GPs are seeing a rise in appointment demand from parents worried that their children have a strep A infection, with doctors describing the situation as ‘relentless’.
On Monday, Pulse reported that GPs have been advised to ‘have a low threshold’ for prescribing antibiotics to children presenting with symptoms.
But the BMA said GP services must not get too overwhelmed to see other sick patients, urging NHS England to bring in urgent additional capacity to NHS 111 call handling services.
Pharmacy organisations meanwhile reported shortages of liquid antibiotics commonly prescribed to children.
According to reports by The Independent, NHS 111 services are also overwhelmed by the demand.
Dr Kieran Sharrock, acting chair of GPC England at the BMA, told Pulse: ‘We completely understand parents’ and guardians’ concerns about the latest Strep A outbreak, however, it’s important to remember that serious cases of the infection are incredibly rare and most children will recover, at home, without any clinical intervention.
‘GPs are seeing an increase in demand about Strep A, but what mustn’t happen is that general practice gets overwhelmed. We are already working at capacity, with too few doctors, and need to make sure that we remain available for other patients who need us.’
He said that in order to help GPs, NHS England ‘should ensure concerned patients are initially signposted to contact NHS 111, so that they are given the right advice or directed to the most appropriate service if necessary, while allowing GP practices to continue delivering care to those patients who need them most’.
‘NHS England must also therefore urgently commission extra capacity in NHS 111’, he added.
‘This means more appropriately trained telephone operators and appointment slots to ensure that unwell children who need a GP assessment are identified, and booked in to be assessed by their practice as soon as possible.’
Speaking to Pulse, Dr Osman Bhatti, a GP in East London, said: ‘We started seeing the increase on Friday (2 December). Patients are being triaged and assessed online and by telephone, but we are bringing in more patients, so we have to ensure we aren’t mixing patients coming into the practice with infectious diseases.’
Dr Bhatti described the situation as ‘relentless’ adding that one of the doctors was still processing patients at 9pm.
‘We have had a practice huddle to discuss and work closely with the team to meet the demand to ensure we have everyone involved, not just clinical staff but support staff,’ explained Bhatti.
Dr Sanjoy Kumar, who is a senior GP in East London, said he has noticed an increase in antibiotic cases and is concerned the rise in demand could result in antibiotic shortages.
He explained: ‘In our area, we have had a rise in antibiotic cases and uses and our fear if additional resources in terms of commissioning clinics and the model similar to Covid hot clinics should be thought about by commissioning bodies to give Primary Care a hand. We would advise supply chains are being bolstered.’
Dr Bhatti said his practice is prescribing more antibiotics than normal, however, they have protocols in place.
He said: ‘There are protocols in place for issuing antibiotics, so we can alter the management to liquid or crushed tablets or alternative antibiotics.’
Dervis Gurol, a superintendent pharmacist at HealthyU Pharmacy in Saltdean, East Sussex echoed Dr Kumar’s concerns.
He said: ‘There is a real struggle at the moment to obtain first or second line liquid antibiotics. If we are lucky enough to find any, some of the wholesalers are charging extortionate prices. For example, one of the wholesalers was charging an item or medicine around £1. Yesterday, they were asking £5.99 but the NHS will only reimburse us the tariff price of £1.29.
‘We have been taking the hit for a number of months. We are subsidising the NHS’ drugs bill because the price concession is not working,’ added Mr Gurol.
Speaking to Pulse, Mr Gurol described how a nine-year-old patient had fainted in the pharmacy yesterday and was admitted to the hospital. He explained that the family had visited a number of pharmacies searching for Strep A antibiotics.
‘This is having a huge impact on patients, especially little ones,’ he added.
The Association of Independent Multiple Pharmacies is seeing a rise in the number of prescriptions for penicillin and amoxicillin. According to chief executive Dr Leyla Hannbeck, the supply of these medicines in oral liquid form (used for children) from wholesalers is ‘patchy’ and ‘pharmacies are experiencing supply issues from ALL wholesalers’.
Dr Hannbeck confirmed there are also supply issues with other antibiotics.
She said: ‘We are worried that if the government and the DHSC do not put effective plans in place, we will be running out of these medicines fast.’
The Association couldn’t say how long the shortages would last as supply follows demand. They are advising pharmacies to work closely with GP practices on this to ensure GPs are aware of the situation and are asking that GPs communicate any relevant info they may have with pharmacies so that they can help manage this situation better.
Rise in Strep A cases
UK public health officials issued the low antibiotic threshold advice across primary care, emergency and paediatric services amidst concern over high levels of infections and the deaths of seven children since September.
GP consultations for scarlet fever and disease notifications are rising more steeply than expected for this time of year as are cases of invasive group A streptococcus, although less pronounced, the UK Health Security Agency has warned.
A total of 4,622 notifications of scarlet fever were received from week 37 to 46 this season (2022 to 2023) in England, with 851 notifications received in week 46 compared with an average of 1,294 (range 258 to 2,008) for this same period (weeks 37 to 46) in the previous five years, UKHSA figures show.
There is considerable variation across England with the highest rates seen in the North West.
Laboratory notifications of invasive group A streptococcus disease are also higher than seen over the past five years at 509 compared with 248. The highest rates to date have been reported in Yorkshire and Humberside.