Labour Ministers unprepared for swine flu second wave Lords warn

The labour Government appears to be unprepared for an expected second wave of swine flu in the autumn, according to a report by peers published this week.

The House of Lords Science and Technology Committee said that ministers had failed to offer reassurances that NHS services could deal with the predicted surge, when several million people may become ill.

It called for clarity on how intensive and critical care departments will cope with high patient numbers. It expressed concerns about NHS staff providing services outside their usual expertise if they are transferred around the country to the areas experiencing most demand.

The committee also criticised ministers for not setting up the National Pandemic Flu Service for England earlier in the year.

An interim service is now in operation to diagnose cases over the phone or internet and distribute drugs at pharmacies and health centres. But this was beset by problems when it launched last week, with the website crashing in the first few minutes.

The committee praised the Government’s actions in stockpiling antiviral drugs such as Tamiflu and entering into advance purchase agreements for a vaccine for the H1N1 flu strain, but said ministers needed to offer better guidance over who could have access to these treatments.

Swine flu is affecting about 100,000 people a week, and hundreds are being treated in hospital.

Lord Sutherland, the chairman of the committee, said that he was disappointed that tests to examine how the full range of health services would respond in a pandemic had not been carried our earlier.

“While the Government have got some things right in preparing for a flu pandemic, such as the stockpiling of antivirals, there are other areas where we appear to be under-prepared,” he said.

“We were surprised and disappointed that the Government had not undertaken ‘whole system’ testing of health services preparations for a flu pandemic before swine flu emerged.”

The peers said that the national swine flu helpline in England should also have been set up sooner and asked for assurances that it will cope with high demand this autumn.

Lord Jenkin of Roding, a former health secretary, who was asked to sit on the committee’s flu pandemic inquiry, told The Times earlier this year that ministers had said the hotline would be ready by April or May.


Pregnant women up to four times more likely to become seriously ill with swine flu

Pregnant women are up to four times more likely to be seriously ill and require hospitalisation when they have swine flu than the general population, new research from the United States suggests.

They are also more likely to die of swine flu or even seasonal flu, meaning they should be prioritised for the flu vaccine as soon as it is available, a study by the US Centers for Disease Control and Prevention (CDC) concluded.

So far, at least two pregnant women are known to have died in Britain after contracting the H1N1 flu strain, while a third had to be flown to Sweden for emergency treatment.

The researchers said that pregnant women with flu symptoms should start taking antiviral treatment as soon as possible, while all expectant mothers should receive a vaccine once one becomes available in coming months.

Little is known about the possible ill-effects of the drugs on the foetus but scientists say their benefits are likely to be greater than the risks.

Data collected by the CDC showed there were 34 confirmed cases of swine flu among pregnant women in the United States between mid-April and mid-May, the first month of the outbreak that has since been declared a global pandemic by the World Health Organisation.

Eleven of the pregnant women, or about a third, were admitted to hospital. The hospitalisation rate for members of the general public infected with swine flu was around eight per cent, or a quarter of the rate among pregnant women, the study showed.

One of the women who became ill in that first month died, but five more pregnant women died of swine flu in the United States during the following month of the outbreak, the report said.

None of the women who died had been given antiviral drugs promptly, within the first 48 hours of symptoms occurring. All of them had developed pneumonia and “acute respiratory distress syndrome” which required them to go on a ventilator, it said.

Denise Jamieson, the CDC’s lead author of the study, which is to be published next month in the Lancet medical journal, said: “We know that in seasonal influenza as well as in pandemic influenza, situations that pregnant women have an increased risk of severe disease and of dying.”

The increased risk is likely to be due to the changes that take place in a woman’s body during pregnancy, she said.

“There are mechanical and hormonal changes in pregnancy, there are changes in the cardiovascular and respiratory systems, there are immunologic changes.

“Lung capacity decreases because as the uterus grows it moves the diaphragm up and there’s basically less room for the lungs. All these changes make pregnant women more susceptible to and more severely affected by certain viruses, including influenza.”

Once a vaccine is available, pregnant women will be a high priority, Dr Jamieson suggests. However, she said she was concerned that women may not come forward to be vaccinated because of fear of any effect on their baby.

The babies of five of the six pregnant women who died during the study period were delivered by Caesarean section.

None had any evidence of influenza infection and all but one, who was born 13 weeks before term, have been discharged in good health, the study said.

