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Emergency Preparedness -Archive

This section is provided for health professionals (GPs, dentists, pharmacists etc).

Members of the general public are welcome to use these pages but should be aware that they are not written with them in mind. Please choose an option on the left for information aimed at the general public.

The documents on this page can help practices respond to a range of emergency issues, from power cuts to pandemic flu.

Main index (updated 07/04/10)

Latest update
(full guidance from this page as a printable word document)

 

Summary of current situation - April 2010

The Department of Health is recovering materials no longer required for the management of the pandemic. Practices have been asked to identify;

  • the number of swine flu swab kits they may still have
  • the number of spare boxes of needles and syringes not required to continue to deliver the vaccination programme to at-risk groups and frontline staff over the summer.

Vaccination programme

JCVI has advised that the vaccination of healthy children aged over six months and below five years should have been completed by the end of March 2010.

However, the vaccination programme for the following groups will continue during the coming spring and summer:

  • people over the age of six months in clinical risk groups (which include those people aged 65 and over and in a clinical risk group but not healthy people aged 65 and over),
  • pregnant women,
  • household contacts of immunocompromised individuals, and
  • front line health and social care workers

Could practices please check that the information about the number of swine flu vaccinations given to their patients on the ImmForm website is up to date.  This includes information about housebound patients vaccinated by the District Nursing team.

Antiviral medication

Antiviral collection points closed on the 31st March 2010. Antiviral policy has now reverted to normal, with NICE guidelines applying from 1 April 2010 onwards.

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The National Pandemic Flu Service has closed

The National Pandemic Flu Service has now closed. 

Could practices please remove posters and other materials that make reference to the NPFS which they use or have on display in their surgeries.

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Pandemic flu activity and planning assumptions

Health Protection Agency update 1 April 2010

  • In England, the rate of general practitioner consultations for influenza like illness was 6.2 per 100,000 population for the week ending 28th March 2010. The rate for the previous week was 8.2 per 100,000.

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Assessment and management of patients

Assessment guidance

The Department of Health and the Royal College of General Practitioners have produced the following flowchart (designed for printing on A3 size paper) to assist GP receptionists to determine which symptomatic swine flu patients should be seen most urgently - particularly in the case of patients referred by the National Pandemic Flu Service

Assessment of children

The Department of Health has released an information /training module on the assessment and management of children in a pandemic.

Assessment index

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Clinical management guidelines

The Department of Health have produced updated clinical management guidelines for adults, children and pregnant women. These include sections on primary care.

Assessment index

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Advice to patients diagnosed with swine flu

Please advise the patient that for at least seven days from the onset of their symptoms they should stay at home and away from crowds and groups of people including not going to work, school or nursery.

  • The patient must have completed their course of Tamiflu and have been asymptomatic for 24 hours before they return to work, school or nursery.

This is the advice we have been given by the Flu Response Centre which is being reiterated at the Antiviral Collection Point.

In children the illness may be a bit longer and 10 days isolation may be required. A cough may persist after the flu has abated. Whether or not further isolation is required is a clinical decision based no individual cases, but advice may be obtained from the local Health Protection Agency.

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Assistance with the decision to refer to hospital

The swine flu clinical package is a set of tools for use by frontline healthcare professionals, in severe and exceptional circumstances, during a pandemic situation. The revised version reflects changes in the guidance on the use of empirical antibiotics and on oseltamivir prescribing in young children.

Please note: these tools and pathways are for use only when high surge demand leads to the need for strict hospital admission triage in affected areas. They should not be used when emergency departments and acute admissions units are working with their usual establishment of trained staff, and can operate their usual daily decision pathways, including providing hospital beds for every person fulfilling normal criteria for admission.

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Guidance on sickness certification in response to the swine flu pandemic

As yet there are no changes to the normal provisions for sickness self-certification or for GPs to provide medical statements for patients who are ill for more than one week. The situation is being kept under review. The guidance includes the following statement about patients who have used the National Pandemic Flu Service or have discussed their condition with their GP over the phone.

  • Can a doctor issue a medical statement after speaking to the patient on the telephone?

