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The draft guidance recommends that organisations consider linking prescribing to GMC numbers, other identifiers, so that GPs can receive individualised feedback on their own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

  • Antibiotics-square-online

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 bullying...how 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 sensibly..like 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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  • I want on a recent talk on sepsis.The ICU consultant remarked they're seeing alot more cases of sepsis secondary to strep throats and mastoiditis since the crackdown on antibiotic prescribing.GPs cannot win.Damned if you do damned if you don't.

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  • 11.05 It is naive to believe that good history taking and documentation will save your bacon.

    Doctors who miss sepsis risk going to prison and people who dare to point out the flaws of the NHS or deviate from guidelines are hung out to dry. Before this culture of fear is reformed, no-one in their right mind would take on more risk than is strictly necessary.

    Ithttp://davidsellu.org.uk/
    http://www.theguardian.com/commentisfree/2015/feb/17/jeremy-hunt-nhs-bully-in-chief-health-secretary-staff

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  • Don't meddle with my clinical decisions please. NICE is not perfect and a lot of decisions are made it seems to appease the pharma companies because they are irrational to say the least - statins are a fine example.
    We are wary of antibiotic resistance and do not require another wad of papers to go through.

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  • Of course reflective practice in this area is always vital, but what we really need is a government funded education campaign aimed at everyone about appropriate antibiotic usage.
    Someone needs to look at antibiotic usage in animal farming as well.

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  • Took Early Retirement

    1. But we have just been advised to give MORE antibiotics for sore throats because of increase in Strep infections.
    2. I was in Spain 3/52. I bought some Ciprofloxacin OTC. Quite cheap. I wasn't even asked what it was for!

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  • 12:36 I am not sure what you are advocating? Clinical, evidence-based decision-making based on well documented facts at the time? Or blanket antibiotic prescribing and defensive medicine?

    Surely you do not mean we should prescribe antibiotics for every ear infection in case of a future mastoiditis? And if you saw someone with ear pain and documented - no effusion, no mastoid tenderness, no headache and apyrexial and a clear safety-net how could you be blamed if it progressed? I am not sure the MDU expects you to see the future....

    Missing sepsis is very different to prescribing antibiotics for a benign self-limiting illness.

    I would rather take the chance personally than be bullied by litigation into prescribing defensively against my findings... Surely that is what this article is attempting to highlight?

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  • we should have performance rankings with the lowest prescribers at the top. we could 'name and shame' GPs who prescribe too much. we could link it with practice performance and pay ! all we need is a new quango to manage it preferbly run by a lady or lord and charge GPs a mandatory subscription to run it with online support tools (charged yearly). Great !

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  • I am not sure what you are advocating? Clinical, evidence-based decision-making based on well documented facts at the time? Or blanket antibiotic prescribing and defensive medicine?

    The choice is rarely a binary one as you describe - everyone sets a threshold for their prescribing habits based on guidelines and experiences (which change depending on recent events and other pressures) and most peoples notes are OK most of the time. What is clear is that we are being forced to lower those thresholds because of the toxic culture being encouraged by our regulators, politicians and rising public expectations. Defensive medicine is just a survival technique that 'resilient' doctors use to stay sane. I'm afraid it has earned it's place in the current NHS.

    Missing sepsis is very different to prescribing antibiotics for a benign self-limiting illness.

    If only it was so easy! When you read up on such tragic cases there is usually the feeling of 'there before the grace of God go I.' Scientists accept that there is a trade-off between sensitivity and specificity and you will never be right 100% of the time due to a multitude of factors outside of our control. Its entirely possible for a child that looked OK 3h before to become overtly septic but we don't have time to write medical notes that look like legal contracts to defend ourselves (if you care to look at some American medical forms you will see what the future holds if we don't get a grip on this).

    That's not an excuse for being reckless, but it's unfortunate that the courts are unable to accept how imperfect a science medicine is. This is probably because the people that work in them come from arts backgrounds and are often not well versed in the pitfalls of statistical and logical methods.

    What I'm advocating is reform of medico-legal law and transition to a no blame system that promotes learning above pointing the finger of blame. The crude statistics suggested by NICE will inevitably used to target 'outliers' with 'high variance' and make the current situation worse, whilst doing very little to address the true causes of antibiotic resistance.