Boon Lim, Pandemic Flu Planning spokesman for the Royal College of Obstetricians and Gynaecologists (RCOG) said today: “The World Health Organization (WHO) have stated that pregnant women should be prioritised to receive the swine flu vaccines when these are available. Currently, in the UK, pregnant women are advised to be immunised against the seasonal flu. The recommendation by the CDC to immunise pregnant women from swine flu is an extension of this principle and one which we support.

“The RCOG is working closely with the Department of Health to examine the evidence around safety of vaccination against the swine flu virus. Further guidance on vaccination will be issued in the near future.”

Sir Liam Donaldson, the Chief Medical Officer for England, said that most pregnant women with swine flu would only get mild symptoms but pregnancy brought a higher risk of complications.

Mothers to be were currently advised to continue “normal activities” such as going to work, travelling on public transport and attending events and family gatherings.

“We are not advising pregnant women to cut down on their normal daily activity – some might choose to be very precautionary and not want to go into crowded places, but that is not the advice,” Sir Liam said.


Swine flu could become resistant to Tamiflu because of over prescribing

Swine flu could become resistant to Tamiflu, the only drug that can treat the virus, because it is being over prescribed, a leading doctor has warned.

Dr Holden, the British Medical Association’s lead authority on pandemic flu, said he thought the thresholds for issuing Tamiflu had been set too low, a policy which he fears will come back to haunt the Department of Health if the H1N1 virus becomes resistant to Tamiflu.

The GP, based in Matlock, Derbyshire, helped draft the clinical algorithm used by operators on the National Pandemic Flu Service telephone line, but said doctors are being encouraged to dish out a “pill for every ill”.

Writing in Pulse mageazine, he also accused Andy Burnham, the Health Secretary, and Sir Liam Donaldson, the Chief Medical Officer, of giving different advice to GPs and the public.

“Both … have contradicted themselves by telling the public they can have Tamiflu if and when they want it, but at the same time telling GPs to use their clinical judgement.

“They are running with the hares and hunting with the hounds.

“People are finding it a bit hard to swallow that we are getting beaten up by the DH for antibiotics prescribing but that the same principle doesn’t seem to apply to the judicious use of Tamiflu.

“Personally I feel the flu line will help to relieve pressure on GPs but my concern is that the threshold for giving out Tamiflu will be set too low. For most people, given that is a mild illness the amount of medication being given out is overkill.”

As more courses of Tamiflu are distributed, GPs are seeing an increase in the number of patients who have experienced side-effects caused by the antiviral, including nausea, vomiting, diarrhoea and headaches.

“Every day GPs are saying they are seeing people with side effects from Tamiflu,” said Dr Holden. People are going for second and third consultations with their GP. It’s putting even more strain on the NHS.”


Cutting doctors hours during swine flu outbreak is unnecessary risk labour Government is warned

Cutting junior doctors hours during the swine flu outbreak will be “a sledgehammer that breaks the camel’s back” medics have warned.

Implementing the European Working Time Directive next Saturday, when the NHS is already under pressure with 100,000 new cases of swine flu being diagnosed in a week, is the ‘probably the worst time in living memory to do this’, the junior doctors’ campaign group RemedyUK said.

Junior doctors are the last group of NHS staff to come into the Directive this Saturday by cutting their working week from 56 hours to 48.

Experts have warned that the NHS is not ready for the change and there will be gaps left in rotas putting patients at risk.

John Black, president of the Royal College of Surgeons said if swine flu turns into a major crisis, the Government should show leadership and suspend the Directive.

He said: “We could have a one, two or three-stage serious pandemic. If that happens everybody of course will work whatever hours are necessary to keep the patients alive in a crisis.”

“I trust that if that happens the Government will not fudge it and they will actually say that the European Working Time Directive leaves no slack at all in the system and if there is a major crisis it should be suspended.”

Richard Marks, Head of Policy at Remedy, said: “Millions have been spent on staff call-centres using non-medical staff to diagnose and prescribe (for swine flu) but at the same time they are reducing doctors’ working week by one full day.

“It’s probably the worst time in living memory to do this.”

Doctors are likely to be in short supply during a flu outbreak as they are in the frontline of exposure to the virus and are at increased risk of falling ill themselves and may also have sick children to care for during the peak of a pandemic.

RemedyUK has called for the introduction of the Directive to be delayed until the uncertainties over how the flu outbreak are resolved.

Dr Matt Jameson Evans, chairman of Remedy, said: “Unfortunately we have a camel’s back situation and swine-flu is more of a sledge hammer than a straw.

“We already know most doctors are against EWTD, we just need the leadership to do the right thing here.”