The rules governing the issue of medical statement by doctors do not define what constitutes an examination. However, where a patient has previously been assessed as having swine flu, either by the National Pandemic Flu Service or their GP and has been to stay at home whilst ill, a GP may, at their discretion, issue a medical statement after a telephone consultation, once assured of the identity of the caller as a registered patient. As with issuing any medical statement or certificate, the GP would need to be assured they are able to make an adequate assessment of the patient’s fitness or non fitness for work. This would be in keeping with their clinical responsibility for the patient.

Assessment index

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Antiviral medication -
authorisation, dosage and prophylaxis

Stand down of the antiviral distribution arrangements

Practices should have received the following letter from the Department of Health advising them that antiviral collection points would close on the 31st March 2010:

The letter states that “From the 1 April 2010 antiviral medicines will no longer be available from the national stockpile. Treatment of individuals demonstrating flu symptoms will revert to business as usual in line with NICE guidelines, normal charging arrangements for prescriptions will resume. Antiviral authorisation vouchers and the right hand side of FP10SS should no longer be used.”

On the 31st March 2010 the message below was issued by the Department of Health.

Message from the Department of Health - applies to ENGLAND only:

"The letter from the Chief Pharmaceutical Officer and the Interim Director of the Pandemic Influenza Preparedness Programme on the stand down of the antiviral distribution arrangements - dated 25 March 2010 (Gateway Reference: 14041) - explained that antiviral medicines will no longer be available from the national stockpile and that the treatment of individuals demonstrating flu symptoms will revert to business as usual arrangements.

This means that from 1 April if any patient presents with severe influenza like illness and clinical judgement is that they may require hospital in-patient treatment, then they should be referred urgently to hospital where they may be prescribed antivirals on the judgement of the treating hospital clinician. NICE's appraisal guidance on the use of antivirals for the treatment of influenza (TA 168) does not constrain the ability of hospital clinicians to prescribe antivirals to individuals who are seriously ill, where they judge that is clinically appropriate"

In summary the above approach is in keeping with NICE guidance for seasonal flu when the prescribing of antiviral medication for certain groups of patients is recommended only when national surveillance schemes indicate that influenza is circulating in the community. Normal charging arrangements for prescriptions would resume at that time.

The management of localised outbreaks of influenza-like illness in long-term residential or nursing homes should be discussed with the Health Protection Agency.

Patients with a flu-like illness requiring hospital referral can be prescribed antivirals by secondary care clinicians

Destruction of unused authorisation vouchers

As detailed in the letter and accompanying guidance all practices and out-of-hours services should now destroy unused authorisation vouchers. They should be securely destroyed in the presence of a suitable witness of appropriate seniority.

A record of destruction should be made, capturing the following details:

  • Name of person authorising destruction
  • Quantity and serial numbers of Antiviral Authorisation Vouchers destroyed
  • Names and signatures of the person destroying the vouchers and of the witness
  • Date of destruction
  • Method of destruction.

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Swine Flu vaccination programme

Briefings and guidance

This CMO letter includes the following advice from the Joint Committee on Vaccination and Immunisation regarding the recommended vaccination schedule. Please note that only one dose of the Pandemrix vaccine is recommended for individuals aged ten years and over unless they are immunocompromised.

Pandemic H1N1 (2009) swine flu vaccines for travel use

Practices should have received the attached letter from Professor Salisbury at the Department of Health regarding the use of the swine flu vaccine for travellers to the Southern Hemisphere.

Vaccine preparation and administration

This practical guide for health professionals includes answers to queries such as the potential blunting of the needles by piercing the bung and the infection control implications of the use of multi-dose vials. 

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Pandemrix (manufactured by GSK)

The licence for Pandemrix is expected to change soon to permit one or two doses according to national advice.  Colleagues may therefore prefer to delay giving the second dose of Pandemrix to children who are not immunosuppressed or who do not have an immune deficiency until there is further confirmed guidance.

Parents should be advised to look for signs of fever following H1N1v vaccination. Childhood antipyretics can be given to treat a fever should one develop. However, they should not be given before or shortly after vaccination in anticipation of a fever since there is some evidence that this may make vaccines less effective.

Amended guidance for the Pandemrix vaccination is shown below and is
based on the JCVI advice from 8th December 2009.

