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GPs should be given individual reports on their antibiotic prescribing, recommends NICE

GPs will be given annual reports on their antibiotic prescribing and local resistance patterns under draft plans to curb the use of the drugs in primary care released by NICE today.

The draft NICE guidance says local ‘antimicrobial stewardship teams’ should review GP antibiotic prescribing and target areas where inappropriate prescribing may be driving the development of drug resistance.

The draft guidance recommends that organisations consider linking prescribing to GMC numbers, other identifiers, so that GPs can receive individualised feedback on their own antimicrobial prescribing.

NICE recommends developing annual reports for individual prescribers on their prescribing patterns, local patterns of resistance and any patient safety incidents.

NICE suggests GPs should consider point-of-care testing before prescribing, but GP leaders say services - such as CRP testing - are not widely available to practices.

GPC deputy chair Dr Richard Vautrey told Pulse that GPs were already responsibly prescribing antibiotics in many cases.

He added: ‘GPs don’t prescribe antibiotics lightly and value receiving information that compares their prescribing with their peers, something that has happened for many years. They would welcome a greater focus from Public Health England and other bodies on stepping up patient education and support so as to reduce the expectation that some patients still have about antibiotic prescriptions.’

Professor Mark Baker, director of the Centre for Clinical Practice at NICE, told Pulse: ‘It’s often patients themselves who, because they don’t understand that their condition will clear up by itself, or that perhaps antibiotics aren’t effective in treating it, may put pressure on their doctor to prescribe an antibiotic.

“The draft guideline therefore recommends that prescribers take time to discuss with patients the likely nature of their condition, the benefits and harms of immediate antimicrobial prescribing, alternative options such as watchful waiting and/or delayed prescribing and why prescribing an antimicrobial may not be the best option for them.’

The news comes as Pulse revealed in October that public health officials are in talks with NHS England about the possibility of introducing targets to cut antibiotic prescribing into QOF and publishing individual GP antibiotic prescribing rates.

What does the guidance say?

[Commissioner and provider] Organisations should consider including the following in an antimicrobial stewardship programme:

1) Monitoring and evaluating antimicrobial prescribing and how this relates to local resistance patterns

2) Providing regular feedback to prescribers in all care settings about:

  • their antimicrobial prescribing, for example, by using professional regulatory numbers for prescribing as well as prescriber (cost centre) codes
  • patient safety incidents related to antimicrobials, including hospital admissions for rare or serious infections or associated complications

Source: Draft NICE guidance


Related images

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Readers' comments (50)

  • Mark Smith

    So how exactly are we going to get accurate prescribing feedback when prescriptions for antibiotics on repeat for COPD rescue for example are allocated in rotation or by registered doctor name by software, not by the prescriber. And how will locums and salarieds have any idea of their prescribing when their prescription is allocated to the partner or practice they are working for. Annually our meetings have shown outlying prescribing initiated by locums for off formulary food items or Melatonin for example. Non starter for those docs who always fly under the radar of locality prescribing gurus and never seem to get sent any advisory communications or formularies despite being on performers list. Another non starter thought up by people who have no idea where the coal face is, let alone any idea of the mechanics of the coal face.

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  • Agree, to many issues with the system to be able to accurately ascribe antibiotic prescribing to individuals. Guess it will happen anyway, despite the system being flawed.
    Unfortunately, I see lots of antibiotics prescribed when documented findings would not be sufficient to warrant them, usually from local walk-in centres, but some from a partner closer to home!

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  • The sad fact is that the intention behind this advice is correct.
    However, I am so sick of being micro managed, dictated to and judged on statistics that do not reflect reality that I resent even this essentially sensible suggestion.
    If the powers that be want co-operation they need to leave us alone for a bit to redefine our own sense of personal responsibility.

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  • to 0900..that seems to be exactly what is proposed, not micromanagement but personal responsibility. We have tried to do it our our practice, but very difficult to reconcile prescribers to prescriptions, especially for repeats for patients with complex lung disease eg bronchiectaisis or CF and patients requesting rescue antibiotics eg COPD

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  • Well we have a patients with Severe asthma on Lifelong Azithromycin, patients with CF who require freq 3rd generation cephalosporins and fluroquinilones and occa patient with Bronchiectasis and sinusisits who requires monthly Abx.
    Do we refer them all back to secondary care to deal with their prescriptions.
    Also using Trimethoprim Prophylaxis for elderly with recurrent UTI prevents same (evidence based). As many need weekly scripts these are counted at new issues every week whereas if they were prescribed monthly they are counted less.
    Also OOH prescriptions are counted towards each practice data so how is that squared!

    Lies ,damned lies and statistics

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  • 1) Deal with the availability of buying antibiotics over the counter abroad
    2) Deal with patients demanding antibiotics and complaining about the GP who doesn't prescribe them. All complaints believe the patient
    3) Deal with the fact that many tragic cases on retrospect the GP should have prescribed antibiotics and now suing the GP. Indementiy 8k a year!

    Then come back to me to discuss my antibiotic prescribing data.

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  • Who gives a sh*t?

    I will continue to prescribe antibiotics where appropriate and I do not give a monkeys if I am at the bottom or top or middle of some pie chart

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  • More useless advice from NICE. Other than providing secure employment for anankastic academics, what is it for?

