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The draft guidance recommends that organisations consider linking prescribing to GMC numbers, other identifiers, so that GPs can receive individualised feedback on their own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

  • 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.


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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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