Joint guidance from the BMA GP committee and Royal College of GPs has been issued, instructing GP practice on preparations for and operational techniques in the event of a flu pandemic.

Concerns have grown in recent weeks as the incidence and prevalence of flu has risen to its highest levels in the population since the 1999 events which provoked the NHS winter beds crisis that led to the massive new investment in the NHS.

Back to work blues
This week has seen the return of most employees to work on Monday and the start of most new school terms on Tuesday. With the greater proximity of school and workplace environments, not to mention confined spaces on crowded and poorly-ventilated public transport, concerns about spread among the working and student populations are running high.

_The new guidance, supported by the Department of Health, warns that a pandemic will put the NHS under “unprecedented pressure” and that general practice in particular will be “stretched beyond its current limits.”
It predicts that during the pandemic’s peak, an average GP practice could see an extra 186 cases of flu a week. The guidance says sensible preparation now will make the difference between just ‘getting through’ a pandemic and maximising the number of lives that can be saved.

The BMA / RCGP guidance is meant as a practical guide for GPs and practice managers, and details how GP surgeries will be expected to adapt from their usual method of working and gives information and guidance on the following:
Every practice will have to follow “command and control arrangements” which will be monitored and co-ordinated by Primary Care Trusts to ensure there is a robust, uniform response.
GP surgeries will be expected to ‘buddy up’ with neighbouring practices to share resources and exchange staff as necessary. The guidance recommends that practices should ensure these contingency plans are in place by 31 March 2009.
There will be changes to the death certification process, including bringing in retired doctors to ease the pressure on local services.
Patients with flu will get access to antiviral medicine via a new National Pandemic Flu Line Service, not via their GP surgery.
Additional capacity in the health service will be created by prioritising services and patients in a systematic and ethical manner.
How practices can minimise the spread of infection, for example by setting up separate waiting areas for patients with flu.

Dr Laurence Buckman, Chairman of the BMA’s GP Committee, said, “We've seen over Christmas how seasonal winter pressures put strain on the health service but this is in a situation where the system is still operating on a normal basis. During a pandemic the NHS would have to work differently - it’s a major health emergency and as such requires a totally different way of helping patients. Family doctors need to be prepared for this and this guidance has been produced to help them with their planning. During a pandemic many people will get flu and a few will be very poorly, but there will still be people suffering from other illnesses and they will also need our full attention. So plans are being put in place now to make sure general practice and the health service not only copes during the crisis, but does the best it can do to minimise the spread and impact of a flu pandemic in the UK.”