018. Community Pharmacy Influenza Pandemic

Community Pharmacy Pandemic Influenza Plan

Central Lancashire Primary Care Trust Review Date: January 2011.

1

Contents Introduction

3

Background

3

Key Planning Assumptions

4

Key Planning Principles

6

Plan Activation and Alert Levels

6

Managing Demand Surge

7

Identifying Critical Functions and Responses

7

Critical Functions

8

Continuation of Service

8

Influenza Pandemic Key Criteria

9

Supporting Self-Care

9

Community Pharmacy: Key Roles and Services

9

Support for Pharmacy Planning

10

Risks and Hazards

11

2

Draft Community Pharmacy Pandemic Influenza Plan Central Lancashire Primary Care Trust Review Date: January 2010.

Introduction Under the Civil Contingencies Act 2004 PCTs along with police, fire, ambulance services and hospitals are classed as Category 1 responders. All Category 1 responders must have plans in place that make explicit how the organisation will respond effectively in the event of an emergency or major incident. Central Lancashire PCT has in place a major incident plan which defines mechanisms by which it will contribute as part of a multi-agency response to such an event alongside the emergency services. The Civil Contingencies Act 2004 also requires that all category 1 responders put in place and maintain plans to ensure that they can continue to deliver key services and perform their functions in the event of a major incident. While the PCT major incident plan focuses on a response to and recovery from an incident, it also identifies the need for a concurrent plan to ensure that key services are maintained during this time. This process is known as business continuity planning. This document provides details of the pharmacy network business continuity plan to be activated in the event of an influenza pandemic at the request of the relevant PCT Officer. It is intended to be used in conjunction with and compliment the Community Pharmacy Business Continuity Plan and forms part of the PCT’s corporate business continuity plan.

Background An influenza pandemic will present unique international, national and local challenges to the delivery of health and social care, producing case numbers likely to be far in excess of the capacity and capability of both systems to cope in conventional ways. Due to the specific nature of these challenges this plan has been devised separately to the Primary Care Trust’s Community Pharmacy Business Continuity Plan, however it is intended to be used alongside and with reference to the mechanisms therein.

3

• •

The impact of an influenza pandemic on the PCT is likely to be intense, and sustained. Services may quickly become overwhelmed as a result of: Increased workload from patients with influenza and its direct complications

•

Increase workload from people unable to access hospital care

•

Additional pressure on health services caused by anxiety and bereavement

•

The particular needs for infection control facilities and equipment

•

Depletion of the workforce and of numbers of informal carers, due to direct or indirect effects of influenza on them and their families

•

Delays or difficulties in dealing with other medical conditions

•

Logistical problems due to possible disruption of supplies, utilities and transport as part of the general disruption caused by an influenza pandemic

•

The longer term macro-economic effects of an influenza pandemic on the national (and global) economy

•

Pressure on mortuary facilities, possibly exacerbated by delays in death registration and funerals

•

Pressure on social services, which will impact upon the health-social care interface, and on integrated health and social care teams

Influenza pandemics have occurred three times in the last century: the 1918 Spanish Flu, the 1957 Asian Flu and the 1968 Hong Kong Flu. A further pandemic is thought to be inevitable. A pandemic arises when an entirely new strain on virus emerges to which the vast majority of people are susceptible. As a result it is able to spread widely and easily from person to person with little or no immunity.

Key Planning Assumptions The epidemiology of an emergent influenza pandemic virus and its clinical behaviour cannot be predicted with certainty. In previous pandemics, the overall UK clinical attack rate has been in the order of 25% to 35% compared with the usual seasonal range of 5% to 15%. The national framework recognises the possibility of a clinical attack rate of up to 50% in a singlewave pandemic. Response plans should be flexible enough to deal with this range of possible attack rates. Once established in the UK a virus is likely to

4

spread rapidly over 2-3 weeks and then gradually decline over the following 46 weeks. A second wave may occur 6-9 months later. Up to 50% of the population may show clinical symptoms over the entire period of a pandemic, and up to 25% of these may develop complications. Up to 2.5% of those who become symptomatic may die. Up to 50% of the workforce may require time off at some stage over the entire period of the pandemic, with individuals likely to be absent for a period of seven to ten working days. Absenteeism should follow the pandemic profile, with an expectation that it will build to a peak lasting for two to three weeks, when between 15% and 20% of staff from the workforce may be absent, and then decline. Additional absences are likely to result from other illnesses, taking time off to provide care for dependants, family bereavement, other psychological impacts, fear of infection or practical difficulties in getting to work. Modelling suggests that small organisational units (with 5 to 15 staff members) or small teams within larger organisational units should allow for higher percentages of absenteeism – up to 30-35% over a two to three week period. Weekly excess demand for healthcare contacts in first wave of influenza pandemic within Central Lancashire PCT based upon a population of 460,000.*

