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Antibiotic prescribing targets in the GP contract? A medicolegal nightmare

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True, it’s probably just an embryonic thought. But I’d give it a shot of mifepristone just in case. Because the recently reported idea of putting antibiotic prescribing targets into the GP contract is - even allowing for the mad, mad, mad, mad primary care world we currently inhabit - significantly off the scale of one to insane.

On the one hand, our terms of service oblige us to prescribe and refer when appropriate. On the other, targets, enhanced services and other initiatives pressurise us to do less of both, or else.  And all that to a backdrop of media and politicians blaming us for antibiotic Armageddon and an over-stretched NHS, while defence body subs make our eyes bleed and we click to the fact that you never get complained about for doing too much.

Difficult to reconcile that little lot, isn’t it? No, not difficult. Impossible.

I sincerely hope that, when whoever dreamed up this latest germ of an idea gets hit with a germ of his own, his GP will explain that the options for his pneumonia are, not to prescribe antibiotics or not to send him to hospital.

True, it’ll probably screw the GP’s career and potentially kill the patient. But at least it’ll save the NHS the cost of some clarithromycin.

Dr Tony Copperfield is a GP in Essex. You can follow him on Twitter @DocCopperfield 

 

 

 

 

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Readers' comments (20)

  • we've had antibiotic targets for some time. our local hospital was a national scandal with its c. diff rates. i t really isn't a problem with treat/not treat pneumonia but peddling antibiotics for coughs and colds, which just increases demand, plus non existent UTI's which you moaned about the other week.
    As a profession we need to get our act together and the proposal for targets is just a symptom that we havn't.

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  • Tony is completely correct. Although antibiotics are often considered over prescribed with preventable factors, at the same time they are frequently under prescribed, increasingly when there are targets. The delays in treatment with antibiotics are difficult to measure, especially in the fragmenting NHS when someone else usually has to sort things out, and cause various degrees of unnecessary suffering, including death at the extreme, which I postulate is probably quite common. Even simple coughs and colds can lead to misery with secondary bacterial infection, which if left, can be life threatening.

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  • to 1.21you are incorrect- read the NICE guidelines!!!!!!!!!

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  • "Misery" is not life-threatening; antibiotic resistance potentially is. Almost by definition, anyone simply walking into your consulting room complaining of URTI sx, but NAD on exam does not need an antibiotic.

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  • Disagree. (with some of the above).

    I don't give a monkey's what any contract says.

    I've personally seen death and pneumonias which were completely avoidable by failure to give antibiotics.

    To hell with a contract, I will continue to have a very low threshold to prescribe them and no one can tell me otherwise!

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  • Well said 3.10pm.I am sure many older doctors have similar experiences to you and are practicing preventatively for very good reason.It is an absolute nonsense to blame G P's for antibiotic resistance when a far greater cause is the use in agriculture which will not be addressed for economic/political reasons.Look what happenned in Australia when use of AB's in agriculture was restricted.

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  • To 3.02, nobody is arguing against your simplistic statement that "anyone simply walking into your consulting room complaining of URTI sx, but NAD on exam does not need an antibiotic". However there are exceptions such as a low WCC and immunodeficiency, covert secondary infection and numerous rare scenarios.
    For example Lemierre's syndrome is a simple throat infection which gets very serious if untreated with a touch of penicillin and in the 60s and 70s was virtually extinct with all the penicillin that was being used. However it is increasing again with lower antibiotic use but actually requires a low threshold for suspicion and early treatment with antibiotics. I know someone who was lucky to survive this after a long hospital stay and it took three years to fully get over.

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  • There's a very simple solution.Indemnify us and we will stop prescribing immediately

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  • It's the same old story over and over blame the guys working in the egg factory for the fact that sometimes eggs get broken

    On another tack entirely has anyone bothered to analyse the impact of the ever increasing numbers nurse prescribers on the use of antibiotics. I don't want to knock these hard working colleagues but from experience I'd guess antibiotic prescribing is significantly higher in this group...and there are far more of them as each year goes by

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  • It's one of those areas where heavy-handed approach can't work. Antimicrobial resistance is a huge and very serious problem. But if you don't give antibiotics when they are needed, patients will die. The right balance must be struck.

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From: Copperfield

Dr Tony Copperfield is a jobbing GP in Essex with more than a few chips on his shoulder