Memorandum by Royal College of General
Practitioners
1. The College welcomes the opportunity
to comment on the Intergovernmental Organisations Ad Hoc Committee
inquiry into Intergovernmental Action to Control the Spread of
Communicable Diseases.
2. The Royal College of General Practitioners
is the largest membership organisation in the United Kingdom solely
for GPs. It aims to encourage and maintain the highest standards
of general medical practice and to act as the "voice"
of GPs on issues concerned with education, training, research,
and clinical standards. Founded in 1952, the RCGP has over 33,000
members who are committed to improving patient care, developing
their own skills and promoting general practice as a discipline.
3. Whilst recognising that "no country
is an island" when considering infectious disease, the intergovernmental
structures for tackling them have little day-to-day impact on
the working lives of GPs. Consequently, many of the questions
raised, whilst fully valid for exploration, are not those which
the college feels competent to give evidence upon, particularly
with regard to intergovernmental structures.
4. The college would, however, wish to see
the problem of communicable diseases raised as a priority on a
national and international stage. We would also like to draw attention
to other pressing issues related to world health: supplying clean
water; providing adequate food and sanitation; supplying preventative
medicine, including immunization programmes; lifestyle challenges,
such as smoking, alcohol, sexually transmitted diseases and obesity.[1].
REDUCING
HEALTH INEQUALITIES
5. The college would like to highlight the
fact that GPs have a duty within their ethical code, as laid down
by the General Medical Council, to provide care in the best interests
of patients and the public health, regardless of their socio-economic
status. This is particularly relevant to this inquiry because
allowing equitable access to healthcare is vital to our efforts
to control the spread of communicable diseases.
6. Reducing health inequalities and improving
patient safety are national priorities that have international
counterparts. We suggest that proportionate study is given to
the major public health problems and that resources are realistic
for preventive work in disadvantaged communities. It is more important
than ever to enhance the self esteem of vulnerable families, to
take simple steps to intercept transmissible disease and not have
our attention monopolised by borderline technological advances
that benefit a fortunate few.[2]
INTERGOVERNMENTAL
COLLABORATION
7. To tackle the issue of communicable diseases
effectively, a joined-up approach is necessary on a national and
international level. A recent RCGP response to a Department of
Health consultation on Pandemic Flu documents[3]
argued the case for government departments, principally the Department
of Health and the Cabinet Office, to work in close collaboration
to respond to a pandemic influenza epidemic. A national framework
must be brought into existence to encompass all the departments
involved. A joined-up approach is also necessary on an international
level, both within the EU and elsewhere. The consequences of an
influenza epidemic will be exacerbated by global interconnectedness.[4]
PUBLIC ENGAGEMENT
8. Public engagement is critical if measures
to tackle communicable diseases are successful. This will depend
on the extent to which governments and/or healthcare systems are
able to engender the trust and confidence of the populations they
serve. Any policies in place to respond to the problem of communicable
diseases must be patient-centred and developed from the perspective
of the patient, particularly those with complex and interrelated
health problems e.g. those with positive HIV status suffering
from additional infections, such as pneumonia.
POLICY FORMULATION
9. Policy decisions must be based on advice
from a wide spectrum of scientific disciplines. It is, for example,
not sufficient for governments to rely exclusively on the advice
of virologists or modellers. Medical historians and behavioural
scientists could provide valuable insights and ensure that appropriate
lessons are adaptively learned from past experiences.[5]
To illustrate this point we can use the example of planning for
an influenza epidemic. From the GPs perspective, the following
expert disciplines will need to be incorporated:
— Operations research, using modelling
and algorithms to determine the most efficient ways to act
— Queuing theory, for example to evaluate
probable waiting times and numbers waiting
— Logistics, for managing the supply
chain
Intergovernmental organisations must take account
of these varied disciplines and consider how skills can be utilised
from a number of sectors. They also need to consider how leadership
expertise can be drawn from multiple sectors, including the military
and media as well as business and academia in order to support
objectives for panic minimisation, assessment of economic impact,
scenario-based decision-making and optimisation of telecommunications
resilience. Academies could potentially play a greater leadership
role in the future.[6].
10. Planning on an intergovernmental level
must take account of the vast disparities which exist between
countries in terms of food supply, utilities, transport infrastructure,
availability of essential medicines, support for the healthcare
workforce and access to specialist advice. The increasing prominence
of Africa in the spread of influenza is a great concern, at an
international as well as national level, given the weakness of
infrastructure and reporting systems in some African countries.[7]
11. It must be recognised that there is
variation between healthcare systems in individual countries,
some of which have greater capacity than others to deliver healthcare
services to their populations. Furthermore, different types of
healthcare systems may affect our ability to implement policies
to control communicable diseases. It may, for example, be more
difficult to implement policies in a country whose health system
is based on privatisation and/or outsourcing because private companies
will have a specific contract as opposed to the potentially open-remit
of public sector organisations.[8].
THE IMPORTANCE
OF PRIMARY
CARE AND
THE ROLE
OF THE
GP
12. It is essential that individual countries
have effective primary health care systems in order to implement
policies successfully. In the UK, frontline primary care accounts
for 90% of the contacts with the NHS. In the case of a pandemic,
it will be the GP's role to assess those patients at particular
risk or who are developing complications and to provide urgent
care for non-pandemic problems which may be exacerbated by the
pandemic, in particular by the increased difficulty in admitting
non-pandemic patients to hospital.[9]
RESEARCH AND
ETHICAL CONSIDERATIONS
13. All action to control the spread of
communicable diseases should be carried out within an ethical
framework. Research into the prevention of communicable diseases
should not be driven by commercial interests. Furthermore, the
process of using modelling when planning for a pandemic must take
account of additional variables when setting parameters.[10]
These should include the greater frequency of co-morbidities in
the elderly when comparing with children to select target populations
for intervention, and the impact of population density on behavioural
change.
OTHER POINTS
14. The RCGP feels that our educational
and primary care expertise should be shared with our counterparts
abroad. Those delivering health education and those delivering
health care need to be adequately trained and supported. The opportunity
to influence the continuing professional development of health
care clinicians can be seized as we consider practice quality
and re-accreditation here in the UK.[11]
15. The college believes that GPs are better
able to prepare for the consequences of a new pandemic rather
than try to prevent it.
16. With reference to Issue 12, there is
some concern that GPs will be blamed for over-prescribing anti-biotics
and thus contributing to the increased microbial resistance to
them. There is arguably pressure on GPs to "play safe"
and give antibiotics to those who might not require them. For
example, a GP may face recrimination for missing an emerging pneumonia
in a toddler but also face criticism for treating an infant's
sore throat with amoxicillin.
17. I acknowledge the contributions of Dr
Simon Stockley towards the above comments.
6 February 2008
1 RCGP response to the Department of Health Consultation:
Health is Global: Proposals for a UK Government-wide Strategy,
May 2007 Back
2
RCGP response to the DH Consultation: Health is Global Back
3
RCGP response to the Department of Health Consultation: Pandemic
Flu Discussion Documents, May 2007. Back
4
The Royal Society, Report of a Royal Society/Academy of Medical
Sciences symposium on pandemic influenza held on 27 November 2007 Back
5
RCGP response to the DH Consultation: Pandemic Flu Discussion
Documents Back
6
The Royal Society, Report, 27 November 2007 Back
7
The Royal Society, Report, 27 November 2007 Back
8
RCGP response to the DH Consultation: Pandemic Flu Discussion
Documents Back
9
The Royal Society, Report, 27 November 2007 Back
10
The Royal Society, Report, 27 November 2007 Back
11
RCGP response to the DH Consultation: Health is Global Back
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