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ICGP Winter Meeting

HPV uptake fallen to 50% and lower 

The current uptake rate for HPV vaccination in Ireland could be as low as 50 per cent or even lower in some areas, the ICGP’s Annual Winter Meeting heard. The timing of the vaccine, among other options,  is now being looked at to help reverse the downward trend, GPs were told.

Dr Brenda Corcoran, Consultant in Public Health Medicine with the HSE National Immunisation Office (NIO), and Dr Elyce McGovern, Specialist Registrar in Public Health Medicine, presented a well-attended talk on the HPV vaccine, where they raised their concerns over the declining rates of uptake.

“Initially we had a very successful programme,” said Dr McGovern.

“The highest uptake was achieved in the 2014/2015 cohort, which had an 87 per cent uptake rate. We also had very good retention. Of girls who accepted dose one of HPV, 97 per cent completed dose two; excellent compared to other international figures.”

However, during 2015/2016, around 5,000 girls declined to be vaccinated and uptake fell from 87 per cent to 70 per cent.

“Today, this year, we estimate it’s 50 per cent or less in some areas. So, obviously, we’re extremely concerned,” she explained. The increase in vaccine hesitance may also be affecting other vaccinations.

“What we have seen unfortunately is a little spill-over in terms of concerns about the HPV vaccine into some of the other vaccines, such as the Tdap and Men C, that are given at the same time in the schools programme.”

Despite the evidence showing the vaccine to be safe, stories about young girls allegedly suffering debilitating side effects were eagerly reported by the press, said Dr McGovern. At times the interactions between those supporting the vaccine and those opposed have also been fraught both on social media and at public meetings, she added.

Outlining the facts, she said that since the vaccine was rolled out in 2010 there have been 1,072 adverse events reports to the Health Products Regulatory Authority (HPRA). However, nearly all of these are expected side effects and less than 30 related to chronic fatigue type side effects, she said.

In Ireland it is estimated that the prevalence of chronic fatigue rates range from 0.2 to 0.4 per cent.

“So, in the population of girls that have been vaccinated so far, which is 220,000, we’d expect 440-880 to suffer from chronic fatigue. Less than 30 have been reported. That is much, much less than expected.”

Dr McGovern said that healthcare professionals have to be consistent in the message that the vaccine is safe, adding that the NIO is working on a timeline of evidence demonstrating the vaccine’s safety and hopes to have that online as soon as possible.

She said that changing the timing of the vaccine is also being considered, though studies have shown that it is most effective in girls aged 12-13 years, where an almost two-to-threefold increase in antibody response was observed.

Dr Corcoran said that anti-vaccination feeling comes in waves, but that social media had allowed information and misinformation to be disseminated faster than before.

“We have been here before. It’s taken us 16 years but we’re still not up to 95 per cent with our MMR.”

She warned that it may take longer to get HPV uptake rates back up and that this “will have a more lasting, devastating effect, as you don’t see the cancer immediately”.

To address this, a number of bodies, including the Irish Cancer Society, NIO, the HSE communications department, and the National Screening Programme, “came together to try and reverse the tide”, said Dr McGovern.

A three-pronged approach was agreed, which would see increased and strengthened information materials, a bolstered media campaign, and a series of public meetings. Meetings were also arranged with the political parties’ health spokespeople.

However, the trust the public has in GPs and other healthcare professionals is key to helping people make positive decisions about vaccination, both doctors said.

They also suggested making non-vaccination an ‘action’. “Make it very clear to them that they are making the decision,” said Dr McGovern, “that they are actively denying the vaccination”.

GPs cannot deliver on quality and standards unless resourced – Gillman

The HSE cannot demand GPs deliver on quality and standards unless they are resourced adequately to do so, the Chair of the ICGP Board told the College’s Winter Meeting. Dr John Gillman said that Irish GPs need to follow their UK counterparts’ lead and lobby for significant additional resources for general practice.

The elephant in the room, he told the audience, is lack of resources.

“We need to be thinking along the same lines as our colleagues in the UK – 3.1 per cent of the [health services’] resources is not acceptable. We need to be looking for 11 per cent of the health budget and we will deliver for our citizens,” he said

“If anyone says to me FEMPI is a fait accompli, I say ‘no’ I want it unwound, I want it reversed. Our patients, our practices, our communities have already paid a heavy enough price and we are not going away.”

