Strep A lateral flow tests available in Wales but not England

Strep A lateral flow tests that cost £7.50 and can tell in less than five minutes if a person has the infection are available on the NHS in Wales but not in England due to a lack of funding, it has emerged.

The tests help to ensure only people who need antibiotics get them, as well as reassure people with viral infections that they do not need drugs and help to fight the rise of superbugs, while also reducing the number of people seeing GPs for a sore throat.

However, they are not offered by NHS England, which opted not to fund the service, or stocked in English pharmacies.

It comes as official figures showed at least 15 children have died of Strep A in the UK, with 13 in England and one known case in both Northern Ireland and Wales. There have been no reported deaths in Scotland.

NHS data also revealed that the 111 service failed to answer more than a third - 37 per cent - of calls, as parents concerned about Strep A were told to ring the helpline as the first port of call if their child is deteriorating.

Boots ran a trial in 2016 at 35 high street pharmacies in Nottingham and London where a Strep A swab kit, which is made by a company in Maidstone and is 98 per cent accurate, was made available to people with a sore throat.

Of more than 2,000 people who had a sore throat, only 367 needed medical attention, just 149 warranted a swab and only 36 were Strep A positive and given penicillin. Eleven people were referred to their GP.

“Out of the 2,000 people who enquired, 48 per cent of them said that if this service didn't exist they would have gone to the GP,” Marc Donovan, director of healthcare development and public affairs at Boots and chief pharmacist when the trial was run, told The Telegraph.

The pilot study was presented to the NHS, said Mr Donovan, and funded and adopted in Wales, but not Scotland or England.

“We often try and do these pilot initiatives to help the NHS understand that there are solutions in community pharmacy and other areas of primary care,” he said.

“NHS Wales did pick it up and we worked with NHS Wales for a number of years.

“Many Welsh health boards have launched the sore throat test and treat service as part of the NHS, and Scotland and England haven't picked this up but it's very successful. Of course it's inundated, as you can imagine, at the moment.”

Strep A often causes tonsillitis, known as Strep throat, and can also lead to scarlet fever, impetigo and in rare and severe cases iGas, which can be fatal. Fifteen children have died of iGas so far this winter.

Health officials have told GPs to have a “low threshold” for giving out antibiotics to patients, which involves a prescription if people have a sore throat and fever.

However, surgeries and A&E departments have reported being inundated with children with sore throats and there is no quick and easy way to tell if a patient has Strep A or is suffering from a viral infection, as viruses cause most sore throats and colds.

Mr Donovan said that if the NHS had funded the Boots trial, then the service would be able to help curb the current Strep A and ease uncertainty around the outbreak.

“It's very, very similar to the Covid test. You take the swab, put it into a solution and get a result,” he told The Telegraph.

“It identifies people where the cause of the infection is Strep A and then we could prescribe antibiotics. But importantly it also identifies people where the symptoms were caused by a virus and we give them reassuring advice and send them on their way,” said Mr Donovan.

The test itself was £7.50 and if a person needed antibiotics, they were £10. However, Mr Donovan pointed out that this is cheaper than the cost to the NHS for a single GP appointment, which is thought to be around £33.

The tests are not available to buy off the shelf at Boots and are not readily available in England.

“For something like the current Strep A situation, the solution can exist outside of the GP framework,” said Mr Donovan.

“The tests would be able to help patients and worried parents who could go into their local pharmacy and receive reassurance of the origin of the sore throat or confirm that it's viral. I think this would ease the anxiety that currently exists.

“Pharmacists are also very accessible in the high street, we are open on Saturdays and Sundays where GPs may not have those sort of appointments available.”

Lord O’Neill, an economist who penned a seminal review on antimicrobial resistance, told The Telegraph that had the Boots trial been adopted widely by the NHS, it would have significantly helped in the current strep A situation.

“Win-wins are pretty rare in life, but it is a complete win-win,” he said. “It takes the pressure off doctors because they can turn around to parents and tell them their child does not need antibiotics.”

He said the reason why the trial was not adopted more widely “is because it is easier and cheaper for a doctor to just write a prescription”.

He added: “You have to have some kind of central government support to make the average cost of testing lower.

“The Government needs to wake up and realise that without central diagnostics, you can't solve these problems.”

When approached by The Telegraph, NHS England did not provide comment but provided National Institute for Health and Care Excellence (Nice) guidance that states Strep A tests have a “limited” impact on antimicrobial prescribing and stewardship and the tests are “unlikely to be a cost-effective use of NHS resources”.

To date, five children under the age of five have died of iGas in England this season - five between five and 10 years old and three between 10 and 14 years old.

In the winter of 2017-18, the last time there was a high level of Strep A in circulation, 27 children under the age of 18 died of iGas in the entire season.

NHS 111 has been inundated with calls about the bacterial infection, with Saturday and Sunday being the busiest days so far this winter. There were 95,000 and 86,000 calls respectively.

On average, in the week ending Dec 4, a quarter of calls were abandoned - up from 21 per cent on the same week last year.

Only one in seven, 15 per cent, of calls to NHS 111 were assessed by a clinician over the last weekend, significantly below the target of more than 50 per cent.