepare for, and respond to, a pandemic influenza outbreak in the UK.


It explains why there is a need to take action and how this will help minimise the spread of flu in a pandemic and make the best use of limited health resources. We have worked with the Department of Health in England to produce this guidance, and where possible it should apply to the other countries of the UK. Not everything has been finalised, but we felt it was important to get information to GPs and their teams as soon as possible.

It is a living document, which will be updated regularly as ideas emerge. It is therefore very important that you visit this website regularly: www.dh.gov.uk/en/Publichealth/Flu/PandemicFlu/index.htm.

In a flu pandemic general practice will be under enormous pressure. We will all be working differently and, at the pandemic?s peak, we will have to suspend some normal services in order to get through. An example of such adaptation is the work practices under the Quality and Outcomes Framework (QOF). Your practice resources will be protected so that you will not be penalised for diverting your efforts to care for your patients during the pandemic.

There will be clear command and control systems to make sure we act together in a fair and ethical way. A flu pandemic will stretch the NHS to the limit ? general practice in particular ? requiring us all to act together in a coordinated way.

GP practices will be asked to work together in groups ? buddying-up ? to make maximum use of all the staff available. This guidance is meant to be practical and show you how pandemic planning should be done. You will find action points, and checklists, which you can download and use to prepare your practice for a pandemic. Links are given to key information sources so that you can access them easily.

What is important is that no GP practice is left isolated and that we think about the potential problems in advance, training up as necessary and putting systems in place so that when a pandemic arrives we are as ready as we can be.

It will not be easy.

There will be things such as prioritisation of services at the peak of the pandemic, which no one will like. However, by thinking things out now, before the pandemic, we can try to ensure that we limit the extent of sickness and death from flu, and will be able to care for non-flu patients as well.

If general practice is ready it could make the difference between ?getting through? and saving extra lives. Previous experience has shown us that there is a danger that non-flu patients with serious health problems could suffer in a pandemic unless general practices are on the alert to meet their needs.

A flu pandemic will place huge demands on general practice, but with the help of this guidance you will place yourselves ? and therefore your patients ? in the best possible position to cope.

Dr Laurence Buckman (1) Professor Steve Field (2)
(1) Chairman of the British Medical Association?s General Practitioners Committee
(2) Chairman of the Royal College of General Practitioners

(...)
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[tropical]

Re: Pandemic Preparedness, United Kingdom. Preparing for pandemic influenza - Guidance for GP practices. What to do now and in a pandemic. (Excerpts)

It is good that the authors gave to the GP's a guide.

Stil that's only an slow docs starting of WHO reccomendations about producing countries internal proceeding paperwork guideliness IMO.

 

[sharon sanders]

Re: UK - Guidance for GP Practices - Preparing for Pandemic Influenza

Re: UK - Guidance for GP Practices - Preparing for Pandemic Influenza

From Senior Moderator Fla Medic -


Thursday, January 08, 2009

UK: Pandemic Realities


# 2637


No matter how many times it's been said, I seriously doubt that most people in the UK and the United States `get it'.

That during a pandemic, 95% or more of those stricken will have to be cared for at home.
​

It is a matter of simple mathematics.

Here in the United States, there are roughly 1 million hospital beds, and 90%+ of those are occupied at any given time by heart attacks, strokes, trauma victims and other assorted medical cases.

In the UK, there are roughly 200,000 beds, and 90%+ of those are occupied.

While some beds could be freed up by discharging non-critical patients and delaying elective procedures, the shortfall in the face of millions of flu victims would still be enormous.

And of course, staff reductions due to a pandemic are expected to be heavy as well. It isn't enough to have an empty bed. You have to have nurses, techs, and nursing aides available to provide care.

The UK pandemic plan for General Practitioners, released yesterday, emphasizes that during a pandemic, the public should not rush to their GP if they have the flu.

GP's will not stock or dispense antivirals during a pandemic. Access to antivirals will come from calling a National Pandemic Flu Line service.

From the UK Plan:




GP's are urged to post the following notice in their surgery (clinic), advising anyone with `flu symptoms' to go home and call the hot line.




The concern here is not only that GP's would be overwhelmed by flu cases, but that non-infected patients would be exposed to those carrying the virus in the waiting room.

Of course, it remains to be seen whether people will accept this advice, or whether they will still show up at their doctors expecting treatment for themselves, or a loved one.

The UK plan envisions that `up to 4%' of those affected may need hospitalization, but admits there may not be hospital beds for them.

