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)
(full guidance from this page as a printable word document)
The Department of Health is recovering materials no longer required for the management of the pandemic. Practices have been asked to identify;
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:
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 collection points closed on the 31st March 2010. Antiviral policy has now reverted to normal, with NICE guidelines applying from 1 April 2010 onwards.
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.
Health Protection Agency update 1 April 2010
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.
The Department of Health have produced updated clinical management guidelines for adults, children and pregnant women. These include sections on primary care.
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.
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.
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.
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.
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.
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:
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.
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.
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.
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:
For children aged from 6 months of age to less than 10 years of age who are immunosuppressed or who have an immune deficiency:
For individuals aged from 10 years to less than 60 years of age:
For individuals aged 60 years and over
For immunocompromised individuals aged 10 years and over
For children from 6 months of age and adults
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:
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
The groups below will be prioritised for vaccination in the following order:
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.
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 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.
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:
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.
In order to avoid miscommunication with GPs it is recommended that:
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.
From the CMO letter the groups below have been prioritised for vaccination in the following order:
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.
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.
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.
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.
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.
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.
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.
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.
Personal Protective Equipment (PPE)
The requirements are laid out in the HPA algorithm.
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.
Brighton and Hove City Teaching Primary Care Trust
Level 4, Lanchester House, Trafalgar Place, Brighton BN1 4FU Telephone: 01273 295490 Fax: 01273 574737 Email
© Brighton and Hove City Primary Care Trust