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London GP: my ordeal dealing with suspected swine flu case

By Lilian Anekwe

A GP has contacted Pulse claiming he has been left to investigate a suspected case of swine flu without adequate local advice or access to antivirals.

Dr Gregor McEwan, a GP in Clapham, south west London, told how he is having to coordinate tests and treatment for a woman he says the Health Protection Agency has declared is potentially infected with the H1N1 virus.

And Dr McEwan, one of the first GPs to have to deal with a suspected case of swine flu in the UK, claimed he had received little guidance from the local Health Protection Unit, NHS Direct or his PCT.

His comments are strongly refuted by the PCT and local Health Protection Unit.

The patient, a woman who recently returned from holiday in Canada via New York and who is now suffering from fever and a flu-like illness, was told to contact her GP by NHS Direct.

Dr McEwan told Pulse: ‘I rang the local Health Protection Unit in Lambeth and spoke to a person who was blasé at best. They told me they would courier over the swabs to take and advised me to issue a prescription for Tamiflu and that's pretty much all they could help me with.

'I am supposed to give this woman a prescription for Tamiflu but I know for a fact she won't be able to find any pharmacist in Clapham who has it in stock; I've already called.

‘They told me they have dealt with other practices and told them to tell any patients with suspected swine flu to come in and for GPs to see them in another room. Even on that advice, they would have exposed themselves to several more people.

‘But other than the most basic hygiene measures, I have nothing I can use in terms of infection control. We have no face masks because there are none available, we have no prophylactic antivirals to take because we are not entitled.

‘When I asked the HPU should I keep seeing patients in the meantime, they said yes. I asked them "what should I tell my patients?" and they said "don't tell them anything".

'I've been trying to get hold of someone at the PCT as well but no one is available and in any case, I have no idea what the PCT policy is or who is responsible for it.

‘Between now and the time the swab results are confirmed I might have had 30 or 40 patient contacts. Not to mention I have a young child and a wife, who is extremely worried.

‘I completely understand that we don't yet have an understanding of the lethality of the virus but I have a duty to my patients and the Government has a duty to me to make sure I can take the best care of my patients.

‘They obviously have not thought the management of this potential health crisis through. As a GP I am happy to be responsible for suspected cases but I have to be given the practical tools to do my job.

‘I have already had six or seven other patients call the surgery after returning from holiday in Spain and elsewhere with fever, even more patients panicking and worried staff whose fears I have to allay.

'I have the HPA guidance and all of that but certainly my dealing with the HPU left me feeling they were not living in the real world. If the situation carries on as it is things are going to be completely unmanageable.'

Dr Rachel Heathcock, director of the Health Protection Agency's South East London Health Protection Unit, said: 'It is disappointing that this GP feels he didn't receive adequate assistance, however, our unit have spent a considerable amount of time today, advising him about his patient's treatment and testing and offering to help source antivirals.

'We will constantly review our guidance and management of suspected cases of swine flu as the situation evolves but numerous GPs across the country have implemented the current guidance over the last few days. If any GPs are concerned, or have patients they would like advice about then they can contact their local Health Protection Unit and we will provide all the help and support we can.'

A statement from NHS Lambeth said: 'NHS Lambeth sent guidance on patient management with regards to swine influenza to GP practices in Lambeth on Monday with further updates on Wednesday morning.

'The Clapham Family practice confirms that they received these details. Dr McEwan's comments reflect his personal view and are not shared by the practice. It is felt by the practice that Dr McEwan did not review the guidance thoroughly enough before making his comments.

'NHS Lambeth has developed positive working relationships with local GPs, and we will endeavour to make contact with Dr McEwan as a matter of urgency to discuss any on further concerns he may have.'

Influenza virus Influenza virus

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