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Conflicting HPV guidance puts GPs in 'impossible situation'

GPs are being placed in an ‘impossible situation' by PCTs issuing conflicting guidance on how they should deal with a surge in requests for HPV vaccinations.

The national schools-based programme to immunise all 12- and13-year-old girls against HPV began in September, but GPs are facing increasing numbers of requests from parents and girls not covered by the national programme.

The Department of Health says it is preparing guidance on the issue but that in the meantime GPs should base their decisions on ‘clinical judgement'.

Confusion is also growing over whether GPs who decided to immunise girls are free to use the quadrivalent Gardasil vaccine or whether they should stick to Cervarix, the vaccine chosen for the national programme.

Some PCTs are ordering GPs to use Cervarix on cost grounds but one LMC has warned that GPs who do so could be taking a medico-legal risk.

Gardasil protects against HPV types 6, 11, 16 and 18 whereas Cervarix is only effective against types 16 and 18, which together are responsible for around 70% of cervical cancer cases.

The Department of Health's decision to use Cervarix for the national programme has been widely criticised by public health experts, academics and GPs.

Details from Wessex LMCs minutes reveal that some PCTs have been asking GPs not to prescribe Gardasil ‘on the grounds of it having huge repercussions on prescribing expenditure'.

But Leeds LMC is warning GPs they may not be protected in the event of a future claim brought against them by a woman who was denied Gardasil. It advised members: ‘It is not possible to offer guarantees against future legal action should a woman develop an infection that would have been covered by one vaccine but not the other, and that woman or her parents asked for and was denied Gardasil.

‘This leaves GPs in an impossible situation and we have raised our concerns with the Chief Medical Officer nationally.'

Dr Pran Bhattacharyya, a member of Leeds LMC, said: ‘There's no clear guidance for the girls who fall between the two stalls. More and more people are ringing and asking for it for their 14- and 15-year-old daughters – the Government should give GPs clear guidance on who to say no to.

‘At the moment anyone we vaccinate we pay for out of our prescribing budget, but if GPs prescribe over budgets we stand to lose out on incentives from the PCT.'

GPs unsure whether they can use Gardasil (pictured) or Cervarix, the official vaccine for the HPV campaign GPs unsure whether they can use Gardasil (pictured) or Cervarix, the official vaccine for the HPV campaign

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