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  • I've just read an article on yahoo titled "GPs urged to blow whistle on collegues who over prescribe antibiotics'

    That's why this kind of approach sucks ...antibiotic resistance is a complex issue and these kind of high profile GP focused initiative misses a good deal of what's actually going on...and distorts reality. Yes 'Nick Taylor' it is important that GPs prescribe antibiotics appropriatly...that's is pretty obvious to anyone with a medical degree, not just the likes of you...suggesting that GPs are primarily to blame for this however (which inevitably will be the likely result of this well meaning initiative e.g yahoo article) is simply crap and distorts reality.

    An increasing number of antibiotics are prescribed by people who aren't Drs and wether you like it or not there are a significant number of patients who demand antibiotics. Of cause we should resist this but it would be completely naive to suggest this won't have an impact. Antibiotic resistance is a well known problem, there are other sections of society who perhaps are not so aware and it might be more productive to focus on them....we are an easy target. But this guy is paid to monitor and advise GPs so of cause that's what he's going to do.

    There are too many people like this ...we are getting too much advice and too much monitoring and too much regulation. Enough already.

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  • Yeah, more naming and shaming, because that works so well, doesn't it. Yet more bullying from the well meaning issued on high from their ivory towers.

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  • Una Coales. Retired NHS GP.

    @12:21 I agree with the ICU consultant. When I did ENT surgery, I spent almost every on call admitting a patient a GP had refused to prescribe antibiotics for, whether it be tonsillitis that was now quinsy and the patient could no longer swallow his or her saliva and lancing did not help as it was too far gone and needed high dose IV antibiotics, steroids for the inflammation, IV fluids, and 24 hours of tying up a hospital ward bed so a patient waiting for a bed for head and neck cancer surgery the next day had to have his op rescheduled, or it was a patient whose ear canal was so swollen because a GP refused antibiotics and now only a pope wick could be inserted to get antibiotic and steroid ear drops through, to orbital cellulitis requiring urgent imaging to rule out optic neuritis because a GP refused to prescribe antibiotics for sinusitis. Year after year, it did make me wonder why on earth GPs thought they could diagnose viral vs bacterial in 10 minutes with such certainty that the patient ended up in A&E and seen by hospital doctors. I always wondered if the discharge letter ever served as a learning point for GPs.

    Then I became a GP and felt the enormous hand on my shoulders, that pressure from aboev that says that most patients we see in general practice have a viral infection and not to treat with antibiotics.

    I ignored populist trends and followed my own clinical expertise as I know many GPs do and would if they did not feel the pressure to prescribe less of everything to make sure their prescribing patterns fall within the same range as their neighbours,

    This reminds me of Ryan Air pilots being monitored on how much fuel they use for each flight and being named and shamed for being an outlier. There are many reasons why a pilot would choose to use more fuel. Trust the pilot to do his job?

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  • just noticed this advert on pulse next to this article - having trouble with your partner (GP) call Radcliffes **** Solicitors.

    i can see it now - 'i'm worried 'cos my GP partner is prescribing antibiotics 3% more than average, is paid 2.5 % than average and only got 89% positive patient feedback - who do i call? GMC, NHSE, CQC ?

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  • Practice Manager | 18 February 2015 3:16pm

    there are a few doctors i've worked with in the past who enjoy naming and shaming. They revel in the fact that they might be doing something to help 'patient care' - it can also help them on the career ladder as well. they gloss over their own faults though ...

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  • so if a locum uses my prescriptions for antibiotic prescribing I will get the blame

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  • Just came back from Athens..could buy augmentin otc from a pharmacy over there.

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  • I came to UK in 1978 and since then every 5 years i have seen this topic resurrected in some form or other -nothing drastic has happened.
    majority of my colleagues are very cautious in prescribing antibiotics and there is nothing more we can do -we have even tried delayed scripts
    NICe and the Governments should now heavily spend money to empower the patients and carers
    may be in 2050we will be importing Marshans but for that please cajole the Pharmacutical industry to invest into new products -this may help make money for the rich friends of the politicians

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  • Hang on a minute guys! It could be useful for us all. prescribing data has been used in Australia for years and as long as you get a comparator - in other words, how do your prescribing habits differ from the norm - it can help to guide our habits and, if you need to, advise your patients and it might help to adjust our thinking.

