Swine flu vaccine agreement reached for Wales

Agreement for a swine flu vaccination programme to be rolled out by GPs across Wales, I am pleased to say, has been reached.

General practice is an efficient and adaptable model that reaches into every community in Wales and is best placed to deliver the vaccination. GPs are used to delivering large scale vaccination programmes that target patients at highest risk and this agreement means that GPs and their teams will have the resources they need to take on the additional workload and run the vaccination programme smoothly and efficiently.

This agreement is testament to the cooperative work we have produced with the Welsh Assembly Government and our GP members look forward to delivering the protection for vulnerable groups that the people of Wales deserve.

Tamiflu isn’t a wonder drug

This piece of BMJ research certainly grabbed the attention of the media yesterday. Though at the moment, anything to do with flu seems to get picked up on and linked to swine flu in some way.

As the research itself actually details “it is difficult to know the extent to which the findings can be generalised to children in the current swine flu pandemic but, based on current evidence, the effects of antivirals on reducing the course of illness or preventing complications might be limited.”

This is not to say that all children should not be given anitvirals like tamiflu. What perhaps we need to bear in mind is that we are learning more about antivirals, the more we use them. And while we know they are safe, we also know that vomiting and diarrhoea can occur in some children and adults who take them.

GPs have always said that doctors need to balance the risk of major complications from swine flu and the risks of side-effects from antivirals.

The more we learn about these drugs the more we will know how to treat patients with the most up-to-date clinical evidence. Tamiflu has a place in dealing with and containing the spread of swine flu, but it’s not a “cure all”.

Wales is right to opt out of swine flu helpline – for now

Looking at some of the media coverage over the weekend and the past week in fact, it only serves to reassure me that Wales is right so far, to opt out of the National Pandemic Flu Service, now operating in England.

The Chief Medical Officer for Wales, Dr Tony Jewell, attended a meeting of our GP committee last week to keep us up-to-date with what’s happening and it was agreed by everyone how well GPs and primary care are coping at the minute, as well as our hospitals - hence why we don’t need to be signing up to the flu service just yet.

The focus in Wales is to ensure that cases of swine flu, or potential cases are clinically managed and advised. This is likely to best achieve what everyone wants - clear advice and guidance, the most accurate diagnosis, and the right treatment at the right time, but not to be treated unnecessarily, or to be treated for the wrong condition.

It really is important to keep perspective on this as I mentioned here last week and to not be sucked in by the scaremongering which seems to be going on in certain areas of the media. Despite an increase in cases of swine flu in Wales, the number is still at a level that would be considered normal for flu in the winter, in others words, nothing GPs and our helath services don’t deal with every year.

Tamiflu, the ant-viral drug being prescribed for swine flu is not without side-effects, such as nausea, insomnia and irritability. As most people who’ve had swine flu report it as being no worse than a bad cold, for the otherwise healthy the treatment maybe worse than the disease and symtomatic treatment alone is all that is necessary. That doesn't of course apply to those in the at risk groupS, where Tamiflu would be indicated. But everyone is different and the decision to treat should rest between patient and doctor, as always.

What we need to ensure in Wales, is that the right decisions are made by independent and experienced health professionals, as is happening currently. That's not to say that things won't change and use of the "Flu-Line" will be welcome. However BMA Cymru Wales has faith in the Chief Medical Officer to make the right decisions for the people in Wales, at the right time, as the Chief Medical Officer and the Welsh Assembly Government has faith in GPs in Wales to deliver for their patients.

Employers need to keep us informed as swine flu spreads, to stop NHS Wales from grinding to a halt

As swine flu continues to grip the UK, everyone is looking to the health of the public, which is of course only right. I think there is also though an urgent need to look at the implications for health staff and how services can be best managed to ensure they can cope with the demand. There is an enormous amount of planning and logistics going on behind the scenes to "keep the show on the road", but sometimes it is the practical matters that need to be clearly communicated - and that make all the difference. Some of the issues raised by BMA Members that need clarity and that we are raising with Welsh Assembly Government and employers include:

Medical rotas

I know that, while many medical rotas are EWTD compliant on paper, they rely on doctors’ good will to undertake additional duties for their effective operation. As such there is a real risk that these rotas will become inoperable due either to sickness among the doctors on the rota, or those doctors being redeployed to other duties. When (or hopefully in advance of) these rotas are on the point of falling apart, who makes the decision to either suspend their normal operation or combine them with other rotas or otherwise? Clarity is needed.

