Dr Tony Copperfield on the impact of the largely media-driven panic around the Strep A outbreak
So, obviously, condolences to those who’ve been affected by the strep outbreak. But that goes not only to the individuals, but also to the NHS itself. Because the knock-on effect of this latest panic will include, off the top of my head:
- Delays in assessment and treatment of patient significantly ill with non-strep pathology because of the worried well/mildly ill taking the current guidance and running with it, as in running with it directly to our practices and A&Es which are now too overwhelmed to cope;
- Those few with actual iGAS suffering similar delay (with added irony) because of point 1 above;
- Shortages of commonly used antibiotics;
- An epidemic of spurious penicillin allergy caused by the new ‘low prescribing threshold’ meaning viral rashes are misinterpreted as antibiotic allergy after unnecessary prescription;
- Another epidemic of rash caused by amoxicillin inappropriately given for glandular fever misdiagnosed as strep infection;
- Worsening shortage of the antibiotic shortage mentioned in point 3 as antibiotics are unnecessarily given/re-prescribed when the rashes described in points 4 and 5 are mistaken for the rash of scarlet fever;
- A spike in C diff cases caused by the new all-u-can eat antibiotic prescribing policy;
- The complete undermining of patient and parent education about the management of minor illness and judicious use of antibiotics which has taken years to achieve, a few headlines to unravel and will last Gawd knows how long.
The things screamingly lacking here, apart from amoxicillin suspension, is a sense of perspective and pragmatism. Scarlet fever may be four times as common as usual, but it’s still essentially tonsillitis plus a rash; and while iGAS is horrible, it’s only around twice as common as normal – and when a very rare incidence is doubled, it’s still very rare.
I don’t blame patients or parents for currently reacting like every RTI is an RTA – they’re just reacting proportionately to a disproportionate panic. But I do question the messenger and the message. I don’t know whether to blame the UKHSA for saying anything at all, or for saying it the wrong way, or the media for doing what we know they’ll do with that sort of information. But ultimately, when the panic created causes far more havoc than the issue itself, something is clearly wrong with that chain of communication.
In the meantime, I’m putting a trough of whatever antibiotic the pharmacist can provide in the waiting room. Patients can help themselves. Literally.
Dr Copperfield is a GP in Essex. Read more of his blogs here
Love these witty articles …
a simple reminder to HCPs would probably have been better in hindsight
RTIs as RTAs, that’s great. The football and some prosecco will distract nanny short term memory, don’t worry.
This is so true and insightful and can only be noticed by front line GPs who have spent time in a practice for many years and who have been trying to train their patients to self manage self limiting illnesses to the long term benefit of the NHS. This has set all this back perhaps forever and I honestly think will collapse services over the Xmas Bank Holiday.
Our clinical team have lost huge swathes of time we should be spending on important health issues to managing URTIs. As the expectation is now antibiotics there is very little opportunity for pharmacy diversion and you can no longer tell the difference between primary care and A and E minors which further eroded our long term argument that GPs need to be specially trained and offer continuity.
The state of primary care breaks my heart as I have spent 20 years trying to build a service I am proud of
and this week it felt broken for ever.
Well written and witty as usual. If only the government or the daily wail has this much sense. Mass hysteria now. Good luck to anyone with pneumonia or real invasive Strep disease as the worried well flood and deplete the system. Well done daily wail for crippling the country.
They scared the society with covid. Now the society panics about ‘a new virus’.
Media to blame.
And pharmaceutical suppliers profiteering with the price of these antibiotics
We all agree that this situation is awful. Awful for GPs and our staff, awful for the wider NHS generally and pretty grim for patients as well. But, in part this is made by ‘the system’. A media that loves over dramatic headlines, risk averse medical institutions, messaging that the backstop is always ‘ see your GP just in case’. But lets not waste a crisis. So much of this Strep crisis is symptomatic of all the ills of the wider NHS. Primary care capacity, primary care open ended contract, bonkers media messaging, concerns about litigation, supply chain issues, this list is huge. Surely we need to set up a root cause analysis and learn something? LMC/ BMA etc slightly hopeless. Surely some sort of review? Call the press to account? Call the UKHSA to account?: Dr Colin Brown, Deputy Director, UKHSA, saying to contact “NHS.UK, contact 111 online or your GP surgery if your child has symptoms of this infection so they can be assessed for treatment” All madness. But we must learn and every bit of this jigsaw must be called to take some responsibility. We would have to learn if it was a complaint about our care. Not fight among ourselves with bits of the NHS blaming each other. Or next week, next month, next year it will be something else. And each time a bit of the NHS will be destroyed, broken, never to recover.
Dear Tony,
Having retired, and being told that the ceiling won’t paint itself, I cleared out my “library” to avoid dobs of white splashing on my precious tomes, three slim volumes of which are The Copperfield Collection Parts 1-3, starting on 28th Jan 1993, almost 30 years to the day.Your articles are as readable and relevant then as now, but Tony :30 years? How old are you?? Do you actually exist, or are you merely a hologram at the Editor’s disposal? Your readers have a right to be told!
Best Wishes,
Robin Jackson