Flu drug available on NHS

Some patients will have access to Relenza this winter

The controversial flu drug Relenza will be available on the NHS this winter.

Doctors' leaders are worried that the move could lead to GPs being inundated with extra work at a time when they say they are already stretched.

However, ministers have issued guidance designed to minimise the potential impact on GPs.

The National Institute of Clinical Excellence (NICE) has confirmed that the drug should be made available to the following groups:

• the over-65s
• people with chronic respiratory diseases who need regular medication
• people with a lowered resistance to infection
• people with heart disease
• diabetics

The introduction of a new therapy is unacceptable without extra resources

Professor Mike Pringle, Royal College of General Practitioners

NICE estimates that nearly 500,000 people could now be prescribed Relenza at a cost of £11.7m to the NHS.

However, as part of its guidance, NICE said immunisation must remain a first line of defence against flu and Relenza should only be prescribed when levels of the virus circulating in the community reach a certain threshold.

NICE refused to allow GPs to prescribe the £24-a-course flu treatment last year, saying the manufacturer, Glaxo Wellcome, had not proved its effectiveness in high risk groups.

However, Andrew Dillon, NICE chief executive, said on Tuesday: "When we reviewed zanamivir (Relenza's clinical name) last year the data did not show that this product would significantly support the NHS's management of patients with flu.

"New evidence submitted by Glaxo Wellcome (Relenza's makers) for this appraisal demonstrates benefits in using this product for people at risk of serious complications of flu."

Governmment response

John Denham welcomed the decision

Health Minister John Denham welcomed NICE's decision and announced that guidelines designed to minimise the impact on workload for GPs.

The guidelines suggest that the drug should be issued directly by pharmacists and nurses, and that prescriptions for the drug could be issued following a telephone consultation with a nurse, rather than a face-to-face consultation with a doctor.

NHS walk-in-centres may also be able to dispense the inhaler.

Dr John Chisholm, chairman of the British Medical Association's GP Committee, said it was vital that arrangements were put in place to help GPs as soon as possible.

He told the BBC: "We are very fearful that, even with the drug just being available to high-risk individuals, that will place enormous additional demands on general practices and primary care during any epidemic."

He said one calculation had suggested that during a flu outbreak, GPs might have to deal with an extra 75 consultations a week.

That view was echoed by the Royal College of General Practitioners, which expressed "severe concern and disappointment" that NICE had not taken into consideration the effect on the GP workforce in coming to its decision.

Dr John Chisholm said GPs were fearful of demand

Professor Mike Pringle, RCGP chairman, said: "We recognise that Relenza has the potential to effectively treat flu symptoms and we welcome its availability for high-risk patients.

"However, at a time when GPs are being stretched to their limit, the introduction of a new therapy that may involve many hundreds of urgent consultations for each GP, many in the patient's home, is unacceptable without discussion and extra resources."

Inhaler

Relenza is administered through an inhaler and has to be taken within the first 48 hours of flu symptoms developing in order to be effective.

It can reduce both the severity of flu symptoms and the length of time they last.

Mike Stone, of the Patients' Association, said the decision to make Relenza available was particularly welcome given that there had been problems in supplying GP surgeries with flu vaccine this autumn.

He said: "It may be argued that Relenza has come about at the right time because there are a number of people out there who are going to get the flu because they have not had their jabs."

Nikki Hill, of the charity Help The Aged, said Relenza could help ease the strain on the NHS by keeping some elderly people out of hospital.

She said the charity was also confident that concerns over adverse reactions to Relenza had been fully probed by NICE.

"There were worries that it sometimes made breathing more difficult but we will be guided on that by the medical profession."

Chronic disease

Dr John Harvey of the British Thoracic Society said: "The availability of Relenza on the NHS spells good news for those with chronic lung disease.

"Flu can mean more than just a week off work for this group - it can be a killer.

"It is important to stress, however, that prevention is better than cure and people with lung disorders must seriously consider having a jab to increase their protection against flu."

NICE had also been expected to rule on availability of a second flu drug, Tamiflu, but the manufacturer, Roche, has not been granted a licence to make it available in the UK.

Meanwhile, the Public Health Laboratory Service reports that flu levels remain relatively low, with one death attributed to the virus so far this season.

The first confirmed isolate of flu virus this winter - a type A strain - has been in a child hospitalised in the north of England.