Period

Cases In CLPCT

Cases for GP Practice of 7000 patients

Cases Per GP

Cases Per Large Pharmacy

Week 1 Week 2 Week 3 Week 4 Week 5 Week 6 Week 7 Week 8 Week 9 Week 10 Week 11 Week 12 Week 13 Week 14 Week 15 Total

150 230 932 3549 11995 24502 24053 16222 11040 8574 5946 2962 1783 978 748 113655

5 7 30 101 350 718 704 474 320 251 173 87 78 30 21 3347

2 2 7 25 87 179 177 120 81 64 44 23 18 7 7 844

7 7 35 129 432 886 869 587 398 311 214 108 64 35 28 4110

*Figures from BTS/HPA draft clinical guidelines for patients with an influenza like illness during an influenza pandemic http://www.dh.gov.uk/assetRoot/04/12/17/55/04121755.pdf

5

Key Planning Principles It is important that Central Lancashire PCT and its primary care contractors plan according to the same principles. Those that follow are consistent with the National Framework: •

Joint working and integrated planning between all key agencies

•

Flexible planning

•

Flexible thinking in bolstering local staff capacity

•

Building on normal delivery models (as far as possible)

•

Advising and enabling symptomatic influenza patients to remain at home

•

Rapid access to antiviral medicines

•

Reducing routine activities but continuing to make essential care available

•

Adopting measures that maintain public confidence and ‘feel fair’

Further information in these principles can be found in the Department of Health Document ‘Pandemic Influenza: Guidelines for primary care trusts and primary care professionals’.

Plan Activation and Alert Levels The World Health Organisation (WHO) monitors the prevalence of Influenza infections and its subtypes across the world. The emergence of a new strain with the potential for a pandemic will trigger an international alert. The UK has an internal alert system with the following levels of alert: Alert level 0 – no cases anywhere in the world. Alert level 1 – Cases only outside the UK Alert level 2 – New strain isolated in the UK Alert level 3 – Outbreaks(s) in the UK Alert level 4 – Widespread activities across the UK The local response within Central Lancashire PCT will be initiated by the Major Incident Management Team or at the discretion of the chief Executive when appropriate following monitoring of the UK alert level. 6

The alert will be raised to the PCT representative within the medicines management team who will then activate as requested the relevant parts of the plan.

Managing Demand Surge In a pandemic, more people will require care and treatment within primary care, some of whom would ‘normally’ be cared for in a hospital setting. This will be due to illness from the pandemic itself and because secondary care services are likely to become overwhelmed. In order to manage this surge in demand, primary care services will need to focus upon delivering care to those individuals who in greatest need of their services and who cannot be managed with alternative means. This will require a focus on delivering essential services and on mobilising staff within a locality (including those who are recently retired) to bolster frontline resources. Supporting the public to self-care, effective management of the flow of patients between primary and secondary care (including care and nursing homes), and interventions such as the National Flu Line service and information line will also be important in managing demand.

Identify Critical Functions and Responses It is necessary to identify the critical functions of the pharmacy network which must be delivered in the event of an influenza pandemic. This enables prioritisation of the networks functions, identification of critical supporting activities and the resources that are required to deliver them. The NHS community pharmacy contract which was agreed between the Pharmacy Services Negotiating Body (PSNC), the Department of Health (DH) and the NHS Confederation (NHS Employers) and began in April 2005, defines the functions provided by community pharmacies that are remunerated by the NHS. Anticipating a possible extended impact and recovery time critical functions have been defined on a basis of the frequency of provision, the result of function failure and function value in the case of an influenza pandemic.

7

Critical Functions The following as defined by the pharmacy contract, have been identified as critical functions within the pharmacy network with associated activities and resource: Function

Critical Supporting Activities

Resources

Dispensing

Safe Pharmacy Access Pharmacist Resource

Utilities

Repeat Dispensing

Safe Pharmacy Access Pharmacist Resource

Utilities

Support For Self-Care

Safe Pharmacy Access Pharmacist Resource

Utilities

Methadone and Buprenorphine Supervision

Safe Pharmacy Access Pharmacist Resource

Utilities

Minor Ailments

Safe Pharmacy Access Pharmacist Resource

Utilities

Emergency Hormonal Contraception

Safe Pharmacy Access Pharmacist Resource

Utilities

Continuation of Service A core plan has been created which enables the pharmacy network to respond to a wide range of possible scenarios, setting out the common elements of the response to any disruption. In practice the plan takes the form of a series of protocols and checklists (Appendices 1 to 5) that are to be followed in the event of an incident and clearly defines actions and responsibilities. To ensure continued provision of the critical functions the plan focuses on the need to maintain critical supporting activities and resources. In the case of all six critical functions these criteria are the same. Three key criteria have been identified and require a response in the event of an incident, in order to ensure continuation of service: •

