GPs privately urged to prescribe Tamiflu despite concerns

The chief executive of patient charity National Voices also raised concerns about a lack of transparency and patient involvement.

NHS England and Public Health England last week sent a joint letter, seen by HSJ, to all GPs in the Thames Valley area team region. It stresses the “expectation” that they would follow national guidance from PHE to prescribe Tamiflu as a preventative measure against influenza.

It follows a “steep rise in the number of cases of influenza” in recent weeks, according to the letter, including “outbreaks in residential homes that have resulted in hospital admissions and… the deaths of some patients”.

The letter, marked “strictly private and confidential”, calls for the “cooperation” of GPs in “protecting a particularly vulnerable patient group”.

It acknowledges the controversy surrounding the drug’s effectiveness, saying: “We are aware that differing interpretations of the evidence base are being put forward.”

A study by Cochrane Collaboration, published last April, questioned the efficacy of Tamiflu as a treatment for influenza. Researchers found that the drug reduced symptoms by between a day and half a day, but there was “no good evidence” to support claims that it reduces flu related hospital admissions or the complications of influenza.

However, the letter states: “GPs have a clinical responsibility for their patients and it is expected that they would make a decision to prescribe based on the needs of their patient and guidance from national bodies.”

It adds there is an “expectation” on doctors to “respond to an organisation advising on public health”.

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The letter follows “recent email exchanges” between the two national organisations and Thames Valley local medical committee, which represents GPs.

Jeremy Taylor, chief executive of National Voices, told HSJ: “It concerns me that letters of this nature are going to GPs on a private and confidential basis to urge compliance for guidance which is in itself quite controversial.

“That doesn’t seem to be consistent with the principles of transparency, or consistent with the principles of shared decision making between clinicians and patients.”

Paul Cosford, PHE’s director of health protection and medical director, said its “current published guidance is based on a thorough review of the evidence available and recommends the use of antivirals in care homes for post-exposure prophylaxis when outbreaks of flu are occurring”.

He said PHE was particularly concerned that some prescribers might have the impression that “the use of antivirals is never appropriate” and it was working “to ensure that GPs are aware of, and can follow, national guidance on appropriate antiviral use”.  

An NHS England spokeswoman said the letter was in line with PHE and National Institute for Health and Care guidance.