Recommendations for healthy travel

In these days of financial targets, new contracts, enhanced services, revalidation and balancing the underspend, health care professionals and managers have little time left to consider the confusion surrounding Travel Health Provision. Foreign travel has increased greatly over the past 40 years...

Currently 58 million people travel annually worldwide. Advances in flight technology have meant that journeys that previously took many weeks, now take a matter of hours. Many health challenges have resulted from the ability to travel rapidly from one continent to another. The speciality of Travel Medicine has emerged over the last 20 years and helps to meet these challenges. Every year as holiday time approaches, the requests for travel health advice increase. These consultations can take up to 30 minutes, require a good working knowledge of travel medicine and are often requested at short notice. Travel Health advice in the UK is mainly accessed through General Practice, but research has shown that the knowledge among staff delivering this service is variable. The lack of access to a good travel advice database and staff who are not trained in travel medicine may lead to medico-legal problems if incorrect advice is given.

How to avoid medico-legal problems

  • Ensure adequate time for the consultation;
  • Allow staff to obtain a good basic Travel Medicine knowledge by attending one of the travel medicine Courses available. For a list contact the British Travel Health Association;
  • Ask the traveller to provide details in advance of where they intend to travel;
  • Design a travel consultation form which enquires about past medical history, current medications, allergies [especially to egg] and past immunisations as well as details of the proposed travel with dates of departure and type of travel to be undertaken;
  • Ensure staff are kept up to date. This can be done, for example, through membership of either the British Travel Health Association or the International Society of Travel Medicine. Both supply regular newsletters and journals highlighting changes in vaccine procedures, international disease outbreaks and new research;
  • Ensure access to a good travel database such as TRAVAX. This is provided free for practices in Scotland by contacting the Health Protection Agency, Clifton House, Glasgow and can be obtained at a reduced rate for English and Welsh Practices if you are a member of the British Travel Health Association;
  • Obtain all travel vaccines from a reputable source and store vaccines immediately upon delivery at between 2oC-8oC;
  • Document clearly all vaccinations given as well as advice on malaria avoidance, including any prescriptions issued.

The New GMS contract

  • The new GMS contract has done little to clarify or aid the provision of travel medicine in Primary Care. Some two per cent has been allocated in the global sum to all GMS GP practices to provide travel health advice and related immunisations.
  • The contract states ‘If a Practice feels unable to provide a travel immunisation service they will have their global sum abated by two per cent.
  • Those travel vaccines that were provided on the NHS before the 31/03/04 shall continue to be provided by Practices from 1/04/04’.
  • A doctor is only able to opt out if there is an alternative service that patients can access to obtain travel health advice, such as Locality or PCT clinic.
  • Accidental misinterpretations of Travel Health Provision may occur and there is no doubt that a few practices are denying patients services that they are entitled to receive.
  • The DoH stated in 1966 that for public health reasons smallpox, polio, typhoid, and infectious hepatitis vaccines would be provided under the NHS.
  • Despite marked changes in worldwide disease patterns, vaccine availability and need, this list of vaccines has been replicated unaltered in the new GMS Contract.
  • The wisdom of this is not for us to challenge, but it is obvious that little input has been given to the reorganisation of travel health services according to the modern traveller’s needs and current disease.