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“Pandemic Planning”. Oxfordshire Practice Manager Conference 21.1.09. (Paul Roblin 10:15am to 10:45am). “Practice managers in particular should find it helpful”. Launched 07 January 2009 57 pages. RCGP http://www.rcgp.org.uk/pdf/GP_Guidance.pdf BMA

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Pandemic planning l.jpg

“Pandemic Planning”

Oxfordshire Practice Manager Conference

21.1.09.

(Paul Roblin 10:15am to 10:45am)



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RCGP

http://www.rcgp.org.uk/pdf/GP_Guidance.pdf

BMA

http://www.bma.org.uk/health_promotion_ethics/influenza/panfluguiddec08.jsp?page=1


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More to come

  • Document will be updated regularly as ideas emerge. It is therefore important to visit the DOH website regularly:

  • www.dh.gov.uk/en/Publichealth/Flu/PandemicFlu/index.htm.


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Buckman letter

  • Practices should identify Buddying Groups (clusters of practices which actively cooperate for pandemic work)

  • Pandemic Flu Contingency plan to be agreed between buddying group and PCT by March 31 2009.


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Anna Hinton(PCT operational lead) “Please send all updated plans to into PCT by 1/3/09”


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The Government’s messages to the public will be:

  • Stay at home

  • Don’t spread it around

  • Phone the National Pandemic Flu Line Service not GP practices.

  • Arrange a ‘flu friend’


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National Pandemic Flu Line

  • 24-hour telephone line for the general public.

  • Capable of activation from spring 2009.

  • For the public to access antiviral medication

  • Issue URN to collect antivirals from a local ‘collection point’.

  • GPs will receive referrals from the National Pandemic Flu Line Service call centre.


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Flu Line Professional Service (No public access)

  • Doctor access to a patient’s National Pandemic Flu Line record

  • Bypasses National Pandemic Flu Line Service

    • Check previous antiviral authorisations.

    • Authorise an antiviral

    • Generate a URN


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Uncertainties of Pandemic Planning

  • Prediction is inaccurate

  • Clinical attack rate could be 25% to 50%, (normal seasonal flu rate of 5% to 15%).

  • Adaptability will be needed.

  • Responses stepped up as appropriate.(Escalation)


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Buddying-up system

  • A buddying-up system is proposed

  • Clusters of practices will actively cooperate for pandemic work, sharing resources and exchanging staff as necessary.

  • Templates at www.rcgp.org.uk

    • Tees Primary Care Services – Primary Care Continuity Agreement:

    • Caduceus Medical Practice Influenza Plan:


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Role of LMCs

  • Organising buddying groups.

  • Ensuring no practice is left isolated

  • Involved in making decisions about stopping non-essential work.


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Pandemic Spread

  • It seems likely that a flu pandemic will start outside the UK, but within two to four weeks of the start of the outbreak in the host country it will affect the UK.

  • It could spread around the UK in one to two weeks, with the peak incidence occurring only 50 days from the initial entry to the UK.

  • There may be single or multiple waves

  • It is likely that between a quarter and a half of the population will be affected.


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Practice Funding

  • Financial protection of practices when they have to suspend some normal operations such as Quality and Outcomes Framework (QOF) work and enhanced services.

  • More details can be found in Appendix 1


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GP workload

  • GPs will be looking after patients in the community who are more seriously ill than under normal circumstances

  • About one-third of symptomatic patients will require assessment and treatment by a GP

  • Other practice patients who get flu will be asked to self-care.


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Peak Weeks

  • The duration of a pandemic is unknown

  • The peak is likely to occur within 50 days of the first cases of pandemic flu appearing in the UK.

  • 22% of cases likely to occur in the peak week.

  • For a typical practice of three GPs with a list of 6,000 patients, that works out at 186 extra cases in the peak week of the pandemic.


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Bird Flu (A/H5N1 flu virus )

  • The worry is flu with the virulence of bird flu and the transmissibility of human flu

  • A new strain of avian flu virus mixed with human flu virus is likely to transmit more easily to people


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Ethics

  • At the peak of the pandemic it may be necessary to prioritise who will benefit most from treatment.

  • No one will like this but it will be done in an ethical and objective manner.

  • Scoring systems for hospital admissions are being validated at present

  • Modelling suggests that up to 2.5% of all flu victims may die.


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Coronors

  • Likely relaxation of the legal requirement to have seen the dead patient in previous 14 days .

  • Possibly the period will increase from 14 days to 28 days.


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Flexible Certification

  • Death Certificates: Doctors who have not attended the patient allowed.

  • The same doctor could also complete a streamlined Cremation Form B.

  • Need for a second cremation doctor will be suspended



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UK Alert Levels

  • If a pandemic is declared, action will depend on whether cases have been identified in the UK and on the extent of spread.

  • Therefore, for UK purposes, four additional alert levels have been included within WHO Phase 6.

  • These UK alert levels are:

    1. Virus/cases only outside the UK

    2. Virus isolated in the UK

    3. Outbreak(s) in the UK

    4. Widespread activity across the UK


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Clinical Aims and Philosophy

  • Minimise the spread of the flu virus: isolate flu patients wherever possible.

  • Limit the morbidity and mortality from influenza

  • Stay at home and self-care.

  • Only certain patients will be seen by a GP or other healthcare professional.

  • Only the most seriously ill should be sent to hospital (assessed as likely to benefit from specialist treatment) .