Dr Andy Thornley, Chairman of the BMA’s Junior Doctor Committee said: “Clearly pandemic flu is going to place additional pressure on an NHS that is trying to adapt to the introduction of the 48-hour week for junior doctors.

“The government need to be much clearer in communicating how it plans to deal with these additional pressures as it is unacceptable that so little information is trickling down to junior doctors.

“It is also important that the NHS works hard to reduce unnecessary bureaucracy and inappropriate work so that junior doctors can do what they do best – treat their patients.

The Directive does not allow for wholesale suspension but if individual staff work longer than the 48-hour limit the time can be balanced out over the coming months.

A report due from the House of Lords Science and Technology Committee is expected to criticise ministers for not setting up the National Pandemic Flu Service in April.


Swine flu- labour ministers blamed for chaos

The labour Government will be criticised over its handling of the swine flu crisis by a powerful parliamentary committee this week.

The report will attack the labour Government’s failure to keep its promise to set up a flu telephone helpline by April.

Labour Ministers will be held to account for the delay in setting up the national flu helpline and for giving confusing advice to vulnerable groups and NHS staff.

The report will be published as senior doctors hold an urgent meeting with Andy Burnham, the Health Secretary, in a last ditch attempt to persuade him to drop controversial European rules limiting the hours doctors can work, which are due to come into force on Saturday.

One doctor gave warning that the NHS was facing a “triple whammy” as it struggled with swine flu, the introduction of the European Union Working Time Directive and– four days later – the movement of more than 30,000 junior doctors between hospitals as part of the annual rotation of specialities.

Further concerns over Britain’s swine flu response are raised today by a Sunday Telegraph investigation, which has exposed major security lapses in the national flu pandemic service.

The flaws would allow fraudsters to obtain dozens of doses of Tamiflu – the main drug being issued to swine flu victims.

The Sunday Telegraph has also discovered that maternity units are planning to cancel home births and planned caesarean sections if the outbreak turns into a major epidemic.

Andrew Lansley, the shadow health secretary, said government planning failures had created a response to the pandemic that already appeared to be “riddled with problems”. He accused ministers of taking “an ad hoc approach” to a situation which needed careful planning.

This week’s report by the House of Lords science and technology select committee is the first to look into the Government’s preparedness for pandemic flu. It will attack its failure to keep its promise to set up a flu telephone helpline by April when the world was on the brink of a pandemic.

This newspaper disclosed in May that the delay was caused by the Treasury, which took seven months to sign off on the deal.

The hold-up meant the Government had to introduce a stopgap flu phoneline, introduced last week, manned by staff given just one day of training.

In the meantime, NHS Direct, which should have been running the service, has made hundreds of its highly trained staff redundant.

The Lords report will also question the adequacy of advice being issued to the public, in particular that offered to vulnerable groups such as expectant mothers. In evidence sessions, committee members described the lack of public advice for pregnant women as “extraordinary”.

The advice was only publicised last week, leading to further confusion when ministers appeared to distance themselves from recommendations they had previously endorsed.

Last night senior doctors said ministers must take urgent action to avert an impending crisis.

From Saturday, doctors will not be allowed to work more than 48 hours a week, under EU rules. The change has been fiercely resisted by many senior doctors who say it will put lives at risk.

It could mean that the NHS is short of doctors just as pressure on hospitals caused by the swine flu outbreak intensifies.

Britain’s top surgeon has urged ministers to suspend changes to working hours. John Black, the president of the Royal College of Surgeons, accused ministers of “having their heads in the sand”.

He said: “The courageous thing to do would be to step in and suspend the 48-hour limit for the whole of the NHS, once we come under pressure, but that would require political leadership. I don’t expect it to happen.”

Mr Black said despite warnings the Government had made no useful concessions over the rules which he says will put lives at risk, and “devastate” the training of health professionals. He will restate his plea for concessions over doctors’ hours in a meeting with Mr Burnham on Wednesday.

The weekly 48-hour limit for doctors is measured over a sixth-month period, allowing doctors to work extra hours some weeks, if they then cut back on others.

Doctors can opt out of the directive on a voluntary basis, but only individually, throwing rota planning into “chaos”, according to senior doctors. They want whole departments or specialities to be allowed to suspend the rules.

Both Mr Black, and John Heyworth, the president of the College of Emergency Medicine, said they did not expect the introduction of the working directive to have an immediate impact, but they fear it could cause shortages of doctors by September, when flu cases may soar. Mr Heyworth, an A&E; consultant at Southhampton General Hospital, said: “There is a triple whammy heading inexorably our way – the directive, doctor rotations, and swine flu, and the impact of all of this happening at once is unknown.”

