Dr John Garner: Isolation the answer to overabundance of swine flu advisories

Published on Monday 3 August 2009 19:50

FOR the last three months my colleagues and I have received a torrent of paper and electronic advice concerning swine flu.

There have been the daily dispatches about suspected cases, the exhortations to be vigilant and to prepare together with instructions about prevention in the surgery etc.

My practice, like all in Scotland, has been considering how we will manage if swine flu numbers really increase. At that time, half the doctors and nurses may be off sick while other health and administrative staff may be concerned about the risks of working at epicentres of the infection.

There are, for instance, contingency plans for practices to buddy up. This means two local practices would work together – one would do all the flu cases for the two practices and the other "clean practice" would try and keep ordinary medical work going. Regardless of who your doctor was, you would be directed to the appropriate surgery.

The problem though is not only the volume of information cascading out to the front-line troops, but that it comes from multiple sources. I've received communications from my health board, the Scottish Government, the UK Government, my professional association (the BMA) my other professional organisation (the Royal College of GPs) as well as doctors' websites, pharmaceutical company websites and, of course, the media.

This deluge of information takes some time to download and assimilate, and there are subtle and not so subtle differences. There was to be a voucher scheme for your medication, but Scotland decided to do something different from England. England got the national flu line, as our Chief Medical Officer didn't think Scottish GPs were busy enough to warrant it. Though some of these decisions appear sensible, it's awkward for patients if they read an NHS website, national newspaper or listen to Radio 4 and it only applies if they are in the correct country.

However, never mind the boffins – what about the patients? I guess they're a little muddled. My first patient had phoned the flu line and got the automated advice, then was directed to NHS 24 who advised the patient to make an appointment with a GP. WRONG! – speak with the GP, as we are now into diagnosing and treating by telephone.

My next patient had been on the NHS Choices website where the algorithm reads "Influenza – assess severity – patient unwell – urgent referral to infectious diseases team at hospital". Some would and have interpreted that as "head off to the hospital" – WRONG!

Then there are the 60 million courses of antiviral medicines stockpiles in warehouses throughout the country. Some guidance protocols say they should be for all diagnosed cases, while another says only if within 48 hours of onset of symptoms. Yet another says prescribe if under five or over 65, or in the case of other illnesses, but use discretion otherwise.

Then a pharmaceutical rep tells me all the drug company's staff and their immediate families have already been supplied with the antiviral drugs for personal use. So, I hear, have some bank staff. Never mind us, the front-line workers and their families.

So what's a doc to do? I think the front-line doctors should make sensible decisions based on their knowledge, skills and experience.

For my practice of 10,000 patients (that's 20,000 doses as the swine flu vaccine is likely to be two doses, three weeks apart) that's 1,700 hours work (if you allow five minutes per patient). So, it isn't going to happen quickly.

What might have to happen is non-medical and non-nursing staff will have to give the vaccines to receptionists, teachers, etc. That opens up a can or worms, concerning training, liability and supervision.

For what it's worth, here is my advice: if you think you have swine flu, stay at home and socially isolate yourself. Keep warm, drink plenty, take paracetamol. Phone your doctor and discuss whether antivirals are appropriate for you.

Do not panic – 99.7 per cent of patients recover, usually within the week. Good luck.

&#149 Dr John Garner is a member of the British Medical Association's Scottish council and a practising GP.