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The draft guidance recommends that organisations consider linking prescribing to GMC numbers, other identifiers, so that GPs can receive individualised feedback on their own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


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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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