He said doctors had explained their concerns to ministers about the changes to working hours “at great length”. Last night the Government defended the operation of its Pandemic Flu Service. It said that on the first day of the service, Thursday, it carried out more than 58,000 assessments, and almost 6,000 courses of antiviral drugs were collected in England.


Swine flu helpline hit by problems

The launch of the national pandemic flu service for England yesterday was marred by some early hiccups as the number of the country’s swine flu cases was estimated to have almost doubled in a week from 55,000 to 100,000.

Despite the steep rise in cases, there was a smaller increase in the numbers in hospital with the disease – up to 840 against 652 last week – and a rise of just 10 in the number in intensive care to 63. All strategic health auth­ority areas are classified as suffering from “exceptional influenza activity”. Some areas, including eastern districts of London, are hot spots.

But at 150 consultations per 100,000 population, the number of patients visiting the GP nationally remains below the rates seen in the last sizeable outbreak of flu like illness in 1999-2000 and the number of actual cases is far below the peak of the last flu pandemic in 1969-70.

Sir Liam Donaldson, the chief medical officer, said more detailed investigation of the deaths that have to date been attributed to swine flu had resulted in some new cases being counted in and others discounted, leaving the provisional total at 26.

The English figures were disclosed as Professor Hugh Pennington, a leading virologist at the University of Aberdeen, said that Scotland was “possibly through the worst” of the first phase of the virus as latest figures showed far lower GP consultation rates than in ­England.

The relatively small rise in those being admitted to hospital in England and an apparent drop in the GP consultation rate in some parts of the country provided a possible first hint that the initial wave of the infection might also be peaking in England, as it has in the US.

But Sir Liam warned against “reading too much” into those figures. If the data held for another week or so they might indicate a lull in the pandemic, “but I don’t think so yet”.

The infection remains mild in most people and continues disproportionately to affect children. Two thirds of those who have died had other severe underlying medical conditions, Sir Liam said, with only 16 per cent of the small number of deaths in otherwise healthy people.

“The bad thing would be if 100 per cent of the deaths were healthy people,” he said. With the current state of the virus, “the vast majority, even with an underlying condition, will get flu and recover well”.

The Federation of Small Businesses wrote on Thursday to Andy Burnham, the health secretary, calling for measures to help its members through the pandemic.

It wants routine inspections of businesses suspended in areas with high levels of infection and a simpler system for the smallest companies to reclaim statutory sick pay.

“A small firm employing only three people could expect to have all of its workforce off for up to two weeks this autumn,” John Wright, the federation’s national chairman, said.

Sir Liam said that school closures had not been ruled out for the autumn, but “it would be a huge step to close schools across the country”, with a considerable economic impact.

The pandemic flu service is intended to lift the burden from GPs and give swift access to anti virals. Patients whose replies to a list of questions indicate they may have swine flu will be given an access number and told where a relative or friend can, with suitable ID, collect their Tamiflu.

The Association of British Insurers said its members would accept the number as the equivalent of a medical diagnosis of flu for travel insurance claims.

Early callers to the swine flu hotline on Thursday afternoon were greeted with the slightly disconcerting question asking whether they were “conscious”, write FT reporters.

More worrying was the fact that the online version had already crashed after being swamped, though the telephone service seemed to be working well and call centre staff were responding promptly.

One potential sufferer with flu-type symptoms said the person taking his call appeared to be reading from a similar list of “do you have swine flu?” questions as seen online. The questions ranged from “do you have trouble speaking?” to “do you have a patch of purple dots underneath your skin?” and “can you bring your chin down to your chest?”

Callers are also told that if they misused the service they would be prosecuted.

No questions were asked of the caller whether he was part of an “at risk” group, such as asthmatics.

He described the process as similar to “ringing a bank or an insurance company”, with the call-centre worker “clearly not a medical professional”. The 2,000 operators will liaise with GPs to report problems. So far, the hotline is available only in England.


Swine flu- travellers abroad face hostile reception

Long viewed with suspicion for bringing drunken rowdiness to foreign cities, the British face a new reason for hostility as they head abroad for summer holidays: the risk that they bring swine flu with them from the country with one of the world’s highest infection rates.

While the pandemic has spread to nearly 200 countries, the UK has intrigued public health specialists by reporting to date the most cases outside Mexico and the US, with 100,000 new suspected infections in recent days and rising fast.