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  • or indeed any other chart

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  • If the data was accurate (i.e. my own clinical decisions only) I would very much welcome this move. There need to be a study first on if imposing such change will change clinical behaviour to the point of causing harm to patient first. e.g. Patients coming to harm due to Clinician's reluctance to prescribe AB as we are pressurized by CQC/GMC/CCG/NHSE.

    However majority of "out of guidance" AB are initiated by secondary care when we carried out our audit. Many delayed scripts are also counted as prescribed AB. So if this comes into effect, I'll be refusing to do all of them citing clinical responsibility for AB prescribing.

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  • I presume that our farming colleagues will be subjected to similar public scrutiny and publication of their individual use of antibiotcs for their livestock. It could then be compared by volume to the use in medicine and a clearer picture as to where the problem of resistance will emerge.We will obviously then see frontpage headlines in the DM etc pointing the finger of blame to the farmers. Dream on!

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  • sorry should be'where the problem of resistance originates will emerge'.

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  • Una Coales. Retired NHS GP.

    I called NICE a quango on Sky News this morning, an arm of government. And raised concerns that blowing the whistle on colleagues alleged to be overprescribing antibiotics may lead to easy it is to put in an allegation against a NHS GP that NHSEng are seeking to get rid of? This is just another tactic to get GPs to report other GPs and for everyone to keep watching their backs in fear that they may be 'overprescribing' antibiotics?

    GPs therefore are between a rock and a hard place. Get it wrong and don't prescribe and be sued when the patient dies. Get it right and prescribe correctly and be faulted for overprescribing because you had a batch of very sick patients in one month from your list size of 18,000 compared to your neighbouring practice with a smaller and healthier list.

    How accurate can one be in a 10 minute consultation when one cannot keep the patient in for results of a FBC or xray as A&E can? GPs are time pressured to make quick clinical judgements on scant information and some cases are not text book.

    Another form of micromanaging GPs until they all quit...

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  • I had an interesting conversation with a clinician working in India. Apparently their routine practice is to give out 3rd generation cephalosporins as first line for infections such as otitis media. If this is standard practice in huge populations like India then one does wonder why we are being micro managed and lambasted here in the UK over antibiotic prescribing!

    There is also the issue of antibiotic prescribing in veterinary medicine that seems to have little regulation in the use of high dose, broad spectrum drugs...

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  • first educate the regulators and investigators of complain about abx , then only situation will improve.
    by not giving antibiotics to pt will invite complain. then first thing we will be told why you didnt give abx , need of abx was so obvious , we need to look into your competencies.

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  • I am a locum so am exposed to a huge array of antibiotic prescribing. On the most part it is terrible!!! I whole-heartedly agree with some personal accountability - I would happily take that on myself and currently audit my own prescribing as it annoys me so much!

    The expectations of patients and the general health beliefs of the population are severely damaged by Drs giving out antibiotics for ear infections, sinusitis, viruses and bronchitis that are entirely not indicated and is just lack of assertiveness, poor communication of the lack of need or just laziness which then leaves you in a difficult position of "well, last time I got them" which then undermines you when you justifiably refuse, resulting in repeat consultations with GPs or secondary care based on incorrect health expectations.

    If you document your history and examination correctly and make a decision based on this and then a further bacterial infection develops then how are you accountable in response to 10:20? Every decision cannot be made with the benefit of hindsight.

    And if you excluded everyone coded for rescue antibiotics surely that would remove the issue of CF/COPD/bronchiectasis?

    I am worried there is going to be a crisis in resistance well within my career.

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  • I completly agree with the comment about farming...vast quantities of antibiotics are used there...who's monitoring that?...of cause we should prescribe antibiotics sensibly...just as we should do everything make sensible diagnosis, like choose appropriate investigations and make referals appropriatly...that's our job...we do a lot of stuff ALL of which should be done sensibly

    I rage against yet another bureaucratic organisation, one step removed from the job, sending dictats from above trying to control how we work using coarse, clumsy, floored tools that won't do the job and will cause unforeseen, unpredicted distortions to our practice.

    There are too many people employed to monitor, control and provide well meaning 'advice' to primary care. NICE has become a self important monster...I thought they produced guidelines ....what are they doing setting up antibiotic monitoring schemes ?? Why aren't these people getting off their back sides, putting shown their protocol writing pens and working in general practice instead? Why isn't the money wasted on their offices spent funding district nursing?

    Of cause we need to prescribe appropriately...what we don't need are expensive government organisations justifying their existence by coming up with yet more ways to interfere with and monitor with how GPs do their job.

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  • This is pointless micromanagement. The main antibiotic issue is, literally, the tons of antibiotics dumped into our water supply by farmers via their herds. No one ever seems to mention this Incidentally, sticking to GPs, there is published evidence that UK doctors prescribe significantly less antibiotics than their (especially southern) European colleagues..

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  • "Professor Mark Baker, director of the Centre for Clinical Practice at NICE, told Pulse: ‘ ...the draft guideline therefore recommends that prescribers take time to discuss with patients ...."

    Suggest Prof Baker takes time to discuss with a few GPs how not to aggravate GPs with laughably inept advice.

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  • Maybe the pharmacists et al need educating when they send all and sundry to us with "green phlegm". Give me strength!

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