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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

“Pandemic Planning”

Oxfordshire Practice Manager Conference

21.1.09.

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

slide4
RCGP

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

BMA

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

more to come
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.
buckman letter
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.
anna hinton pct operational lead please send all updated plans to into pct by 1 3 09
Anna Hinton(PCT operational lead) “Please send all updated plans to into PCT by 1/3/09”
the government s messages to the public will be
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’
national pandemic flu line
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.
flu line professional service no public access
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
uncertainties of pandemic planning
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)
buddying up system
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:
role of lmcs
Role of LMCs
  • Organising buddying groups.
  • Ensuring no practice is left isolated
  • Involved in making decisions about stopping non-essential work.
pandemic spread
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.
practice funding
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
gp workload
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.
peak weeks
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.
bird flu a h5n1 flu virus
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
ethics
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.
coronors
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.
flexible certification
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
uk alert levels
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

clinical aims and philosophy
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) .
infectivity
Infectivity
  • The incubation period: 1-4 days
  • Most infectious soon after symptoms develop.
  • Droplet spread and Hand-to-face contact
virus survival on surfaces
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)
surfaces and hands
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.
personal protective equipment ppe
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?
using surgical masks
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.
staff absence levels
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’.
staff illness and safety
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.
staff contracts and pay
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.
practice continuity plans
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.
photo id
Photo ID
  • Each practice should develop an electronic library of staff photographs
  • Photo ID during a pandemic
  • Fuel supply for their vehicles.
emergency box advised
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.
retired doctors
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.
locum gps
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
gp registrars
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.)
litigation risk
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)
practice actions now
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
daily sit reports
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.
antiviral medicines
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’.
collecting antivirals
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.
rebuilding restoring and rehabilitation
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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