As doctors rooted in the community, GPs are true advocates for their patients. “We have to deliver, we cannot afford not to,” Dr Gillman added.

“We should not sell down the College or sell down general practice. We’re not ‘just GPs’, we are the cornerstone of the health system. We’re the foundation; we are what makes everything tick.”

“We have shown endurance, resilience, and we are unbroken,” he added.

He acknowledged that after eight or nine years of savage cuts induced by the recession to pay for the failings of financial governance, the health system has been decimated.

“It is left to the GPs to advocate for our patients and deliver a quality service. We cannot expect people to deliver a service unless they are adequately resourced.”

Describing himself as a village doctor, Dr Gillman told his colleagues that he is here to listen “and we are here to represent you”.

“The College is a living organism and you are the central focus of it and we can achieve nothing without your support, voice or input…. We have to do the heavy lifting and that will only work if we work as a unified group.”

He emphasised that while the ICGP advises the Government on relevant matters, it is not a trade union.

“Our unions have their areas of expertise. We will support our unions in whatever capacity they ask us to support.”

Over 200 GPs attended the ICGP 2016 Winter Meeting, which took place in the Sheraton Hotel, Athlone, on Saturday, 19 November.

New nursing home group formed at Winter Meeting

GPs involved in nursing homes and long-stay residential care formed a new group at the ICGP Winter Meeting in Athlone. The group has three sub-groups and Dr Brian Meade is overall Chair of the group’s governing committee for the next year.

“We formed a nursing home group for GPs within the IGCP, which will support the educational and training needs of GPs who work in nursing homes. A lot of GPs are finding this work challenging. Their workload has gone up, especially with HIQA. There’s a lot more paper work,” explained Dr Meade. Payments have also reduced as a result of FEMPI.

“The challenges facing GPs in nursing homes aren’t necessarily the same issues that crop up in a community. We’re dealing with sicker patients and we’re having to make decisions about end-of-life, legal issues, and prescribing.”

The sub-groups will be looking at training, engagement and advocacy, and the development of standards. It is hoped that the first group will design training programmes for GPs who wish to work in nursing homes, while the standards group will establish a national approach to, for example, medication reviews, antibiotic prescribing, and antipsychotic prescribing.

The advocacy group will engage with other stakeholders, such as HIQA, the HSE, Department of Health, patient groups, and nursing home owners as well.

“We feel we have to talk to them about our issues.”

He added that doctors are leaving nursing home work due to the challenges being faced. One possible improvement, he suggested, would be to have a dedicated nursing home session once or twice a week.

It is hoped that the new group will have a webpage on the College’s website soon and anyone interested in the group can contact the ICGP for further details.

Pharma not ‘around the table’ on College’s education policy, says ICGP

Thepharmaceutical industry does not influence educational policy at the ICGP, the College’s Winter Meeting in Athlone heard.

Mr Nick Fenlon, ICGP Director of Education, made the comment as he discussed recent developments in education and e-learning at the College.

While thanking pharmaceutical companies for sponsoring educational modules and the meeting itself, he stressed: “Without such sponsorship this meeting and our modules would not be able to happen. Having said that, I want to assure all of you that the pharmaceutical companies involved in sponsoring are literally sponsoring the production costs of our modules.

“They are never around the table for content development on any of our modules. The content development is exclusively the remit of the ICGP and the content experts working on behalf of ICGP.”

The College has developed a number of new e-learning modules. These include a new module, in conjunction with the HSE National Immunisation Office, on the HPV vaccination due to the fall in the vaccine’s uptake. It will provide GPs and practice nurses with up-to-date, accurate and evidence-based information, to inform parents about the safety and efficacy of the vaccine.

Mr Fenlon also provided details on another module on infection prevention and control (IPC), which has been designed to help practice nurses and GPs plan and implement IPC policies in their practices in line with the current guidelines for best practice. Issues covered in this practical module include transmission-based precautions, staff immunisation, and management of needle stick injuries.

“We have a number of other modules on the way, either imminently or in the next six weeks,” Mr Fenlon added. “The first one is the new primary childhood immunisation schedule and that is being added to the existing e-learning module.”

A long-acting reversible contraception (LARC) module will also be rolled out before Christmas, which is separate from the LARC insertion training programme provided by the College.

Other modules on medical records and risk management are also forthcoming. Mr Fenlon also drew attention to the recently launched sign language interpreter service.

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