Given the current febrile climate, it seems criminally negligent not to mention the words, ‘Bawa’ and ‘Garba’ in the opening sentence of any self-respecting blog, even if that blog is all about the latest flu fiasco. This isn’t tokenism, though. This blog might appear to be about flu. But really it’s all about Dr Bawa-Garba.
First, the flu backstory. Last November, the JCVI suggested that using a newly licensed flu vaccine for the over 75s – as opposed to the bog-standard one – should be a priority for next winter. In December, NHS England firmed up this advice in guidance sent to all GPs. Yet, at the end of January, it suddenly instructed us, very seasonably, to freeze our flu order plans immediately. And finally, in a reversal of that reversal, with an added tweak, we’ve been told to go ahead, but to order the new jab for all over 65s, not just the over 75s.
All of which might seem irrelevant, because your flu ordering is probably done and dusted by now. But no: according to the blurb, you’ll just have to undo it all. Don’t worry, you’ve got a few weeks to do this, and there are plenty of supplies. Sure, you’ll ‘…need to contact any supplier you’ve placed an order with’, but ‘…although responsibility sits with you as the purchaser, the provider you are switching to may be able to provide advice.’ And NHS England is always there to help. What could possibly go wrong?
But if it does, as the guidance explains, ordering and using the correct vaccines is a ‘contractual and professional duty’, and seeking reimbursement for the ‘wrong’ vaccine might prompt NHS England into checking that, ‘Such a decision was an exercise of reasonable care and skill as required by the GMS/PMS contract’. Whether we’d be exercising reasonable care etc in having to jab over 65s with the ‘less ideal’ vaccine because we’ve been unable to change orders or guestimate numbers correctly, is unclear. What is clear is the menacing tone.
Post Bawa-Garba, we realise that there are too many systems and individuals who can let us down and for whom we carry the can
In other words: system dysfunction dumping hassle, work and responsibility on frontline doctors with thinly veiled threats of contractual and professional retribution should things foul up. Sound familiar? This is Bawa-Garba writ small. Very small, admittedly. But it’s really not that much of a stretch to suggest her treatment is just the most horrible tip of a huge iceberg.
Doctors are used to being the final common pathway for everything to do with patient care and have traditionally sucked this up as part of the job. Not any more. Post Bawa-Garba, we realise that, with expectations being so high, scrutiny so great, the workload so crippling and the stakes so high, there are too many systems and individuals who can let us down and for whom we carry the can, with little hope of understanding or forgiveness when things go wrong. This applies whether you’re treating a very sick child or you’re trying to sort out flu jabs which, in essence, are the same thing.
That’s why I read the influenza guidance with something of a chill. It could be a dose of ironic flu, of course. But I think it’s a symptom of something much more serious.
Dr Tony Copperfield is a GP in Essex