Wednesday, 8 July 2009

The NHS Flu Pandemic Plan vs reality 002

Listen up soldiers, in order to help fellow grunts stuck in the trenches we here at ND Central thought we would share some of our experiences thus far of the real world swine flu pandemic.

Today we stumbled into a meeting of the practice COBRA committee - alright then we exaggerate a bit - some reception staff, our practice manager and nurses were trying to work out what they should do if someone rings in and thinks they have swine flu (the terms are usually mutually exclusive at this stage of the game).

This may seem simple given that the Party’s advice. Stay at home and a doctor will ring you. However, one eminent medical blogger has pointed out the dangers of the simplistic advice given out by the Party. His well written piece points out (and saves us having to do so, respect Dr C) and illustrates the pit falls of telephone diagnosis and treatment.

The full article is here at Dr Crippen's well respected blog and we reproduce this section :

"In the meantime, though, other illnesses continue as normal. Children still get meningitis, and may well present with high temperatures, tummy ache, headaches and a dry cough. Children still get bacterial pneumonia and may well present with high temperatures, tummy ache, headaches and a dry cough. Children still get pyelonephritis (kidney infections) and may well present with high temperatures, tummy ache, headaches and a dry cough. Children still get acute appendicitis and may well present with high temperatures, tummy ache, headaches and a dry cough. Children still get acute leukaemia and may well present with high temperatures, tummy ache, headaches and a dry cough."

While we may get medical indemnity in a flu pandemic this will not spare a doctor a hard time if they don’t see a patient who subsequently dies of meningitis even though they were being a Party stooge and prescribed Tamiflu for high temperatures, tummy ache, headaches and a dry cough. Real world medicine is not a checklist and swine flu is not the only illness GPs see.

After all any patient with a checklist could land a plane in the Hudsen as the checklist would say put the plane down on an airfield. Just ring NHS (re)Direct they use check lists and land planes every day in GP’s surgeries and A&E departments. Look at their Swine Flu check list here.

During the course of the COBRA meeting we looked at the multiple and often contradictory emails from the local Politburo who, safe in their Party bunker and clutching their personalized packs of Tamiflu, spout forth rainforest after rainforest of cows manure for us to tread in, sorry, for us to read carefully and consider their words of collective wisdom and follow in order to treat our patients to the best of our (not their) ability.

We found out that our local chemist, who a week ago could not dispense Tamiflu, as the Politburo Tamiflu Guardian Committee had blocked them from doing so and more importantly because they hadn’t got any, is now an official TamDP (Tamiflu Distribution Point).

We rang the newly established TamDP and asked them if they had got it (they had) and asked them how did we go about prescribing it? They did not know as someone senior from a pharmaceutical giant was coming down to see them that afternoon. We found that interesting as we read in our email that Tamiflu can now be issued on a standard GP prescription form a FP10.

However, in order to make the magic Tamiflu work, a special spell has to be written across the top of the FP10. We will not give the exact words of the spell for this is highly classified stuff but it is something a kin to “soft and ready to use toilet tissue” and must be written on the FP10 to activate the magic of Tamiflu here in the UK.

We asked our pharmcist if they knew these magic words and they knew nothing about it. This was most interesting as the last sentence in that email from the Politburo’s Coms centre said “that all TamDP chemist’s would have been notified of the master plan”.

Another email told us that each local GP Practice would be issued with one face mask ventilator. Now given that ND Central composes of over 40 personnel over 3 sites we immediately worked out if we formed a circle and each took a breath through the ventilator, did not exhale and passed it one to the next man taking no more than a second to do so we would all be protected against ever inhaling the swine flu virus.

Of course if you have to hold your breath for 40 seconds before your next breath you won’t be able to do anything else but you won’t get the dreaded Swine Flu. A circle is well known in Western movies as a good defensive position so that should further deter the evil Swine (Flu) from attacking us as as all airbourne virus detest a defensive circle.

But we are just simple grunts on the ground.

There is no replacement filter so that won’t last too long but nonetheless each Northernshire practice will shortly have one such mask and 30 disposible face masks to protect their staff.

A colleague recounted their experience of ringing for authorization for Tamiflu as per another previous hour’s Swine Flu Plan and they were repeatedly asked by the call centre operative “Are you sure it is not just seasonal flu doctor”?

Well we can’t be sure because we are no longer allowed to test for it as we now have to use our clinical judgement. So if you as a doctor are ringing the Flu line is it because we have nothing better to do or might it be because we suspect someone might actually have it and want to follow Party Central advice and treat it?

You may recall in our last post that we were waiting for a swine flu swab result.

This took 10 days to come back (and was unsurprisingly negative) which isn’t bad when we are told the disease usually only lasts a week and treatment is best given in the first 48 hours. So when the swab was taken we couldn’t treat with Tamiflu without a proven index case? When the swab result came back the patient was better.

Is someone trying to protect Tamiflu at all costs or is their a conspiracy afoot like there is not enough to go round? (Cue X-files theme music).

A further Politburo email dicktates (small mistake possibly?) that each practice should appoint a responsible GP as a swine flu co-ordinater and the Practice had to email who that responsible GP is back to the local Politburo Public Health Co-ordinator by the end of that working day by 13.00 Zulu or 14.00hrs local.

Their duties would be to read all Party email mountain re swine flu on a daily basis so it would have to be a retired GP with no brain or will to live to do this job. Needless to say as most people don’t read NHS email spam there was no shortage of volunteers running away from the Coms centre here at ND Central.

Anyway like all high powered COBRA meetings nothing much was decided but a lot of merriment was had. We await the next batch of rainforest destruction with baited breath as we are still using the respirator while it lasts. We don’t want it to go to waste do we?

Local NHS planning is akin to the state of British readiness at the start of the second world war. We have a few time expired generals posturing, a jaw jaw rather than war war situation and the combined might of the NHS is the equivalent of the Local Defence Volunteer Force led by several Captain Mainwarings but with no General Eisenhower anywhere on the horizon.

And the War has not even begun yet.

Praise be to the Party for claiming we are one of the best prepared countires in the world. All those telling us this from comfortable media bunkers while the troops in the trenches muddle through. One soldier gets an empty gun, the next a bullet and so on . . . onward to victory?

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