After recent incidents when British citizens have been detained in China, Brunei and Romania, the Foreign Office is warning visitors to its website that they could be screened on entry to a foreign country and even placed in quarantine if found to have swine flu like symptoms.

But with many countries across Europe and elsewhere yet to be significantly affected by the flu, and often with modest stockpiles of the medicine Tamiflu, those who do fall ill while abroad may face greater hurdles than normal in gaining swift access to treatment.

Some countries are simply putting up posters at ports of entry advising travellers to seek medical help if they have flu symptoms, but it says Romania is among those now specifically asking those arriving from the UK to fill in a medical questionnaire and placing those with symptoms in isolation in hospital for treatment.

The Association of British Travel Agents has also criticised overzealous imposition of screening of British travellers by foreign countries including Egypt and Turkey despite advice that it serves no purpose from the World Health Organisation.

Official advice warns those who have already fallen ill to defer their trips, while the airlines BA and Virgin have already indicated that they may prevent people from travelling if they have the symptoms.

After concerns that two travel insurers had said they would not cover cancellation costs for people contracting swine flu, the Association of British Insurers stressed this week that all would be reimbursed provided their condition had been recognised by the government’s new Pandemic Flu Service.

To date, at least 52 British students have been quarantined in China, 200 soldiers in Brunei and eight school children in Romania.

The Foreign and Commonwealth Office said that it was providing consular assistance to at least 160 British nationals in swine-flu quarantine in four countries: China, Singapore, India and Egypt.

“We are paying close attention to the welfare of Brits in quarantine. We are keeping in touch by phone with those in quarantine to check on their welfare; ensure they understand the procedures; and to pass messages to and from parents and relatives in the UK.”


Companies in swine flu fight over staff and profits

Most businesses were trying to avoid being swept up in the panic this week. But with the number of cases doubling to 100,000, companies were testing business continuity plans to make sure they could cope with large numbers of sick workers.

“With companies already hit by recession, the threat from swine flu is the last thing firms need,” said David Frost, director-general of the British Chambers of Commerce.

One research group, FirstCare, estimates the number of people off work because of colds, coughs and flu is three times higher than normal for the time of year.

The caution shown by companies such as Britvic could help explain part of the jump. The drinks maker said it was taking the “sensible approach” of asking staff to work from home if friends, family or anyone else they meet has swine flu.

However, BT, one of the country’s biggest employers, said it was not seeing “significant absentee rates at this stage”. Nevertheless, the telecommunications group is sending out regular bulletins to staff about the threat and has given “hygiene packs” to engineers, including alcohol wipes and face masks.

Ocado, the Waitrose owned online grocer, is issuing delivery drivers with hand sanitisers and wipes to reassure customers. Domino’s Pizza said in the event of a more serious outbreak it could leave orders at a customer’s front door to avoid contact. J. Sainsbury has bought masks for workers in case of a serious outbreak.

The BBC was criticised this week for buying 4,000 doses of the anti viral drug Tamiflu, and there is sensitivity among companies anxious not to be seen to hoard stocks, though several banks including Nomura and HSBC have supplies if needed.

Centrica, owner of British Gas, said: “Tamiflu is being provided for our employees who work in critical roles, for example those working on offshore platforms and service engineers who provide essential maintenance support in customers’ homes, to be taken only if they begin to display symptoms.”

Some companies– such as Google, Nomura and Goldman Sachs– are installing extra hand cleaning facilities, including alcohol wipes outside lifts and in staff canteens. Inter­Continental Hotels Group, owner of the Holiday Inn chain, has gone further by installing hand sanitisers for customers in hotel bathrooms and restaurants.

Honda, the carmaker, has introduced “enhanced cleaning” for all solid surfaces, including door handles, and issued staff with antiseptic handwash. BBH, a large advertising agency in London’s Soho, has “deep cleaned” the desks of infected staff.

Away from business but reflecting the general caution, students graduating at Sussex university were given alcohol gel on Friday before they went on stage to receive their certificate and shake hands with Sanjeev Bhaskar, the comedian and university chancellor.

“It seems like a good idea– he’s going to be shaking hands with 400 students,” said Tom Wills, president of the university’s student union.


Cherie Blair suffering from swine flu

News that the former prime minister’s wife had become Britain’s most high profile victim of the virus came as figures emerged showing that the number of swine flu cases jumped by nearly 50 per cent in a week.

Mrs Blair started feeling unwell at the start of the week and received a diagnosis of swine flu on last week.