For every 100 patients with flu symptoms up to four of them may require hospital admission, if there are beds available. Up to a quarter of these patients are expected to require critical care.

The average length of stay in hospital is likely to be up to six days (ten for patients in intensive care). Modelling suggests that up to 2.5% of all flu victims may die.
​

At first blush it may appear that some of these assumptions are at odds with each other.

After all, the statement that 4% of those infected may require hospitalization, and of those that 1/4th may require critical care implies that only 1% would have grave complications.

Yet a death rate of up to 2.5% is envisioned. How does that work?

Here I can only assume that being seriously ill isn't enough to get you admitted to a hospital. You have to be in serious condition and considered salvageable, as well.

Unstated, but implied, is that a certain percentage of those who will die from a pandemic will do so at home.

​

The following chart comes from a sister document to yesterday's release, Pandemic influenza: surge capacity and prioritisation in health services - provisional UK guidance.





Based on this chart, it is envisioned that during a pandemic, only 28% of those infected would get to see a doctor, and only 4% would gain admission to a hospital.

These numbers are based more on what can be done, than on the expected severity of a pandemic. If far more people become severely ill, or if the CFR is higher than 2.5%, there is no magic wand to wave to increase health care capacities.

Before anyone screams, "This isn't fair!", I think we can all agree there is nothing fair about a pandemic.
​

These are realities. There are only so many doctors, so many hospital beds, and so many staff. Like it or not, people are going to have to accept that.

The situation here in the United States is unlikely to be any better, and could be far worse.

All of this, of course, highlights the need for families to be equipped and prepared (mentally and physically) to care for loved ones who get sick during a pandemic.

Now, before a pandemic becomes a reality, is a good time for everyone to develop a family pandemic plan.

One of the things you can do is to download, print out, and read Doctor Grattan Woodson's excellent guide on the home treatment of influenza.





Every home should have a `flu kit', with over-the-counter medicines, masks, gloves, alcohol hand gel, and disinfectants, and everyone who lives alone should have a `flu buddy', to go fetch medicines or help care for them if they get sick.

The good news is, even in a severe pandemic, most people will survive. During the Spanish Flu of 1918, as horrific as it was, here in the United States fewer than 1 person in 100 died.

By being educated and prepared, we can help lower the mortality rate of any pandemic, even for those cared for at home.

 

[sharon sanders]

Re: UK - Guidance for GP Practices - Preparing for Pandemic Influenza

Re: UK - Guidance for GP Practices - Preparing for Pandemic Influenza

Link to Dr. Woodson's Manual on Home Treatment:

http://www.flutrackers.com/forum/showthread.php?t=17174

 

[Giuseppe]

Re: Pandemic Preparedness, United Kingdom. Preparing for pandemic influenza - Guidance for GP practices. What to do now and in a pandemic. (Excerpts)

If pandemic strikes, avoid doctor and get a 'flu buddy' - guardian.co.uk

If pandemic strikes, avoid doctor and get a 'flu buddy'

Guidelines to GPs say drugs could be accessed by phone

* Sarah Boseley, health editor
* guardian.co.uk, Thursday 8 January 2009 13.45 GMT

People with flu symptoms would be told to stay away from their GP if a genuine pandemic were to break out in the UK and will have to rely on a telephone helpline for advice and drugs, doctors said yesterday .


Although more people are suffering from flu at the moment than in the past few winters, the current outbreaks in the UK are still thought unlikely to reach pandemic severity. Pandemics are triggered by new strains of flu virus, to which nobody in the population is immune.

At the launch of their guidelines for GPs yesterday, experts from the Royal College of GPs and the British Medical Association said that if a pandemic takes off some time in the future, public information campaigns would warn patients to stay away from the GP surgery, even though that would make access to anti-viral drugs, which could reduce the severity of a flu bout, more difficult.

Anyone with flu symptoms would be told to phone a national flu helpline. If the nurse taking the call believed they had flu,the caller could be prescribed drugs after supplying their NHS number and other identification.

Since the patient would be too ill to leave the house, the prescription could be collected by a "flu buddy" ? a friend or family member the patient nominates, who must have the patient's identification details.

All of this has to take place within 48 hours of the onset of the flu symptoms, otherwise the drugs do not work.

But the doctors are adamant that such a system would be necessary in the case of a pandemic, or GPs would be swamped by all those turning up at their surgeries for drugs. "There is no route into an anti-viral by seeing a doctor," said Dr Peter Holden of the BMA's GPs committee.

