Richard Smith: Will the NHS let me die of malaria?

Richard Smith
I’m about to spend two weeks in Nigeria and need antimalarial tablets, but it seems that the NHS cannot help me. If I come back with malaria, no doubt it will help me – with two weeks in intensive care and a post mortem if necessary.

It’s Monday morning, and I’m going on Saturday. I should have thought of it sooner, but I’m “only human.”

I start by ringing my GP. The receptionist tells me that I needed to have come six weeks in advance. Can I just see a GP? She says that’s not possible: I have to go the travel clinic, which happens once a week and isn’t happening this week anyway because the nurse is on holiday.

She tells me to go to another local clinic, which she describes as “walk in,” or a true walk-in clinic.

I decide to ring first. I Google the local clinic, ring the number, and discover to my surprise that I’m talking to a university department. The person on the other end says “this happens all the time,” and we discuss how it is happening.

After Googling again, I ring another number. The (small) centre actually has three practices, none of which seems to know a thing about the others. The first clinic tells me that they don’t have a clinic but one of the others might. They don’t.

I then guess that the receptionist at my practice confused two local clinics with similar names. I ring the other clinic, a more modern one, where they have nine choices of numbers to press once I get through. None is a travel clinic, so I try making an appointment. They don’t have a travel clinic and can’t help me.

Next I try the true walk-in clinic, which takes a long time to answer the phone. No, they don’t prescribe antimalarials.

At this point I give up and ask a GP friend to prescribe me antimalarials. Not everybody has this option.

Richard Smith was the editor of the BMJ until 2004 and is director of the United Health Group’s chronic disease initiative.

  • Simongdavis66

    could you have got away with chloroquine and proguanil? I usually prescribe the tablets over the phone. I hope you don't need anything in addition to antimalarials

  • Petermbenglish

    I thought you could buy anti-materials OTC at a pharmacy?

  • Mike Ingram Radlett

    I do sympathise but running a practice with a high travel workload we do our best to cater for last minute travellers. Nursing time is precious but we do our very best. Very very few PCTs allow NHS scripts for malaria prophylaxis and the regs allow GPs to charge for prescribing or supplying. In fact on an international basis UK is about the only country that gives some ( the majority of common) travel vaccs free on the NHS.

  • Lynn Eaton

    Hi Richard – hope they're not giving you Lariam! Try Doxy instead – it's much better for stomach bugs too.

  • Michaelash

    If it had not been rendered illegal by the recent THMPD laws you could have collected some artemisinim and used it as do millions as a prophylactic.

  • Paddy

    I wonder if it might actually save lives if two or three of the safest prophylactic anti-malarials could be dispensed by pharmacists to travellers without a prescription.  Although keeping pharmacists up to date on resistance (which drugs work in which locations) could be tricky, never mind the risks of screw-up (e.g. giving doxy to someone pregnant), it might cut down on the 1500 or so cases of imported malaria seen each year in the UK.

  • Azeem Majeed

    Drugs for the prophylaxis of malaria are not prescribable on a FP10 (the prescription form used by GPs to prescribe NHS drugs). The relevant NHS regulations are laid out in “DH (1995) Malaria prophylaxis regulation permitting GPs to charge for prescribing or providing anti-malarial drugs. London: Department of Health”. The DH guidance states that private prescription forms should be used to prescribe drugs for the prophylaxis of malaria. These regulations have never been changed, despite concerns about the morbidity and mortality caused by imported cases of malaria. Some GPs do prescribe malaria prophylaxis on FP10 forms and their PCTs are willing to allow this – but any GP or PCT that engages in this practice is breaking NHS regulations. So to answer Richard’s question, ‘will the NHS let me die of malaria?’ – the NHS does care about you and does not want you die of malaria – but not sufficiently to allow drugs for malaria prophylaxis to be prescribed on the NHS.

  • Marionpitman

    I used to get chloroquine and proguanil OTC, but am told it doesn't work on Zimbabwean mosquitoes, so I have to get a private prescription for Malarone as I'm not supposed to take Lariam. But i've not had any trouble getting it, doesn't usually take more than a few days to get the scrip. I'm not allowed more than a month's worth or something, though, I think.

  • Paddy

    The problem with that is that we're already seeing drug resistance to Artemisinin in SE Asia, where it's been traditionally used as a herbal medicine.  Using it outside of a multidrug combination is irresponsible because such use leads to resistance.  Should resistance to Artemisinin and related compounds really get going there's no saying how long it'll take to find the next family of anti-malarials, or how many people would die in the meantime of what would otherwise have been a treatable disease.

  • Richard Smith

    How interesting. I didn't know this. Treatment yes, prevention no.

  • Richard Smith

    I'll maybe have to. I don't need anything beyond antimalarials as I travel a lot and am up to date.

  • Docbildstock

    a dilemma: prophylaxis on your own cost, but treatment at the expense of the community. I think, that is not very logical, economical and reasonable, is it?