For children aged from 6 months of age to less than 10 years of age who are NOT immunosuppressed or who do NOT have an immune deficiency:

  • One half dose (0.25ml) of Pandemrix.

For children aged from 6 months of age to less than 10 years of age who are immunosuppressed or who have an immune deficiency:

  • Two half doses (0.25ml each) of Pandemrix should be given with a minimum of three weeks between doses.

For individuals aged from 10 years to less than 60 years of age:

  • One dose (0.5ml) of Pandemrix.

For individuals aged 60 years and over

  • One dose (0.5ml) of Pandemrix (this advice will be reviewed when more data become available).

For immunocompromised individuals aged 10 years and over

  • Two doses (0.5ml each) of Pandemrix should be given with a minimum of three weeks between doses

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Celvapan (manufactured by Baxter)

For children from 6 months of age and adults

  • Two doses (0.5ml each) of Celvapan should be given with a minimum of three weeks between doses.
  • Nationally the advice is that this vaccine should be kept to vaccinate those few people for whom Pandemrix is contraindicated. 

    At present this is for those patients with a history of severe anaphylactic reaction (shock or acute difficulty in breathing) after egg containing products.

    However the Department of Health advises that pregnant women who do not wish to receive Pandemrix should be able to receive Celvapan.

A small number of local practices have kindly agreed to provide Celvapan for local patients.  Information detailing the referral arrangements has been sent to all senior partners and practice managers.

For patients requiring the Celvapan vaccine, practices should send the referral form direct to one of the four identified practices, and give the telephone number of the relevant surgery to the patient.  Patients should then contact the practice to arrange their appointment

Please note that the arrangement regarding egg allergy is only for those patients with a history of severe anaphylactic reaction (shock or acute difficulty in breathing) after egg containing products. It is not for patients with other allergies.

The number of referrals to the practices providing Celvapan will be closely monitored and the current arrangements will be kept under review

The following practices have agreed to see referred patients:

West:

  • Mile Oak – 01273 426200
    Clinics to be held on Wednesday afternoons

Central:

  • St Peters – 01273 606006
    (please inform patients to phone after 10am)
    Clinics to be held on Saturday mornings

East:

  • Longridge Avenue – 01273 305723
    Clinics to be held on a Tuesday afternoon
  • Ridgeway Surgery – 0844 477 8731
    Clinics to be held on Saturday mornings

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Vaccines for children and young people

JCVI confirmed its earlier advice that Pandemrix should be the vaccine of choice for children and young people up to 18 years of age. This is because currently there are no paediatric data available for Celvapan.

This dosage schedule is based on advice given by JCVI, following consideration of clinical data available on the vaccines. The dosage and recommendations will be kept under review as more clinical data become available

Priority groups

The groups below will be prioritised for vaccination in the following order:

  • individuals aged six months and up to 65 years in the current seasonal flu vaccine clinical at-risk groups
  • all pregnant women, subject to licensing conditions on trimesters
  • household contacts of immunocompromised individuals
  • people aged 65 and over in the current seasonal flu vaccine clinical at-risk groups

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Vaccination of children under 5 years old

Regarding the extension of the swine flu vaccination programme to all children aged over six months and under five years you will know that the national negotiations between the BMAGPC and the Department of Health’s representatives failed to reach an agreement.

Practices should have received the following letter from the Department fo Health (15 December 2009) regarding the extension of the vaccination programmme to all children aged over six months and under five years.  The letter confirms the change to the dosage schedule for children and that the licence for Pandemrix has been amended.

  • Details of the planned local arrangements will be sent out as soon as they are finalised. 
  • Practices will receive the payment of £5.25 per vaccination regardless of the final local arrangements put in place.
  • Children under five years of age are more likely than other groups to be hospitalised if they become ill with swine flu.
  • Young children also have high rates of admission to critical care and there have been some deaths.

The Department of Health is working with the BMA and NHS organisations to agree the details of how vaccine will be delivered, so that young children can be offered the vaccine once GPs complete the vaccination of the four priority groups. 

  • The vaccination of people in the four previously identified clinical at-risk groupsremains the highest clinical priority to protect those at greatest risk from swine flu.

