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GPs told to prescribe Tamiflu by public health chiefs against WHO advice

GPs should continue to prescribe Tamiflu even though it was downgraded earlier this year by the World Health Organisation, Public Health England has said.

The WHO advised in March this year that the medicine’s use should be ‘restricted to severe illness due to confirmed or suspected influenza virus infection in critically ill hospitalized patients’.

Following this, the BMA's GP Committee wrote to Public Health England asking them whether they would continue to advise the prescription of Tamiflu for both prevention and treatment, with GP leaders saying it would be 'difficult' for GPs to prescribe contrary to WHO advice.

However, PHE said GPs should take account of the available 'national guidance', and they continue to ‘emphasise the importance of appropriate prescribing of antivirals' for both treatment and prevention.

It follows controversy over PHE's advice around Tamiflu prescribing, with GPs being pressurised to issue bulk prescriptions to care home.

The WHO moved Tamiflu from the ‘core’ list of its 2017 essential medicines list, the minimum medicine needs for a basic health‐care system, to the ‘complementary’ list of essential medicines for priority diseases. These drugs require ‘specialized diagnostic or monitoring facilities, specialist medical care or specialist training’.

Their guidelines for pharmacological management of influenza are due to be updated in 2017, and WHO advisers stated that ‘unless new information supporting its use in seasonal and pandemic outbreaks is provided, the next expert committee might consider oseltamivir for deletion’. 

Dr Andrew Green, clinical and prescribing policy lead at the GPC, said that he wrote to PHE 'asking them to review this matter urgently, and certainly before this winter'.

He added: ‘It would be very difficult were GPs to be asked to prescribe a drug in a way contrary to WHO recommendations, and if PHE have sound reasons for maintaining their current position these need to be published and subject to debate.’

However, PHE told Pulse: 'PHE continues to emphasise the importance of appropriate prescribing of antivirals for the treatment and prevention of influenza in at-risk groups. Clinicians should take account of the available national guidance, including that from NICE, when deciding on whether to prescribe antivirals for people with or exposed to influenza.'

It follows controversy over the prescribing of Tamiflu. Pulse also reported earlier this year that GPC had advised GPs to ignore requests from NHS England to issue bulk prescriptions to care homes experiencing outbreaks of flu as local health commissioners had not set up a contract. Folowing this, health bosses warned GPs they could face medical negligence claims and threatened them with referral to the GMC if they refused to deliver preventive flu treatment to care home residents as part of their usual contractual work.

Dr Green said: ‘It remains our position that this work is not part of GMS contracts and CCGs should be thinking right now about whether they want this service to be provided in their area, and if they do, who they commission it from.’

Readers' comments (6)

  • Vinci Ho

    This is on recent BMJ:

    WHO downgrades oseltamivir on drugs list after reviewing evidence
    BMJ 2017; 357 doi: (Published 12 June 2017)
    Cite this as: BMJ 2017;357:j2841
    Evidence of the Minimal Benefit of Oseltamivir (Tamiflu) is Now 18 Years Old

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  • Prevention is non-contractual - therefore I wont be doing

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  • Are we still working through the ill-thought stockpile? I certainly won't be prescribing just to help make the overall level of government waste look better.

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  • Just Your Average Joe

    The drug has nasty side effects which would cause morbidity and worse in elderly patients. It also requires adequate renal function, and without up to date renal bloods on patients which would take several days to get turned around in local labs, and no staff or district nurses to take samples, it could be woefully negligent to prescribe this blindly.

    On the other hand - if the very under-worked PHE staff wish to take a day trip to the home - and have access to our records, do the testing and prescribing - sure knock yourselves out. Send out the PHE registrar or nurses.

    GPs do not have a spare day to leave the surgery and go and do this unfunded work, to provide a medicine with a very limited evidence base of doing anything more that reducing the duration of illness by half a day, and no proof of reducing any morbidity or mortality, even if the circulating flu was of a strain it had any effect upon.

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  • Just Your Average Joe

    First DO NO HARM!

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  • Dear Public Health England:
    1. The shit doesn't work
    2. it is preventative (your gig)

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