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Gold, incentives and meh

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 are advised to give out antibiotic rescue packs out like smarties to our COPD patients. Make up your mind!

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  • I thought I read the other day that GP antibiotic prescribing had actually reduced in 2013, by about 1%, but that it had shot up in walk in centres and A+Es. Did anyone else see that? It is more likely doctors will prescribe antibiotics where there is no continuity of care, knowledge of patient and therefore little doctor-patient relationship based on trust.

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  • I meant to say will prescribe antibiotics inappropriately...!

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  • Tony's right as usual. Lunatics continue to play a major role in asylum management.

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  • Many of the comments are utter nonsense. The usual course of events in uncomplicated UTI of sending for urinalysis and waiting for the result to prescribe an antibiotic is responsible for much recurrent UTI. This is only one case of not prescribing an antibiotic. GP prescribing of antibiotics is not the cause of resistance but lack of appropriate hygiene standards across the board in medical world!

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  • Edoardo Cervoni

    Another option would be the introduction of a prescription ticket on antibiotics. Antibiotic over-prescribing is deeply rooted in the UK medical practice. Delayed antibiotic prescriptions have been adopted by many GPs, but with limited benefit. Perhaps, the introduction of a £7.98 ticket on antibiotic prescriptions (the cost of a pack of cigarettes to be precise), could have a place. The income so generated should be invested into pharmachological research.

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  • The UK is a small island country (in terms of actual geographical size/surface area) and antibiotic resistance is increasing due to what the rest of the world does not what we do in the UK. It's like global warming and climate change, we can try and be conscientious all we want here, but if the USA, China and India are pumping out green house gases like there is no tomorrow then whatever we do in the UK is irrelevant. Similarly, in most parts of the world you can buy antibiotics over the counter like they are smarties. Not only that, in other parts of the world doctors prescribe antibiotics like they are smarties too! You only have to see that when you tell certain patients that they have a viral illness and they have no clue what you mean by a virus! I'm sorry, but with regards to antibiotic resistance, whatever we do is futile if the rest of the world does not act on this matter either!

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  • Took Early Retirement

    Moreover, almost all poultry chicks get antibiotics in the first few days of life to prevent yolk sac infection.

    Is this the fault of GPs?

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  • Edoardo Cervoni

    Moinuddin Kapadia, you make a good point and - sadly - UK is not hold the black shirt. This link may help to clarify what I mean when I say that UK is not the worse of the league: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=3284
    However, I strongly believe we should be given more "medicolegal protection" and more tools for rapid diagnosis (test kits). There is a well routed culture in the general population, which has been created with decades of antibiotic prescribing for self-limiting - as a rule, infections. Vaccinations have made no difference to our prescribing, which seems to be odd. However, alike for CO2 emissions, you have to do what is right, no matter what others may be doing.

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  • Now everyone knows best EXCEPT the clinician treating the patient.
    Even a DIY handyman gets to choose his brand of screwdrivers......Is this reasonable?Is this professional?Let's join CQC and GMC where there is zero clinical risk and as you do not see any patients, you know best and can then tell all clinicians what to do setting standards!

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From: Copperfield

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