She was given a course of the antiviral Tamiflu and told to cancel all engagements until she recovers. Mrs Blair had been due today to pick up an honorary degree from Liverpool’s Hope University in recognition of her work as a human rights lawyer. A staff barbecue has also been cancelled as a precaution.

Data from a sample of GPs’ surgeries, seen by The Times, shows that up to 40,000 people complained to their doctor last week of “flu-like illness” in England and Wales, with a huge rise in the number of young children being affected.

The report shows that the highest rates of reported illness are in children aged five to 14, with 160 of every 100,000 in this age group reporting symptoms, followed by 114 per 100,000 in those aged up to four years old.

Overall, the rate of people complaining of symptoms increased to 73.4 cases for every 100,000 people in the week to Sunday, compared to 50.3 cases per 100,000 the week before.

This is a rise of 46 per cent and is equivalent to about 39,150 people across the country reporting symptoms compared to about 27,000 people who did so the previous week.

The figures, from the Royal College of GPs (RCGP), are based on a sample of 84 doctors’ surgeries across the country. Although they do not provide a total of confirmed cases of the H1N1 virus they are used by the Government as an official measure of how the outbreak is spreading.

The figures show the current outbreak is already worse than the seasonal flu experienced over Christmas and the New Year which was the worst for eight years. The winter flu outbreak hit a peak of 69 cases per 100,000 people across England and Wales. Doctors would normally expect to see fewer than 30 cases per 100,000 during the summer.

Separately, however, the RCGP criticised the Government’s response to the flu pandemic, accusing it of providing conflicting advice to both doctors and patients.


GPs criticise labour response to swine flu pandemic

GPs have criticised the labour Government’s response to the flu pandemic, accusing it of providing conflicting advice to both doctors and patients.

The Royal College of GPs is collecting feedback from family doctors on issues arising from the current outbreak, which has been linked to 17 deaths in the UK so far.

GPs have complained of poor out-of-hours planning, confusion over prescribing the antiviral drug Tamiflu and a lack of knowledge over how long patients should stay at home if they have the virus.

It comes after GPs saw a leap of almost 50 per cent in the last week in the numbers of people contacting them with fears they have swine flu.

Around 40,000 people a week in England and Wales are now complaining to their doctor of “flu-like illness”, with a huge rise in the number of young children being affected.

The figures, from the Royal College of GPs’ monitoring system, showed 50.3 people per 100,000 were reporting flu-like illness between June 29 and July 5.

But this leapt 46 per cent to 73.4 people per 100,000 between July 6 and 12.

In a submission to the House of Lords Science and Technology Committee, the College said it had an “excellent working relationship” with the Government’s chief flu adviser, Ian Dalton, and was “very pleased” with the responsiveness of health officials.

But it said issues were arising via feedback from GPs, including a “lack of information and conflicting advice” from both the Government and primary care trusts (PCTs).

Changes to the procedure for obtaining Tamiflu – such as patients obtaining the drugs from a flu centre rather than a GP surgery – “were not cascaded down to PCTs/GPs”.

The written evidence said: “Family doctors also noted that conflicting advice was being provided by different agencies.

“Some GPs raised concerns about the lack of support provided by their PCTs, such as no action plan to help primary care respond to the outbreak.”

Some out of hours doctors have complained that they are not being seen as the “major player in the flu plan operationally in their area”.

“They reported that they had received poor and inconsistent communication, including lengthy and verbose documents that were unworkable operationally.”

There was also anxiety among GPs about a lack of protective clothing and whether they should take Tamiflu preventatively with the aim of trying to protect their own families.

“Concerned family doctors have also been in contact seeking the latest recommendations on the protection of pregnant healthcare workers that might come into contact with possible swine flu patients. It appears guidance on this issue is not very clear.

“Family doctors have also informed the RCGP that they do not know when they should advise their patients to come out of isolation following an episode of H1N1 flu. In addition, there seems to be confusion around how long health workers need to stay off work following a presumed flu diagnosis.”

The weekly flu report from the College said flu was evident in all age groups “but remains highest in five to 14 age groups.”

The study said the highest number of cases was being seen in central England but the North had seen “a marked increase compared to previous weeks”.

There has been a small decrease in the number of cases being seen in London although the capital remains a major hot spot for the virus.

The rate of influenza-like illness is highest among those aged five to 14, at 159.57 per 100,000 population.

The next most affected group is youngsters and babies aged up to four, at 114.12 per 100,00 population.

This is followed by people aged 15 to 44, those aged 45 to 64 and then people aged 65 and over.