Resource prioritisation in flu pandemic

How should doctors prioritise vaccinations among vulnerable patient groups should demand outstrip supply?

MDDUS has received a number of calls in recent days in regard to patient prioritisation with the limited supplies of H1N1 flu vaccine. Doctors are asking how best to prioritise vaccinations among vulnerable patient groups should demand outstrip supply.

In response to such concerns the GMC has recently updated its guidance for doctors working in a pandemic. Good Medical Practice, responsibilities of doctors in a national pandemic,which outlines the standards of practice expected of doctors if their work is affected by a pandemic.

In regard to the specific question of allocation of resources – under which the provision of vaccination might apply – the guidance states: “It will be particularly important to ensure that decisions you make in relation to provision of care are fair and based on clinical need and the patient’s capacity to benefit, and not simply on grounds of age, race, social status or other factors which may introduce discriminatory access to care.”

The GMC acknowledges that a pandemic can create a situation in which doctors will be faced with difficult decisions in relation to both workload and limited resources.

The new guidance states: “Doctors need to feel confident that they will not be subject to unreasonable criticism by the GMC, or have their registration removed or restricted, because of the difficult decisions they are forced to make, or the standards of care they are able to provide during a pandemic.”

“In considering any complaint made about a doctor working during a pandemic, the GMC will take into account the resources available to the doctor, the problems of working in unfamiliar areas of practice and the stress and tiredness that may affect judgment or behaviour.”

The guidance stresses what is important is that doctors behave responsibly and reasonably in these circumstances and are able to explain their decisions if called on to do so.

Action: ensure that the allocation of resources in relation to H1N1, including vaccinations, is based on clinical need and the patient’s capacity to benefit. Ensure that you are able to justify such decisions.