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Independents' Day

Can primary care beat superbugs?

It has been a week when superbugs have spread from hospital wards and GP surgeries to the front pages of most national newspapers

By Lilian Anekwe

It has been a week when superbugs have spread from hospital wards and GP surgeries to the front pages of most national newspapers

The airwaves have reverberated with fine words from ministers who claim to be leading the battle against resistant infections.

But the reality is often very different, as one GP, who wanted to remain anonymous, told Pulse. She said: ‘Not enough is being done in primary care. I saw a patient for one matter and discovered she was being treated in the community for MRSA.

‘Therapy had been initiated at hospital – but nobody had communicated this to us, and we were not informed of any special measures needed when she visited our surgery.'

Her comment is just one of a series revealing the difficulties faced by GPs in trying to tackle resistant infections without the resources that have been ploughed into secondary care.

Dr Stephen Fox faced a similar situation at his practice in Leigh in Lancashire, where he was told by a district hospital to repeat MRSA swabs and analyse his own results.

‘I'm not the only one. This has happened to other GPs, who have been left struggling to deal with patients discharged from other tertiary centres. It's not just me,' he says.

Dr Fox feels strongly that better support from secondary care and local microbiology labs is essential.

The Department of Health's plans for a new surveillance system to gauge the extent of MRSA infections in primary care – revealed by Pulse last week – will be welcome news (see box below).

Less so will be new research published in JAMA suggesting that, in the US at least, more than half of MRSA infections are now acquired in the community – more than twice those originating in hospitals.

Experts believe novel strains of MRSA from the US and Australia, including Panton-Valentine Leukocidin (PVL) MRSA, will be a major challenge for primary care in the UK.

But it would appear that PCTs are far from ready to meet that challenge. Pulse's investigation revealed wide discrepancies in how much funding different PCTs allocate to infection control – from nothing to more than £2m per PCT.

Bath and North East Somerset has a budget of £2.2m – 1% of the PCT's overall annual budget – for infection control. This includes a budget of £85,000 for staff directly involved in infection control within the PCT and GP surgeries.

Derbyshire County PCT spends more than £534,000 a year – over 10% of the £5m allocated by the department to NHS East Midlands SHA – on infection control. Much of this is spent on training rolled out across GP surgeries as well as community hospitals and nursing homes.

Contrast these measures to those in other PCTs that have no specific allocation for infection control.

Peterborough PCT has a strategy to fund support needed during outbreaks only. It says: ‘As these are "unplanned", infrequent and dependent on the infection, we do not have an actual budget or cost for this.'

Bedfordshire PCT says infection control is integrated into the daily work activity and responsibility of many different staff. ‘It includes activities ranging from decontamination of instruments to infection control training, procurement of cleaning services and products as well as provision of specialist support and advice,' adds a spokesperson.

‘As such, expenditure is embedded within a range of budgets, there is not one specific central budget.'

The BMA is calling for a far more systematic approach to deal with the potential health timebomb. In response to the Healthcare Commission's ‘annual healthcheck' of standards of hygiene in hospitals, it called for a ‘co-ordinated approach' to controlling infection.

It reiterated that patients ‘have a right to expect the highest level of hygiene in the NHS and to have stringent systems in place to prevent infections from spreading'.

But despite the hyperbole, it seems best practice is not spreading as fast as the infections themselves.

What will the primary care MRSA surveillance system look like?

Population surveillance
10,000 nasal swabs collected at random from MRSA asymptomatic community patients presenting in primary care will be analysed for MRSA, MSSA and PVL-MRSA.This will ‘provide robust baseline data on the carriage [of these infections] and information on the possible risk factors, emergence and dissemination of virulent strains in the community'.

Sentinel surveillance
10,000 samples from patients with skin infections, attending primary care walk-in centres, will be sent to local diagnostic microbiology laboratories. This will ‘enable dissemination of evidence-based data to primary healthcare providers about skin infections occurring in the community'.

Source: Department of Health

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