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Oseltamivir
A patient group direction in London
From Mr J. Mason, MRPharmS, and Mr R. Radia, MRPharmS
We noted the article (PJ, 13 December 2003, p805) describing the development
of a patient group direction for oseltamivir (Tamiflu) by Roche.
In City and Hackney Teaching Primary Care Trust, the local pharmaceutical
committee and the PCT have jointly developed a PGD authorising suitably
trained community pharmacists to supply oseltamivir to at-risk patients
who either present with symptoms of influenza or who have been exposed
to somebody with suspected flu. The at-risk groups are those aged 65
years or older, or adults or children who have chronic respiratory disease
(including asthma and chronic obstructive pulmonary disease), have significant
cardiovascular disease (excludes people with hypertension only), have
chronic renal disease, are immunocompromised due to disease or treatment,
have diabetes mellitus, or live in a residential care establishment or
are otherwise housebound.
We chose oseltamivir rather than zanamivir, for several reasons:
• It is orally administered, so patients do not have to learn how to
use a new device
• It can be used in children
• It can be safely used in people with respiratory disorders
• It can be used during pregnancy and breast-feeding (although we have
specified these as exclusion criteria in our PGD)
• It can be used for both treatment and post-exposure prophylaxis
The scheme is designed to relieve pressure on GP practices should there
be a flu outbreak. The PGD will come into operation if and when the Health
Protection Agency’s Communicable Disease Surveillance Centre weekly
reports indicate that consultations for flu-like illness have exceeded
higher than normal seasonal activity levels.
All pharmacists in City and Hackney TPCT have been invited to participate
and those interested in taking part in the scheme will receive training
in the operation of the PGD.
The LPC and the TPCT are committed to increasing the contribution that
pharmacy can make to improving public health. This scheme will help to
increase awareness within the TPCT of community pharmacy’s valuable
public health role. This is also an example of how community pharmacy
can improve access for patients and deliver new and cost-effective services,
thereby helping the TPCT achieve its access targets.
In addition, by linking a new service development to training we are
helping to improve the knowledge base of community pharmacists, and assisting
in their continuing professional development.
Jonathan Mason
Head of Prescribing and Pharmacy
City and Hackney TPCT
Raj Radia
Committee Member, North East London Local Pharmaceutical Committee, and
Chairman, City and Hackney Community Pharmacy Forum
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