How frequent are localised community out-of-season influenza outbreaks?

In previous years, there have been approximately 30-40 care home outbreaks in England prior to the CMO and CPhO alert authorising the prescribing of antivirals in primary care. These figures rely on voluntary reporting, which may be incomplete.

Can GPs be commissioned to do this?

This is possible, if commissioned as a local enhanced service. However, the ICS needs to ensure that arrangements are available for the whole population and not just those registered to a specific practice.

What hours does this need to operate in?

Any commissioned service needs to be able to operate both in and outside of normal working hours, as a localised community outbreak can occur at any time. If antivirals are recommended, they need to be provided as soon as possible (within 36-48 hours, depending on the precise medicine required). Therefore, if an outbreak was identified over a weekend, it may not be practical to wait until the following Monday to arrange the response.

Why do we need a pharmacy supply?

If the CMO/CPhO has not currently advised that GPs may prescribe antivirals, many community pharmacies or their wholesalers may not maintain stock of antivirals, due to the lower consumption of these medicines at these times. However, when these medicines are needed, they need to be supplied within very short timescales, and so there will not be time to try and source medicines from different suppliers. Some ICSs have commissioned small-scale arrangements for local community pharmacies to hold antivirals year-round to avoid this problem.

Can we use the PHE HPT stocks?

The PHE HPT antivirals stocks consist of limited amounts of antivirals, intended for local use in avian influenza incidents. They are held in the pharmacies of a small number of acute trusts on a voluntary basis to support emergency public health needs relating to avian influenza incidents. The exact locations of these supplies are not in the public domain. These trusts do not receive any funding for this purpose and therefore some are only able to dispense the antivirals in relation to these avian influenza incidents. Some trusts may not have the resources to dispense antivirals for localised seasonal influenza outbreaks and so alternative local pharmacy arrangements will be needed. If a trust pharmacy does agree to dispense antivirals for a localised seasonal influenza outbreak, on receipt of a PSD, then it will charge any associated costs (including supply costs and replacement of the PHE stock) to the ICS where the outbreak is occurring. For contractual reasons, the PHE HPT antiviral must be replaced, as it was not purchased for routine NHS use. In addition, the final decision to release the PHE HPT stock rests with the duty HPT consultant. It should be noted that use of the HPT antiviral stocks in localised community outbreaks is only intended for urgent out of season use; these stocks are not configured to support influenza activity during the season.

What is the PHE Centre HPT role?

The HPT role is to identify outbreaks of influenza-like illness and provide public health advice in relation to these, including a recommendation for use of antivirals as an outbreak response. HPTs do not undertake prescribing for these outbreaks and the individual clinical assessment and prescribing for patients needs to be undertaken by a clinician, as arranged by the regional ICS.