Dr Maureen Baker, from the Royal College, recognised that the helpline system might create difficulties for some people, especially those who don't have a friend or family member ready to drop everything and collect a prescription for drugs from a distribution centre. "It is a very big problem," she said. "There are lots of people who live alone, lots of people who live in big cities who don't have social contacts. It is about all pulling together."

Another problem is that many people do not know their NHS number, the doctors said. Informing people of the steps they would need to take, including how to find out their NHS number and nominating a "flu buddy", would be part of a government information campaign should pandemic flu break out.

But those who think they will get hold of a supply of drugs by phoning the helpline pretending they are ill will also be thwarted, said the doctors - because nobody will ever be prescribed the drugs more than once.

The comprehensive guidelines will go to every GP in the UK, who will be urged to make preparations for a pandemic before it happens. GPs normally run their practices like individual businesses. In a pandemic, they would come under the direct command and control of the health authorities. They would be told they must make arrangements with other practices so that doctors would be available should any practice have to close because of staff sickness. Retired GPs would be brought in to help, by signing death certificates, for example, to relieve the pressure on those who are still working.

The guidance anticipates that some people with flu symptoms would still turn up at surgeries, and doctors are advised to consider segregating them in a separate waiting room.The last flu pandemic occurred in 1968/69 and reached a high of over 700 cases per 100,000 people in the population. In the last few weeks, flu cases diagnosed by doctors have reached 68.5 cases per 100,000, less than a tenth of that rate.

The latest figure, released yesterday by the Royal College from reports by GPs, was 51 per 100,000. Professor Steve Field, chairman of the college, said it looked as though flu had peaked, but added that there had been a rise in cases of bronchitis, which can be a complication of flu, that would put pressure on hospitals.

"Some bronchitis ends up as pneumonia, and can come after flu or be caused by other infections," he said. "Most cold and flu-like symptoms can be managed by looking after yourself, but in some cases bronchitis will require hospitalisation."
-
​

<cite cite="http://www.guardian.co.uk/society/2009/jan/08/health-nhs">If pandemic strikes, avoid doctor and get a 'flu buddy' | Society | guardian.co.uk</cite>

 

[sharon sanders]

Re: UK - Guidance for GP Practices - Preparing for Pandemic Influenza

Re: UK - Guidance for GP Practices - Preparing for Pandemic Influenza

This is also an excellent home care guide:

When There is No Doctor


http://www.flutrackers.com/forum/showthread.php?t=50411

 

[sharon sanders]

Re: Pandemic Preparedness, United Kingdom. Preparing for pandemic influenza - Guidance for GP practices. What to do now and in a pandemic. (Excerpts)

While I do not agree with some of the assumptions made, I applaud the official government recognition that the health care system will be overwhelmed in a pandemic.

This necessitates an aggressive preparation program.


Preparation information at FT:


Personal, Family, & Professional Pandemic Preparations


Local & Regional Communities and Organizations


National & International Government & NGO Preparation & Response


Pandemic Preparedness Tools

 

[tropical]

Re: Pandemic Preparedness, United Kingdom. Preparing for pandemic influenza - Guidance for GP practices. What to do now and in a pandemic. (Excerpts)

As FlaMedic highlighted in #3(Flo.),

finaly it became clear that the health sector in pandemic times must be organized as in old times when the Dr. visits the patients at home.

Unfortunately, because of minimal investments and the number of people, that would be also tricky, as highlighted.

The "Buddy" story even as an good idea, would depict the situations of the ancient plagued, where only an esigue number of volunters helped, and the mass try to fleed or stay put at home.

The above naked the need many time wroted here also at FT (but not implemented) of an individual treatment policy:
- fast recognition tests
- antiviral at home, but it would be nor at GP/farmacy, will maybe vanishing because of potential resistance, or handwashing because small stocks - the "call the line to get it" policy would be transformed in "occupate line", or "wait it" with subsequent delivery problems, except if all it is previously stocked an the distrib. way would be well organised previously and military escorted at delivery
- prepandemic vaccinations for all - to deminish the power and the colapse of an pandemic flu, is not assured because of the same old reasons when money must be spended without a profit
- prep. stocks of food/meds/water are not implemented individualy as it must, because of many reasons and are also not implemented as an strategical national/local stock to be distributed hause to hause because of an policy of JIT economy.