    As long as NICE don't use it as a stick to beat us all over the head, there may be some benefits.

    There's no arguing with clinical findings though. If you make an empirical diagnosis of, for example, 'atypical pneumonia' who would have the courage to dispute your decision to put someone on a macrolide or a tetracycline?

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  • Another stick to beat us with that will be part of revalidation. I think that "not so nice" are going beyond their remit into regulatory areas. “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.’ do we really have the time in a 10 minute consultation! GPS really need a way to bend space time. Maybe nice can investigate how we can do this!

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  • For over 10 years I have treated my COPD, now Stage 3 (never smoked, btw, my COPD is the result of lifelong asthma and bronchiectasis), in accordance with GOLD guidelines. To do this I have had to buy my own antibiotics.

    I have no doubt at all that had I put up with NICE's paranoid and meagre prescribing guidelines I would be long dead. or, at least, very much worse than I currently am.

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  • I feel that NICE has gone over the top by now being seen managing GPs clinical decisions from a long distance by a remote control.It is downright stupid and unacceptable suggestion which should be fought tooth and nail. I have nothing nice to say about NICE.
    We need to use our clinical freedom and decision at the time of seeing a patient. If this stupidity is accepted we will see A& E unable to cope with self/ referrals and unnecessary admissions would increase with cost mounting higher & higher.

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  • Una Coales. Retired NHS GP.

    @6:24 Peter, we already have PACT data here too. http://www.patient.co.uk/doctor/prescribing-analysis-and-audit There is a hidden agenda in this draft NICE guideline. Read between the lines.

    A NHS GP partner sums it up when he wrote to me 'The CCGs/Area teams have all the prescribing data anyway! They could also use the scriptswitch software to remind trigger happy GPs when they are over prescribing. But no, remind the public again that GPs are useless. I think it's just part of the 'Soft Kill' anti-GP agenda from the government.'

    What this is asking GPs to do is essentially 'snitch', 'snoop' and 'blow the whistle' on each other for prescribing more antibiotics. If you just hear the words, you will see how ridiculous NICE suggestions are! And that is precisely what I said on Sky 'I think the suggestions from NICE are RIDICULOUS.'

    It can be used by NHSEng to then target a hapless single handed GP, if any still survive, or it can be used to throw a GP to the GMC and fail his or her revalidation, ie lose their licence to practice medicine forever.

    The bottom line is with mere months away from the General Election, GPs will be scapegoated virtually weekly to gain brownie points for the political parties.

    Look at the big picture, the farming industry and doctors and nurse practitioners in 5 world continents prescribe antibiotics, so why is the onus of global antibioitic resistance placed only on NHS GPs? Not to mention members of the public can just pop into a pharmacy in many EU countries and just buy antibiotics.

    Do not collude with another attempt to undermine NHS GPs. We are already down to 8000 NHS surgeries from 10,000 and still dropping like flies. We are seeing the death of general practice.

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  • Please will somebody start listening to Una and take her comments on board and do something in our defence. The BMA and GPC listening would be a start!

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  • Come on. We all know colleagues who over-prescribe don't we? We all get patients coming in "I usually see Dr X and they always give me antibiotics for this..." . We need to stop the overuse of antbiotics or we will go back to Fever Hospitals for infections we have no weapons against.

    Your Grandchildren's health may depend on you prescribing responsibly now!

    Yes, the fact you can buy them around the world ALSO needs looked at - but that doesn't mean we can just say "I don't care" now.

    Maybe if we want to be given more esteem and professional respect, we should stop acting like belligerent schoolkids.

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  • What is a great leveller is the first time you see someone admitted being extremely ill with a quinsy and requiring emergency surgery with all it,s possible consequences three days after being told by another doctor it was a viral infection etc. Having to placate the patient defend your partner and prevent a major complaint is a very sobering experience and stays with you.There is no experience like experience!

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  • There is too much over prescribing of antibiotics which leaves people vulnerable, it needs to be checked just as does over prescribing of psychiatric drugs but as so often the media is the message........don't trust the GP. Is the documentary 'GPs behing closed doors' helping or is it a carefully chosen snapshot of a GP practice. They seem to be an admirable bunch, shame the producer couldn't resist humiliating the elderly lady whose false teeth inadvertably slipped out. Too often the media gives a shabby picture of medics, that was unnecessary

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  • http://documents.foodandwaterwatch.org/doc/Antibiotic_Resistance_101_2014.pdf#_ga=1.212800020.1676747725.1424341241

    Reveals Nice is in pocket of vested interests just ask any vet. insulting.