Safe Pharmacy Access

•

Pharmacist Resource

•

Utilities

8

Influenza Pandemic Key Criteria In the specific case of an Influenza pandemic as far as it is possible to rationally anticipate the circumstances ‘Safe Pharmacy Access’ and ‘Utilities’ will not be directly affected. As the life of the pandemic progresses an indirect impact upon both of these criteria will become apparent to a greater or lesser extent. This will be due to the temporary depletion of the workforce from the UK infrastructure in both of these areas. As a result the initial impact of the pandemic will mainly be related to ‘Pharmacist Resource’ and additionally ‘Staff Resource’. The CLPCT Community Pharmacy Business Continuity Plan provides details of the PCT plan to maintain Pharmacist Resource and Staff resource, it also provides details of the PCT plan to respond to the indirect impact of a pandemic and its resulting effects on ‘Safe Pharmacy Access’ and ‘Utilities’.

Supporting self Care Self-care will be critical in ensuring an effective response to an influenza pandemic. It will play an important role in enabling members of the public to take steps to protect their own health and reduce the risk of their contracting the influenza virus from others and / or passing it on. It will also play a crucial role in supporting those who are symptomatic with influenza to care for themselves at home where they are able to do so. This is particularly important given that symptomatic patients will be asked to remain at home and, as a first step access antiviral medicines treatment via the National Flu Line service. By enabling those who are more able to self care to do so, this in turn will help to ensure that healthcare professionals are able to focus upon delivering care to those individuals in greatest need of their services.

Community Pharmacy: Key Roles and Services As general practices will need to focus on caring for those with more critical and urgent healthcare needs, it is likely that many patients who are not able to gain access to a GP (quickly) will turn to their community pharmacies for advice and care. Demand for information, prescribed and OTC medicines, and flu-related medicines and advice is likely to be high. As this could mean that community pharmacies become quickly overwhelmed, it will be important for them to have arrangements in place prior to a pandemic that allow them to focus on delivering critical functions. Assuming that stock availability can be maintained, pharmacists will be expected to ensure that patients continue as far as possible to have uninterrupted access to the medicines they need. Medicines will continue to be needed to maintain the health of patients with long-term conditions such as asthma, diabetes and hypertension, for example, as well as those who have illnesses that arise as a consequence of the pandemic. In addition, during a pandemic, community pharmacists and their staff will play a key role in

9

encouraging self-care so that people who are able to manage their own symptoms can do so safely and effectively without placing an extra burden on the healthcare system. In line with the planning principle of encouraging symptomatic patients to remain at home, community pharmacists will not wish to encourage symptomatic patients to attend community pharmacy premises where they could potentially infect other members of the public. Support to symptomatic patients will therefore largely need to be achieved by advising and/or supplying medicines to a representative of the patient or through leaflets or web-based information or over the telephone. As pharmacies are well placed to promote public health messages, a key role for community pharmacy is in supporting the public to prepare for an influenza pandemic. This includes informing and educating the public on how to protect themselves and others from contracting and spreading influenza, and on what preparations they can make now.

Support for Pharmacy Planning It is essential that all business’s in the UK are fully prepared and have in place robust business continuity and recovery plan to ensure that they can continue to provide the critical functions that they deliver. Not only does this ensure that a pharmacy can continue to meet the terms of its contract with the NHS, that its responsibility to the patient population it serves is met but it also ensures that the commercial interests of the business are protected. As a result it is imperative that all pharmacies within CLPCT have a plan in place. Support in writing this plan can be found at the following sites: www.pandemicflu.gov/plan/pdf/businesschecklist.pdf http://www.psnc.org.uk/publications_detail.php/218/flu_pandemic_continuity_planning

Leaflets and resources can also be found on The Department of Health website at www.dh.gov.uk/pandemicflu

10

Risks and Hazards The following risks to the implementation of this plan have been identified. Where possible a response has been defined to aid resolution should one or more of the risks become a reality. Risk

Response

PCT staff are unavailable or untrained to act as the PCT representative.

All relevant staff within the medicines management team will receive training following completion of the planning process facilitating maximum availability of staff to act as PCT representative.

Pharmacists are not aware of the plan and do not understand the process.

All pharmacists and pharmacies will receive full documentation and guidance regarding the plan. The LPC following training will asked to encourage pharmacists to gain a working understanding of the plan.

No rigid plan can anticipate all of the possible major incidents and develop responses to them.

The plan has been devised to provide a robust and flexible framework to adapt to the nature of an incident. To address this inevitable limitation a cognizant human element in the form of the PCT representative is essential.

Telecommunication pathways are compromised / unavailable thus preventing communication across the PCT.

Resolution will depend upon the available methods of communication at the time of the incident. Communication with the emergency services will define the most appropriate method. E.g. handheld transceiver, radio etc.

Appendices and Documentation All necessary protocols, action plans and documentation relevant to this plan can be found in the Community Pharmacy Business Continuity Plan.

11