The Department of Health is also considering extending the vaccination programme to the main carers’ of older people and disabled people.  No further information is available at the moment about the next steps, but the Department of Health is discussing how best to implement this with carers’ organisations.

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Vaccination of children in high-risk groups

Children with chronic neurological conditions are at particular risk of developing complications and dying from swine flu.  Could practices please ensure that all children with chronic neurological problems (including neuro-developmental problems) registered with their practice have been offered the vaccine.

The original letter from the Department of Health is available via the link below:

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Vaccination of hospital inpatients

In line with national guidance that “High Risk Patients” should be vaccinated whilst they are inpatients the following approach has been agreed by NHS organisations across the South East Coast area. Because trusts may have limited supplies of vaccine available for all patients in priority groups and their frontline staff, it is recommend that the following patient groups are offered the vaccination as a minimum.

  • Paediatric inpatients
  • Antenatal inpatients
  • Those priority group patients who are likely to remain in hospital for the duration of this priority vaccination programme

In order to avoid miscommunication with GPs it is recommended that:

  • Children – vaccine given to be clearly recorded in their patient held records
  • Antenatal – vaccine given to be clearly recorded in their patient held records
  • Those priority group patients who are likely to remain in hospital for the duration of this priority vaccination programme – the vaccination must be clearly recorded in the patient notes to ensure that this will not be overlooked when completing the discharge summary.
  • Other priority group patients who are given the H1N1 vaccine whilst they are in-patients – it is imperative that this fact is clearly stated in their discharge summaries which must be issued to GPs within 48 hours and should be copied to the patient

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Vaccination of nursing home residents

Nursing homes in the city are keen to support General Practice in the delivery of the swine flu [H1N1] vaccination to their residents. To facilitate this, the PCT have provided training to update the clinical skills and confidence of registered nurses working in most independent Nursing Homes. Full details of the opportunity and arrangements including good practice guidance and the legal framework have been sent to GPs, PMs and PNs.

Contact Marilyn Eveleigh, PCT Lead Nurse and Head of Clinical Performance for details.

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Vaccination of pregnant women

From the CMO letter the groups below have been prioritised for vaccination in the following order:

  • individuals aged six months and up to 65 years in the current seasonal flu vaccine clinical at-risk groups
  • all pregnant women
  • household contacts of immunocompromised individuals
  • people aged 65 and over in the current seasonal flu vaccine clinical at-risk groups

Given the relatively small number of pregnant women it would therefore seem reasonable that all practices should offer the vaccine to pregnant women at the present time.

The Department of Health advises that pregnant women who do not wish to receive Pandemrix should be able to receive Celvapan.

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Vaccine delivery

The storage and distribution arrangements for the H1N1swine flu vaccine are changing nationally and locally.  More detailed information has been sent to practice managers. 

From the week beginning Monday 25th January 2010 the vaccine distribution will be done by Unidrug Distribution Group Limited (UDG) and not by Movianto.  Movianto will continue to deliver all other vaccines e.g. those for the childhood immunisation programme.

UDG will be delivering to Brighton practices and locations each week on a Wednesday .  Vaccine orders will therefore need to be made by the previous Friday.

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Vaccine storage

Following national reports that vaccine has been wasted because fridges have either broken down or frozen the vaccine, the SHA has asked that we remind all practices that they should have a system in place to ensure their fridge is working correctly.

Re-ordering vaccine

Requests for swine flu vaccine reorders can be made from November 12th. Delivery of needles and syringes will be co-ordinated with the vaccine orders.

The reordering process is similar to that being used for the HPV programme.

  • Orders will need to be placed by 12 noon on Thursday each week with delivery being made by Movianto on Friday the following week.
  • As the PCT only has a limited amount of stock to order against we will have to initially prioritise orders on the basis of at risk population size for 6 months to under 65 years, by practice.
  • Practices that have registered with the ImmForm Vaccine Supply website can track the progress of their orders and will receive an automated email alert when a swine flu vaccine order has been placed and when it will be dispatched.
    If you are not already registered you can do so by emailing vaccinesupplytechsupport@dh.gov.gsi.uk

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Key points regarding the vaccination programme

