Select Committee on Science and Technology Minutes of Evidence

Supplementary evidence by the British Medical Association

  The British Medical Association (BMA) is a voluntary, professional association that represents all doctors from all branches of medicine across the UK. About 80 per cent of practising doctors are members, as are nearly 14,000 medical students and over 3,000 members overseas.


  1.  The BMA welcomes the actions that the Department of Health has undertaken to prepare for an outbreak of pandemic influenza in the UK. Good planning and preparedness might mitigate the enormous consequences of a pandemic, and this opportunity must not be missed.[6] However, even with good planning, an influenza pandemic could potentially have major implications.

  2.  The timing and the impact of pandemic influenza are the greatest uncertainties, and could therefore make planning extremely difficult. Despite the commendable efforts that the Department of Health has made, there are a number of areas that still need to be addressed.

Can you outline what impact you would expect a flu pandemic to have on your work?

Wider NHS:

  3.  It is anticipated that there would be a large increase in demand for primary and secondary care, although the exact degree is difficult to predict. As the NHS normally runs at very high efficiency there is little surge capacity.

  4.  The increased workload giving vaccines and antivirals is likely to be concentrated on Primary Care.

  5.  There would be a reduction in levels of NHS staffing due to flu related illness but staff shortages can be mitigated to a certain extent by selective use of vaccination for staff. However, vaccination is unlikely to be available in the first six months of the pandemic because production cannot begin until the exact form of the pandemic strain is identified, and because inherent characteristics of the production process means maximum production is not achieved for several months.

  6.  In summary, the impact on the NHS would be substantial. The increased demand and reduced staffing may force reassessment of the normal assumptions about triage systems and waiting time for emergency treatment. Moreover, elective work is unlikely to be sustainable.

General Practitioners and Primary Care:

  7.  There would be a need to develop practice contingency plans, although uncertainty about a pandemic frustrates effective planning. General Practitioners (GPs) will need guidance in developing their practice contingency plans. This would be primarily from Primary Care Trusts (PCTs) and strategic health authorities, with technical advice and support from the Health Protection Agency.

  8.  The normal weekly workload for GPs could be expected to increase dramatically. For example, home visit requests may increase 10 fold or more. It is estimated that GPs may expect to see 1,000 new cases per 100,000 of the population per week, which would rise to 5,000 per 100,000 per week at the height of the pandemic.[7] The large numbers of the ­worried well" could have an effect on GP workload whilst the impact of staff illnesses could be higher for small practices. There could also be the probable suspension of all ­routine services" with the risk of practice closure unless temporary staff cover is available.

  9.  Due to high numbers of those infected, there may be the inability to admit sick cases to hospital because of bed unavailability.

  10.  GPs will need specific advice on prevention, diagnosis, management and treatment of flu cases. In addition, GPs will require specific information to pass on to their patients.

Public Health & Health Protection:

  11.  There is some difficulty in engaging some PCTs in the planning process, as senior personnel are occupied with other priorities such as NHS reorganisations and achieving targets. In addition, there is a current lack of dedicated emergency planning posts in PCTs.

  12.  Engagement with GPs has also been difficult, as it is challenging to achieve a balance between providing sufficient detail on an uncertain and changing subject to a busy audience. Furthermore, exercises can cover most of the affected organisations but cannot reach more than a few staff or GPs.

  13.  The modelled impacts of an influenza pandemic vary and this contributes to uncertainty in gauging the exact amounts of antiviral or vaccine to stockpile. Furthermore, lack of resources for stockpiling comes into play for any but the very low impact models.

Wider society

  14.  It would be essential for private industries (e.g. transport, food retail, utilities, fuel, finance) to engage in business continuity planning or multi-agency specific planning. The combined efforts of society will be required to reduce human deaths and ill health and minimise short and long term economic damage.

In general, do you find that health authorities have prepared effective plans to deal with a pandemic, and in particular, do the plans deal adequately with the challenges your own professions will face?

  15.  There are adequate plans in place for the vaccination of, or antiviral provision for vital staff. The alerting mechanisms for incidences of influenza and the methods for cascading of professional advice are also in place.

  16.  Although the Department of Health is to be applauded for its contingency planning in the event of a pandemic, there are a number of barriers to effective planning. Key challenges lie in service-wide demand management, the maintenance of adequate staffing levels and the lack of NHS surge capacity. Other challenges are:

    -   Conflict between regional and county based planning assumptions of the Civil Contingencies Act and the current geography of the NHS;

    -   Focus on achieving targets in the NHS distracts attention elsewhere;

    -   Lack of specific financial resource and the current financial difficulties of a number of PCTs;

    -   Lack of joined up thinking at departmental level - ie assurances to the NHS of the support of other services without commensurate guidance to those services;

    -   Lack of effective engagement with all areas of the NHS, especially Primary Care.

  17.  More preparation is required for:

    -   Organisational plans - specific and business continuity, for PCTs and acute hospitals within the NHS and transport, food and fuel related industries in the private sector;

    -   Management of demand for non-flu related health care at individual GP and secondary care levels;

    -   Provision of resources for mass vaccination, diagnosis and treatment;

    -   Provision of public advice by frontline staff;

    -   Provision of effective triage systems;

    -   Time sensitive flu management algorithms for frontline staff.

What guidance have your members or staff received as to action to be taken in the event of a pandemic?

  18.  The following are in the professional or public domains but there is no guarantee that staff have accessed or will access these:

    -   NHS Influenza Pandemic plan October 2005;

    -   Chief Medical Officer cascades and update briefings;

    -   Health Protection Agency guidance and algorithms for frontline staff;

    -   Recent media reports.

  19.  Some PCTs and trusts have issued specific advice to staff and GPs but this is the exception rather than the rule. Furthermore, exercises have been taking place at organisational level but these do not address the needs of individual staff and GPs.

What input have you, as individuals or representing bodies, had into the preparation of pandemic flu plans?

  20.  The BMA has made informal representations to the Chief Medical Officer. Requests have been made for regular meetings including key stakeholders.

Have changes in NHS institutional structures had an impact on preparedness?

  21.  Institutional structures have had an impact on preparedness in the following ways:

    -   Mismatch of NHS and Civil Contingencies Act related geographical planning boundaries;

    -   The focus on targets does not easily recognise emergency requirements;

    -   Resources diverted to managing NHS reorganisation leading to relative neglect of emergency planning;

    -   Working relationships between organisations involved in emergency planning require rebuilding after changes;

    -   Financial difficulties of NHS organisations restricts resources available for planning;

    -   There is the capacity through the new GP contract to introduce priority service areas and additional funding to back them. For this to happen successfully, the immunisation and contracting sectors of the Department of Health will need to work together.

November 2005

6   World Health Organisation (March 2004) WHO consultation on priority public health interventions before and during an influenza pandemic, pg. 2. Back

7   UK Health Departments (October 2005) UK Influenza Pandemic Contingency PlanBack

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