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Gold, incentives and meh

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The draft guidance recommends that organisations consider linking prescribing to GMC numbers, other identifiers, so that GPs can receive individualised feedback on their own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

  • 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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