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GPs asked to prescribe antivirals to ‘well’ patients in care homes to prevent flu

GPs in the south east of England are being asked to prescribe Tamiflu to ‘well’ patients in nursing homes, with local GP leaders saying the task is ‘taking them away from more important work’ this winter.

GPs in Oxford, Maidenhead and Newbury have been asked by commissioners to prescribe the antivirals to patients in nursing homes who are not yet displaying symptoms but have potentially come in contact with an infected person following a flu outbreak.

Rates of GP consultations for flu continued to rise last week with the entire UK now affected by several influenza strains.

However Dr Paul Roblin, chief executive of Berkshire, Buckinghamshire and Oxfordshire LMC, said the antivirals prescribing process is ‘enormously work intensive’.

He said: ‘If you are to check their kidney function can cope with the drug and it’s appropriate to give it and they’re consenting to give it, informed consent because these are well patients – actually it takes 10-15 minutes per patient.

‘If you have to do this for 80 patients at short notice, there are going to be a lot of things you’re going to have to stop doing.’

He added that the work ‘has not been adequately commissioned and resourced’, with demands on GP time ‘not being prioritised and we’re being asked by the authorities to do less important work, taking us away from more important stuff’.

This winter has seen GPs ‘horrendously pressured’ in an attempt to care for a barrage of patients hit by winter illnesses, whilst being discouraged to pass them over to emergency services.

Dr Andrew Green, prescribing lead for the BMA’s GP committee, said: ‘CCGs were notified some time ago by NHS England that they had a responsibility to set up a service for prophylactic prescribing of antivirals in these circumstances, and most have done so.

‘Where CCGs have failed to make proper arrangements that does not mean that the responsibility rests with GPs. Where GPs chose to do this work for their CCGs they should ensure that they are provided with the resources that they need to do so.’

A spokesperson for Berkshire West CCGs, which covers the Newbury area, said that the local GP out-of-hours provider has been commissioned to prescribe the medicine.

Dr Cathy Winfield, chief officer of Berkshire West CCGs, told Pulse that the CCG discussed with PHE ‘about the possible requirement for prophylactic antivirals’ in a local nursing home after a flu outbreak, which saw GPs ‘provide care for the small number of symptomatic patients which is in line with their GMS contract’.

A spokesperson for NHS Windsor, Ascot and Maidenhead CCG added that CCGs ‘would only request the prescribing of Tamiflu under the direction of Public Health England’.

Pulse has approached PHE about the issue but a spokesperson declined to comment.

Should GPs prescribe Tamiflu to care home residents?

The prescribing of Tamiflu has been an ongoing issue since 2015, when GPs were bullied into prescribing bulk prescriptions at very short notice and without time to carry out necessary checks, leading to a ‘significant untoward incident’ being recorded at one care home.

Last year the GPC 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.

Following 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.

Public Health England then issued guidance telling GPs to continue prescribing Tamiflu even though it was downgraded by the World Health Organisation, which advised that the medicine’s use should be ‘restricted to severe illness due to confirmed or suspected influenza virus infection in critically ill hospitalized patients’.