NHS Direct under growing strain as doctors told to give Tamiflu to low risk patients

HS Direct is struggling to cope as the number of people using the helpline dramatically increases due to freezing weather and the swine flu outbreak.NHS Direct under growing strain as doctors told to give Tamiflu to low risk patientsAmid claims some patients had waited for two days to speak to a nurse, officials urged patients to use a new online health information service.

Senior nurses suggested the helpline was struggling to cope with the overload of calls as figures show the number of people calling the helpline had dramatically increased over the past few days.

An NHS Direct spokeswoman admitted the telephone advice service was “experiencing extremely high demand as a result of the severe weather”. She said the service had received 50 per cent more calls than forecast.

Up to 46,000 people called the service last weekend, the equivalent of almost 960 an hour.

It was also disclosed that there had been 5,700 more calls made to NHS Direct last week compared with the same week last year.

The online “symptom checker” system was used 160,000 times while the colds and flu symptom system was the most used service with almost 59,000 checks.

NHS Direct management apologised to patients who had been forced to wait longer than expected.

It came as doctors were told they could prescribe Tamiflu to otherwise healthy people suffering from flu as the illness prompts a surge in hospital admissions.

The move is an indication of the authorities’ concern about the risks from swine flu, which has become the predominant strain of the virus this winter and is striking younger age groups than usual.

Cases of flu have risen more than six fold in three weeks, the latest figures show.

Normally antiviral drugs, such as Tamiflu and Relenza, are only prescribed to people with flu who have other conditions such as heart disease and severe asthma because of the extra risk that influenza poses to them.

But officials are so concerned at the number of otherwise healthy people who have been admitted to hospital that they are taking special measures to lift these restrictions.

Doctors will be able to use their discretion and prescribe the drugs, which shorten the length of the illness by about one day and reduce spread, to anyone they think will benefit.

The drugs are most effective if taken within 48-hours of symptoms first appearing.

Prof Dame Sally Davies, interim Chief Medical Officer, has written to all GPs with the new instructions as figures were released showing there are more than 300 people in intensive care with flu, higher than during any point in last year’s pandemic. Last week there were 180 people in intensive care.

Nine of the 17 deaths, that have so far been linked to flu this winter, were in otherwise healthy people. None of those victims had been vaccinated with this year’s seasonal flu jab or the pandemic vaccine against just swine flu that was administered last year.

Figures released by the Royal College of GPs disclosed that the number of people going to their GP with flu-like symptoms has more than doubled in a week. There were 87 consultations per 100,000 people in the week up until December 19th compared with 34 the week before.

In the week ending December 5th just 13 consultations per 100,000 people were about fly symptoms. Illness was most common in children aged between five and 14, followed by children under four, and those aged between 15 and 44.

It is not known how many of those people have had swine flu but the H1N1 virus is the most common this winter.

The letter to GPs said: “Antiviral treatments for influenza are currently only available from GPs for NHS patients who are in a designated “at clinical risk” category.

“The most recent surveillance data indicate that higher than normal numbers of patients, who are not in one of the “at clinical risk” groups, are becoming seriously ill with flu – requiring hospitalisation.

“Regulations currently say that prescribers should not order oseltamivir and zanamivir [Tamiflu and Relenza] for patients who are not in the target risk groups.”

It added: “However, the Chief Medical Officer has recommended that the current restrictions should be amended to allow general practitioners (and other prescribers) to exercise their clinical discretion so that any patient who their GP feels is at serious risk of developing complications from influenza may receive these treatments on the NHS.

“This is consistent with guidance from NICE which informs the existing statutory restrictions but which envisages that prescribers may exercise their clinical discretion in individual cases.

“Whilst antiviral manufacturers and wholesalers should have sufficient supply to meet demand, prescribers and pharmacists are asked to consider carefully the need to order sensibly and not to stockpile. Stockpiling and over-ordering could cause shortages.”

It comes as doctors in some parts of the country are preparing to open their surgeries on Christmas Day to deal with large localised outbreaks of flu.

Doctors in Leicester have said the outbreak there is the worst for ten years.

Some GP practices will open on Christmas Day and Boxing Day as well as the Monday and Tuesday bank holidays – although doctors will only see patients registered at the practice.

Ivan Brown, a public health consultant with NHS Leicester City, said: “As things stand at the moment, we are confident we are managing well but we must do anything we can to avoid unnecessary admissions to hospital.

“At the moment, we do have enough hospital beds. There aren’t a huge number to play with but there are enough.

“I understand people are going to have a good deal of anxiety but, for the vast majority of individuals, the raft of winter-related illnesses around are self-limiting and patients will recover.”

Dr Brian Gaffney, NHS Direct’s Medical Director, urged people to use the online system.

“Patients can be assured that they will receive the same quality of advice that they have come to expect from the telephone service when they access our services online,” he said.

Meanwhile sales of over-the-counter medicine have increased dramatically as patients try to keep themselves well at home.

Tesco has reported a surge in demand for cold relieving powders and drinks, cough syrup, lozenges for sore throats and other related pain relievers and is selling around half a million of these products a day.

Tesco pharmacy buyer Joy Wickham said: “As if the Arctic temperatures and horrendous travelling conditions aren’t bad enough the UK is suffering a higher than normal incidence of colds and flu illness.

“We are selling nearly half a million cold and flu remedies plus pain relievers a day while our flu jab service uptake has more than trebled.

“Since the recent heavy snowfall we are also seeing far higher than normal demand in our high street Express stores which suggests that shoppers are finding it easier to buy their essentials in urban areas.”

From: http://www.telegraph.co.uk/NHS-Direct-under-growing-strain-as-doctors-told-to-give-Tamiflu-to-low-risk-patients

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