Supplementary evidence by the British
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.
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?
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
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.
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.
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
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
- 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
- Health Protection Agency guidance and
algorithms for frontline staff;
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
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.
6 World Health Organisation (March 2004) WHO consultation
on priority public health interventions before and during an influenza
pandemic, pg. 2. Back
UK Health Departments (October 2005) UK Influenza Pandemic
Contingency Plan. Back