There is a general theme here, in that there are quite a few things cropping
up where the NHS line (often hiding behind the NICE official line)
recommends something which lags behind what I would call the "what would you
recommend for your family" test.
A few off the top of my head, recommended lipid targets, dementia drugs,
some whole screening programmes (how long have we known the good evidence
for Ca bowel screening whilst waiting for the NHS to get a programme?)
The Gardasil/cervarix choice (along with the arbitrary age thresholds) are
simply more of the same.
It is clearly legal, and to an extent proper, that the NHS can set out what
treatments and interventions it is prepared to pay for. However, those will
not always be what doctors would consider the gold standard.
I presume that if the NHS chooses not to vaccinate 26 year olds with HPV
vac, then working as an NHS doctor I should follow that policy and cannot be
required to do so.
I have always presumed (? right) that the way to address this was to explain
to patients what the NHS offering was, but also highlight where I felt this
failed the "my family" test.
It is then up to them to decide what treatment they want/can afford, but if
they want something different to the NHS offering they will need to get it
privately.
-----Original Message-----
From: GP-UK [mailto:[log in to unmask]] On Behalf Of Cherry Cullen
Sent: 04 November 2008 08:48
To: [log in to unmask]
Subject: Re: Gardasil & Cervarix
I have been on the local training course and tried to work out how why where
what when. I have a form and email address to order vaccine - have done so,
no vaccine has arrived. I have a form to fill in to claim and the form we
usually fill in for the Child Health Computer (FP43 is it?) for once the
updated form was sent electronically so its set up as a mergeable document
in EMIS.
I have a folder in which I am keeping the names of the girls who have missed
the programme at school and been told to come to general practice. Once I
get vaccine we can call them in.
We have already vaccinated our daughters with Gardasil, just prescribing it
and there has been no objection from PPA. It is a muddle, vaccines are
always a muddle. Those of us "at the sharp end" are the last to find out
what is going on. I emailed anyone and everyone involved to ask for
clarification and I have to say, everyone seems muddled.
The rationale given for using cervarix rather than gardasil is that the
extra viral protection of gardasil is against genital warts and this
immunisation programme is to prevent cervical cancer not genital warts!
Seems short sighted.
Cherry
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