Routine clinics

Routine clinics may need to be cancelled, either from general population illness or patient reluctance to attend (particularly those clinics serving patients who may be immuno-compromised). How are medical staff to be redeployed, inevitably at short notice and for short periods, and who will make those decisions?

Reporting arrangements

The reporting arrangements (who to telephone, etc) when medical staff become symptomatic (and with whom to discuss their symptom severity) do not seem to be that well known, together with consequential advice on recommended absence periods before returning to work. How are employers communicating this message?

Medical staff in high-risk groups

Appropriate advice for medical staff who may be in high-risk groups (especially those who are pregnant) is as currently topical for them as for the general population. What steps are employers, through their occupational health services or otherwise, taking to risk-assess these members of staff and to deploy them to appropriate duties?

BMA Cymru has raised these issues and asked that they be addressed as a matter of urgency. We have also asked for confirmation that comprehensive guidance on all the above points as well as other key information is sent to all members of staff - and is consistent across all organisations in Wales. For medical staff, this must include GP contractors, all part-time and locum doctors, and medical students on clinical placement.

It is at times like this that everyone has to pull together, to ensure things run as smoothly as possible - but that will only happen when essential and often basic information is communicated in a timely, effective and consistent manner to those on the frontline - so that there is no confusion or time wasted over what exactly are the procedures to be followed. This will help NHS staff in Wales who do an outstanding job day to day, and pull out the stops further at times like this, to best protect themselves and so better serve the people of Wales.

Aiming for some perspective on swine flu

I thought it about time that I addressed the issue of swine flu here, having perhaps unintentionally avoided doing so, so far!

It is understandable that people will be worried when they hear about the potential number of fatalities that may arise due to the pandemic. However, it should be remembered that these are worst case scenarios, to enable government to plan.

I would urge everyone to follow the recommended advice and telephone their doctor or NHS Direct, rather than physically going to the surgery, if they have symptoms and are concerned.

In most cases, it will be a mild illness and the vast majority of people will recover quickly by taking paracetamol or ibuprofen, and drinking plenty of fluids. Anyone who is not recovering quickly or who is in a more vulnerable group, for example young children, pregnant women, or those with underlying health conditions, should get extra advice as a small number will need more intensive treatment.

The message we need to get across is it's a pandemic flu - this is new, we haven't seen this before and yes, most of us will probably catch it.

It is important to remember that every year there are deaths from complications of seasonal flu; this is unfortunately inevitable with any strain of influenza. But following the recommended advice should minimise the risk.

Simple but effective hygiene measures such as frequent hand-washing can also help. Cover your mouth with a tissue when you cough or sneeze, then put the tissue into a bin and remember the phrase which is fast becoming a mantra amongst healthcare professionals – “catch it, bin it, kill it!”

The latest information from the Welsh Assembly Government on swine flu can be found here.

Health care professionals prove their worth as Swine Flu takes hold

The current outbreak of Swine Flu in Mexico is now spreading to many other countries including the UK. This is a concern for everyone, including here in Wales. However, we have to put this in perspective and rest assured that all necessary contingency plans, procedures and responses are in place to meet any escalation of the current situation. I have been observing the current preparations and it is impressive to see colleagues in GPC Wales and GPs across Wales rising to the challenge that this infection may cause. It is undoubtedly primary care that will be on the front line of reassuring, investigating and treating any and all cases that could arise in Wales, together with our public health colleagues. It is at times of such acute need that our health services perform to their best and will I am sure, as they are now, bring out the best in health professional joint working from doctors, nurses, pharmacists, paramedics and the ambulance service, social care services and a whole range of others, too numerous to mention here.

Strong leadership is also essential at times like this and the Welsh Assembly Government is demonstrating its role here. I have been enormously impressed by the timely and clear information being provided to the public and the profession in a context of reassurance, which I think gives confidence to all. The Chief Medical Officer, Dr Tony Jewell, has been at the forefront of these messages and it reminded me of how important the role of the Chief Medical Officer is in leading on such matters, which cross health boundaries into transport, education, entertainment and so on. The role of the Chief Medical Officer is crucial at times like this and shows unequivocally why Wales' top doctor should be sitting always at the top table of government.