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Infectivity

  • The incubation period: 1-4 days

  • Most infectious soon after symptoms develop.

  • Droplet spread and Hand-to-face contact


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Virus Survival on Surfaces

  • Hard non-porous surfaces

  • Flu viruses can survive >24h on

  • Soft materials(nightclothes, magazines and tissues)Up to 2h (15 mins mainly)


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Surfaces and Hands

  • Remove soft furnishings and toys during a pandemic.

  • Flu viruses are easily deactivated by

    • washing with soap and water or alcohol handrub

    • cleaning surfaces with normal household detergents and cleaners.

  • Good hand hygiene is essential

  • Home visitors should carry personal packs of alcohol hand rub.


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Personal protective equipment (PPE)

  • Fluid-repellent face masks should be worn by any healthcare worker who will have close contact (within one metre) of people with flu.

  • Government to stockpile face masks

  • These will be held centrally until a change in WHO flu phase status triggers dispatch to PCTs.

  • The point at which the face mask supplies are distributed to GP practices will be for PCTs to determine.

  • The masks will be supplied to practices free of charge.

  • Storage in practices?


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Using Surgical Masks

  • Surgical masks should:

    • be worn once only and then discarded to an appropriate bin as clinical waste; hands should then be washed/cleansed after disposing of the mask.

    • cover nose and mouth

    • not be allowed to dangle round the neck after or between each use

    • not be touched until disposed

    • be changed when moist

  • GroupsIf there is a surgery for flu patients, or a GP/nurse is visiting patients in a nursing home, it may be more pragmatic to wear a single mask for the whole time or until it becomes moist and needs replacing.


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Staff absence levels

  • Primary care staff will get flu, or stay at home caring for children or other dependants.

  • Up to half the workforce may require time off at some stage over the pandemic period (up to two weeks).

  • At the peak of the pandemic up to a fifth of the workforce may be absent.

  • Single-handed practices will be hit even harder and may become non-viable without support from ‘buddy practices’.


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Staff Illness and Safety

  • Any GP or member of staff who shows flu symptoms must be sent home immediately.

  • Practice staff who have recovered from pandemic flu and feel well enough to work should have immunity and should be able to treat flu patients.


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Staff Contracts and Pay

  • Alter staff contracts now

  • Flexibility clause.

    • to cover possible redeployment and/or altered hours of work.

  • Additional overtime taken by staff during the pandemic must also be funded by the primary care PCT.


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Practice Continuity Plans

  • All practices must have a service continuity plan. For advice on how to do this and what to include read the joint guidance produced by the RCGP and the GPC at:

  • www.bma.org.uk/ap.nsf/Content/flupanprep?OpenDocument&Highlight=2,business,continuity

  • www.rcgp.org.uk/default.aspx?page=3908.


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Photo ID

  • Each practice should develop an electronic library of staff photographs

  • Photo ID during a pandemic

  • Fuel supply for their vehicles.


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Emergency Box Advised

  • Suggested Contents

    • Torch

    • spare batteries

    • standard phone for use with emergency line

    • e-charging adaptor for mobile phone

    • space blanket

    • up-to-date copy of this document

    • copies of the service continuity plan and the practice’s pandemic flu plan

    • prepared signs for surgery

    • photocopied patient encounter forms (in case computers are down)

    • a ream of A4 paper and writing materials for logging decisions and recording clinical treatments.


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Retired Doctors

  • Retired doctors will be allowed to certify death

  • The BMA is working with the DOH to help identify retired doctors willing to help in a flu pandemic.

  • Legislation is proposed which would permit the GMC, under new emergency powers, to grant a doctor registration subject to conditions.

  • PCTs would pay the costs of GMC registration for this purpose.


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Locum GPs

  • Locums/freelance GPs must be included in

    • preparation and training programmes,

    • information cascades

    • Photo databases

  • PCTs will employ all available freelance locum GPs

  • Arrangements being discussed at national level.

  • Performers List checking now


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GP Registrars

  • Training and teaching will stop

  • Length of training period may well be affected.

  • Training rotational post changes will be suspended during a pandemic(inside and outside hospital.)


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Litigation Risk

  • Special edition of Good Medical Practice will cover what will be expected of doctors in a flu pandemic

  • Doctors acting in good faith unlikely to be disciplined (The GMC and Defence Societies)


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Practice Actions now

  • Staff contractsmaking voluntary changes.

  • Staff telephone numberdatabase(including mobile numbers)

  • Emergency Boxes

  • Buddy Up

  • Protocols “parachuted in” staff (Practice systems and IT use)

  • Plan patient separation


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Daily “Sit” Reports

  • Regular reports to a PCT data collection point

  • Standard national template of content

  • Permits assessment of staffing levels at each site.

  • Precursor to transfer from one site to another.


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Antiviral medicines

  • Not on FP10s

  • Most via National Pandemic Flu Line Service

  • Unique Reference Number (URN), needed to obtain antivirals from a local ‘collection point’.


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Collecting Antivirals

  • Flu FriendsA nationwide campaign

  • Collect antiviral drugs from PCT collection point centres

  • Security measures will be in place

    • no unauthorised or duplicate access to antivirals.


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Rebuilding, restoring and rehabilitation

  • Gradual Return to normality over months

  • Exhausted GPs and staff surprised at feeling unwell at this point.

  • Recuperation time

  • Mass vaccination campaign, could put added pressure on primary care



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