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We can change practice—can we also change culture?

BMJ 2019; 364 doi: (Published 10 January 2019) Cite this as: BMJ 2019;364:l108

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Re: We can change practice—can we also change culture?

Dear Editor,
Wendy Stephen draws attention to a successful claim for compensation, following the development of narcolepsy in a young person given the paediatric flu vaccine.
Will this possible complication be mentioned when informed consent to administration of the vaccine, is sought ?
UK law, following the Montgomery judgement in 2015, rules that adults or parents cannot give valid consent to any procedure, unless they are provided with full information about material risks, including rare risks, associated with the procedure.
The judgement, and numerous commentators since, explained that the provision of written material is not sufficient. (1,2,3)
When I enquired about the consent process prior to administration of the paediatric flu vaccine in Wales, last year, I was referred, by the medical chairperson of the Wales Immunisation Group, to the UK “Green Book”, for all up to date regulatory advice on vaccination matters. I explained to the chairperson that the Green Book is at least five years out of date. It does not mention the Montgomery judgement. (4)
I was given the name and address of the person at PHEngland, who deals with such matters. He has not replied to my two letters.
The GMC embarked on a process to update it’s advice on Consent, more than two years ago.
Publication is about eight months overdue.
People who are already concerned about the consistency of professional behaviour when doctors provide information prior to gaining informed consent, will be as reassured by the clarity of the Montgomery judgement, as they will be concerned at the slow responses of PHE and the GMC, detailed above.
Dr Helen Salisbury’s comment on the logistics of ‘Running flu clinics in a pandemic’ includes the remark that “ Doctors and nurses try not to be drawn into too much conversation before giving the injection.” (4) Perhaps in a future column Dr Salisbury will explain how the Supreme Court’s judgement is best observed in busy flu vaccination clinics ?
If the boundaries between practice and culture pertaining to the long standing flu vaccination campaigns, are as uncertain as this, what hope is there for sensible discussion of new vaccines ?


Competing interests: No competing interests

11 August 2020
Noel Thomas
retired / part time GP
Bronygarn, Maesteg, Wales CF34 9AL