The swine flu lines are manned by people who have no medical training and who are following algorithms to inform them whether, on the basis of the set of symptoms the caller has described, they should be prescribed an anti viral. The distribution centres for those antivirals are the responsibility of the PCTs in England and because they are health care organisations, which contain clinical staff, those clinical staff have had to take part in the process.

I have now carried out 2 shifts at the distribution centre, and will fulfil another tomorrow. The end of July and August are quiet months in the world of maternity and children’s commissioning, so I have volunteered myself where I can. My experience so far tells me that anyone with a slight sniffle, or a bit of a sore throat (or even someone planning to get a sniffle soon) can obtain the code number that will enable them to go to a collection point and collect a 5 day course of Tamiflu. Having said that, most of the people who are having anitvirals collected on their behalf have some kind of viral illness, many of them probably do not have any kind of flu however.

The doctor husband of a colleague asked why we need to provide nurses to run such as service, but in my opinion this is a governance issue. We are a health care organisation. We have pharmacists working for us, therefore they must be in charge of the medicines management, we have nurses and they should be in charge of explaining dosage and generally checking out symptom management and some general health advice and we have admin staff who can type details into computers and check identification. The local council, in whose offices the centres are based, provide front desk people who bring the flu friends into the consultation room and they have security guards to prevent trouble (do people want to steal the stuff?) including infiltration by people with actual flu.

I am not sure that the whole process has been managed in the best way. After all the prescribing is being done by those with the least actual knowledge and the dispensing by those with most. I am sure too that there will be some kind of postmortem afterwards. How many people who get the tablets actually take them? How many people who do take them have any kind of virus? How many people will be sick after the first dose and take no more? Why do people think they are getting an antibiotic, and knowing what we do about healthcare acquired infection, why do they think this would be a good thing to take?

There are more questions than answers, it is a process costing millions of pounds and for us it is fraught with governance issues (like health and safety but only more so!)