General Practice

General Practice

Influenza

Influenza, or "flu", affects significant numbers of people of all ages, particularly in winter. It is an infection of the respiratory tract caused by the influenza virus. Influenza tends to cause a more severe illness than most other viral respiratory infections, such as the common cold. Typical symptoms include fever, cough, sore throat, runny or stuffy nose, headache, muscle aches and extreme fatigue. Although nausea, vomiting and diarrhoea can sometimes accompany influenza, especially in children, these symptoms are not often the main ones.

Most people who get influenza recover completely in 1 to 2 weeks, but a few develop serious and potentially life-threatening medical complications, such as pneumonia. Influenza-related complications can occur at any age; however, the elderly, the very young and people with chronic health problems are more likely to develop serious complications. More information on influenza can be found on the NHS Choices website.

Many people will not contact their GP when they have influenza. However, people with long-term conditions, people over 65 and pregnant women are recommended to get a flu vaccination and to seek advice when they have flu-like symptoms. Practice Team Information (PTI) can provide estimates of the number of consultations and number of patients consulting a GP or practice-employed nurse for influenza in Scotland.

In Scotland the routine monitoring of influenza is carried out by Health Protection Scotland (HPS). HPS operates SISRS (Scottish Influenza Surveillance Reporting Scheme), a surveillance system that was devised to provide more comprehensive surveillance during the influenza pandemic in 2009/10. It includes aggregated data extracted daily from almost all GP practices in Scotland giving excellent geographical coverage of surveillance of GP consultations. It gives a more complete and timely picture of changes within individual NHS boards compared to earlier schemes and provides an early warning signal if consultations are increasing in their areas. It was rolled out over a period of a few months and has since become one of the cornerstones of flu monitoring.

HPS collects information from numerous other sources and regularly produces status reports; for the 2013/14 season there are monthly detailed reports with weekly bulletin-style updates in the weeks in between. The reports contain summary epidemiological information on influenza-like illness (ILI), its severity and impact in the community and secondary care settings and also estimates of vaccine uptake. The reports can be found at the HPS website.

Number of patients consulting

The figure below shows the estimated number of patients in Scotland (per 1,000 patients registered with a practice) who consulted either a GP or practice-employed nurse for influenza at least once in the year ending 31 March 2013, by gender and age group, based on PTI data. Note that patients consulting only for flu vaccinations are not included. These figures and comparable figures for 2003/04 to 2011/12 are provided in an Excel file (see link at the bottom of this page), which also contains 95% confidence intervals for all estimates. In all age categories the rate of patients consulting for influenza was higher in females than in males, except amongst children aged 14 and under. Rates were highest in working-aged adults. The confidence intervals for influenza estimates are relatively small compared to some other conditions, which indicates the greater precision of the estimates. The Excel table shows a total estimate of around 32,000 patients seen for influenza in the financial year 2012/13, with a 95% confidence interval of 26,000 to 38,000 patients.

Influenza¹ - estimated number of patients in Scotland consulting a GP or practice nurse at least once in the financial year 2012/13² per 1,000 patients registered³; by gender and age group
Histogram showing estimated number of patients consulting for Influenza in 2011/12 by age group and gender. Figures were generally higher in females than in males and particularly high in young to middle-aged adults. Highest rates were seen in females aged 25-34 and 45-54 at around 5 per 1,000 registered patients.

¹ Based on ISD's Read Code Grouping (RCG) 'Influenza'.
² Based on 60 PTI practices that submitted complete GP and practice nurse data for the year ending 31 March 2013. Figures are standardised to the Scottish population by deprivation.
For further information see the Statistical Notes.
³ Population source: Community Health Index (CHI) record, as at 30 September 2012.

Number of consultations

The figure below shows the estimated numbers of consultations in Scotland for influenza (excluding flu vaccination) for the ten financial years 2003/04 to 2012/13, by staff discipline. The underlying figures are provided in an Excel file (see link at the bottom of this page) in the sheet “consultations_gppn”, which also contains 95% confidence intervals for all estimates.

The chart shows that nearly all of the consultations for influenza were with a GP. The number of GP contacts for influenza has been fairly stable over the years 2003/04 to 2008/09 but there was a large rise in 2009/10. This was the year of the pandemic flu outbreak (due to the H1N1 strain of influenza) causing an enormous increase in numbers of contacts for influenza. In the most recent year (2012/13) the number of flu contacts appears to have shown a slight increase on 2011/12 levels.

Influenza¹ - estimated number of consultations with a GP or practice-employed nurse in Scotland in the financial years 2003/04 to 2012/13²; by staff discipline³

¹ Based on ISD's Read Code Grouping (RCG) 'Influenza'.
² Based on 59, 53, 51, 49, 48, 58, 60, 59, 59 and 60 PTI practices that submitted complete GP and practice nurse data for the years ending 31 March 2004 to 2013, respectively, and 46, 44 and 44 practices submitting complete district nurse and health visitor data for the years ending 31 March 2004, 2005 and 2006, respectively. Figures are standardised to the Scottish population by age, gender, and deprivation. Population source: Community Health Index (CHI) record, as at 30 September 2003, 2004, 2005, 2006, 2007, 2008, 2009, 2010, 2011 and 2012 respectively. For further information see the Statistical Notes.
³ Health visitor and district nurse data are not available from the financial year 2006/07 onwards.

As mentioned, these figures do not include the large numbers of consultations for flu vaccinations. Each year patients regarded at higher risk of developing serious complications following influenza infection are invited to receive a vaccination. In advance of the flu season, Scotland's Chief Medical, Nursing and Pharmaceutical Officers send a letter to all NHS Scotland organisations involved in the seasonal flu vaccination campaign with detailed information regarding the vaccination policy for the coming season. These letters are available from the CMO section of the Scottish Government website; for example for letter for the 2013/14 season can be found here. The HPS reports include up-to-date information on vaccination uptake during the season.

Health Conditions

Influenza

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