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  • 'Maybe if we want to be given more esteem and professional respect, we should stop acting like belligerent schoolkids.'

    that's all well and good but those of us who play by the rules and do the 'right thing' by the state, NICE etc who then get complaints because we didn't bend the rules for the patient get thrown to the wolves with no support. I've been there. And after a lengthy investigation being told you were right doesn't compensate for the stress and hassle. Now my practice is defensive and the patient gets the benefit of the doubt. Why? because good practice isn't supported.

    i've had colleagues who refused to prescribe antibiotics for viral infections. weeks later the child got ill and was admitted to hospital. the parents were told by the consultant the GP should have given antibiotics. naturally the parents complained ' i want that foreign GPs job'. the poor doc got hounded out but it was clear from the notes he did nothing wrong. where was the support for him?

    NICE can go **** themselves

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  • there are a lot of zealots out there who go on about 'patient safety' and 'good practice'. it is all relative. i know NO GP who is perfect about everything. some are great clinicians but have zero interpersonal skills. some are great communicators but not great clinically and so on. we've all passed individual hurdles but when does the nit picking from faceless desk bound bureaucrats end?

    antibiotic prescribing increased more in secondary care than in primary care. there is wide spread use in farming and access is easier and more widespread abroad so why target and persecute UK GPs without support? The idea is divide and rule. If they can get a few GPs to 'grass up' on this there are more things in the name of patient care they will find.

    'First they came for the Socialists, and I did not speak out— Because I was not a Socialist.
    Then they came for the Trade Unionists, and I did not speak out—Because I was not a Trade Unionist.
    Then they came for the Jews, and I did not speak out—Because I was not a Jew.
    Then they came for me—and there was no one left to speak for me.'

    pastor Martin Niemöller (1892–1984)

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  • Una Coales. Retired NHS GP.

    Thank you @desmond smith for sharing. I forgot that as an ENT SHO at St George's many decades ago, if my dictated discharge letters were not read by GPs, then at least the irate patients could feed back to their GPs.

    Here is what made me angry when ENT emergencies from preventable conditions, blocked beds for head and neck cancer surgery patients. A neurosurgeon at St George's explains how he fights to operate on a patient with a brain tumour because there are no beds. http://www.bbc.co.uk/news/health-31506317

    At the time St George's had the only ENT inpatient beds out of 5 outlying hospitals! Can you imagine trying to get a head and neck cancer operation scheduled and not cancelled and rescheduled umpteen times!

    The other pet peeve was underprescribing antibiotics. Why bother giving 250 mg penicillin qds to a 70kg+ patient? It should be 500 mg qds for all cases of strep tonsillitis.

    Do not let the socialist dogma of rationing, everything is viral, do not overprescribe antibiotics, have a knock on effect on rationed hospital beds. I still have to live with the image of a 37 yo fireman with neck cancer whose op was rescheduled so many times, it made me feel sick! His golf ball cancer grew to a massive grapefruit by the time he finally got a bed and his operation. His face still haunts me as he begged and pleaded and wept with me to cut it out when I first saw him in ENT clinic as a newbie ENT SHO. The consultant said just put him on the list. The urgent list turned into a long NHS waiting list. RIP.

    If only the firemen had workers private medical insurance or a gofund website back then so he could have had his op the same week, not months later...

    A nurse scolded the senior registrar who said it was okay for the fireman to smoke cigarettes in his bed. Why? Because his prognosis was grim anyway and it was too late to quit smoking. :-(

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  • This should be about public education
    like most GP's I struggle to avoid prescribing on a daily basis
    over the course of my career I have had 2 complaints about not prescribing and 1 patient, young and pregnant who died of what seemed at the time to be a mild viral sore throat-
    It is now common place for patients to visit the GP every few days and care homes to ask for repeat visits until antibiotics are prescribed. Our triage duty doctor can have 70 calls a day many of them requesting antibiotics.
    Sometimes we just cant deal with the work load if we don't prescribe , patients no longer take no for an answer !

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