  • Initially each GP surgery will be sent one box (500 doses) of the GSK Pandemrix vaccine directly from the Department of Health. The Department will ensure that GPs are informed of when they can expect delivery of their vaccines so that planning can begin before the vaccine arrives.
  • Fixed needle syringes and mixing needles and syringes have now been delivered to practices.
  • The GSK Pandemrix vaccine will be presented in a box of 50 multi-dose vials of suspension and two boxes of adjuvant. Each pack should provide 500 doses. The pack size is about the size of a small shoe box.
  • Individuals with a confirmed history of anaphylactic reaction to egg, which is a rare condition, should not be offered the GSK swine flu vaccine. These individuals should be offered the Celvapan (Baxter) vaccine. One box of Celvapan will be delivered to each PCT area. Initially this will be kept for patients for whom Pandemrix is contraindicated. These are mainly patients with a history of severe anaphylactic reaction to egg products. The PCT is making arrangements for patients who require Celvapan to receive it.
  • Data collection from practices will be done on a regular basis via the ImmForm website, as for winter flu. The clinical risk group READ codes specification and dataset will be at www.dh.gov.uk/swinefluvaccinetools . PRIMIS+ are providing a swine flu library for their CHART tool for general practices (see www.primis.nhs.uk).

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Need to check patient information leaflets provided for vaccines

The Department of Health has advised that because new clinical evidence on swine flu vaccines is being generated all the time and recommendations are being reviewed, the hard copies of the patient information leaflets (PILs) provided with the first few batches of vaccine will not be up to date. It is therefore very important to check the
Medicines and Healthcare products Regulatory Agency (MHRA) website to make sure that the most up to date version of the PIL is given to the patient. Please download copies of the PILs for your patients. The Department of Health will be sending out printed copies of the PILs as soon as is possible. I am trying to establish when the final version will be agreed.

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Vaccination of frontline staff

Frontline health and social care workers will be offered the vaccine.

Practices should plan how they will vaccinate their own front line staff and the other groups identified for swine flu vaccination (most of these will also require seasonal flu vaccination).

As further information on the vaccination programme becomes available, it will be placed on the Department of Health website.

The normal seasonal flu jabs will not be replaced by the swine flu vaccine programme and will be distributed in the usual way.

Health Care Worker Seasonal Flu and Swine Flu Vaccine Uptake Survey

The Department of Health is measuring the uptake of the swine flu and seasonal flu vaccine by Health Care Workers, including those in primary care.  The national survey will begin soon and further details about the information required locally will be sent directly to practices in the near future. 

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Other guidance

The BMA/RCGP pandemic flu guidance has been reviewed to take in to account the 2009 swine flu (H1N1) outbreak and the guidance that has been published in relation to this.

This is a comprehensive resource for GPs and practice managers, covering the latest evidence and planning for further waves of H1N1. 

The document is described as a “living document”.  The website stresses the importance of revisiting the website regularly to check for any changes to the document.

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Pandemic flu supplies for practices

To support your emergency plans for pandemic flu, these documents may be useful in determining your stockpiling supplies:

See also Personal Protective Equipment (PPE) section below.

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Personal Protective Equipment (PPE)

The requirements are laid out in the HPA algorithm. 

  • Some practices do not have a store of PPE and should seek some from suppliers (not manufacturers) or cooperate with a neighbouring practice that does have a stock.
  • Practices unable to obtain masks, and whose own supplies are fully depleted, should contact Marilyn Eveleigh on 01273 545378 for a limited interim supply.
  • A practical guide to what mask to use and guidance on the cleaning of equipment is available below.

Patient information material for practices

The poster below explains that patients with flu like symptoms should not enter the surgery but return home and call the National Pandemic Flu Service.

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Pandemic flu checklists and templates

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Brighton and Hove City Teaching Primary Care Trust
Level 4, Lanchester House, Trafalgar Place, Brighton BN1 4FU Telephone: 01273 295490 Fax: 01273 574737 Email

NHS Evidence

Brighton and Hove City Teaching Primary Care Trust
Level 4, Lanchester House, Trafalgar Place, Brighton BN1 4FU Telephone: 01273 295490 Fax: 01273 574737 Email: enquiries@bhcpct.nhs.uk

© Brighton and Hove City Primary Care Trust