Dr Jeremy Carter, Pulse PCN editorial board member and clinical director of Herne Bay PCN in Kent, shares his experience of the recent meningitis outbreak
The recent meningitis cluster in the Canterbury region of Kent has been a salient reminder of the adaptability, resilience, and importance of strong general practice, and primary care networks (PCNs).
As news broke on Sunday 15 March that there was a large cluster of cases of meningitis, general practice had both official sources of information as well as that of the public media. What was evident was this was a large cluster, atypical to previous meningitis cases. The initial reporting in the media linked this to an event, or party, but did not specify when or where this event may have taken place.
While initial reporting suggested this mainly centered at the University of Kent, it also became known soon after that sadly one of the fatalities was in fact from a local secondary school; subsequently a number of pupils from various secondary schools across the area were known to be affected.
This set the scene for a very challenging few days for local GP surgeries and PCN's, evoking memories of our Covid response not long ago. Activity levels were certainly the highest seen in recent memory. From the surgery opening on Monday morning, we faced a surge of contacts, both in person and remotely via telephone or online consultation. At the same time the management teams were working hard to outline procedures and ensuring all staff knew how to respond.
As a PCN, we unfortunately did have a small number of affected cases hospitalised with meningitis, or suspected meningococcal disease, but the overwhelming majority were from patients either with very low risk of having had exposure, or indeed no risk.
Enquiries ranged from understanding vaccine history, even before the pathogen was identified, rendering this enquiry of little value in context of the outbreak, to those believing they may have been contacts - sometimes rather tenuously.
We also had enquiries for third parties, not our patients, particularly those who had relatives in universities elsewhere.
Initially there was only a rumour of when or where the contact event occurred which resulted in patients perhaps being unnecessarily concerned and it also made it more challenging for us to counsel patients about possible risk.
As was the case in Covid, reliable trusted information was the key to ensuring patients understood the situation and any risk to them. As a PCN we had developed a social media profile in Covid to pass on clear information, and we replicated this again through the week, updating our patients on the transmission and risk, and how to access help if needed.
A robust system wide response was implemented, largely centered away from practices, with an intention to avoid overwhelming general practice, but our experience was that many people still chose to contact us as their trusted source of information.
As a team, as in Covid, this meant a rapid dissemination and understanding of a significant volume of new information, and new pathways, with not only clinicians having to understand the new information, but crucially our reception team and care navigators, who took the majority of the increased workload.
As would be expected in any rapidly evolving situation there was a continual update and change in information and procedures. Ensuring this was understood and communicated clearly was imperative.
As a PCN Board, we kept information flowing within the practices and across the PCN. Thankfully, even though there was the added challenge of yet another partial IT failure on the Monday morning, practices were able to maintain business as usual, but the PCN was ready to provide support across the network as needed, for example by redeploying ARRS staff.
As a clinical director, it was very helpful to be linked into our local communication networks, and there was a regular source of updates via meetings, often held more than daily.
While perhaps too soon even now to be thinking about lessons learned, what was evident from the initial surge in activity we faced was the importance of clear communication. Most notably for an outbreak knowing any potential risk source event details as early as possible is crucial.
The other notable point, although one we had no doubts about prior to this, was the effectiveness of general practice and PCN's to respond to the unexpected, and the importance and value patients place in having a trusted and well-functioning general practice, who they can turn to in a crisis.