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GPs should be referred to GMC for persistently over-prescribing antibiotics, says NICE  

GPs who persistently prescribe antibiotics inappropriately should be referred to the GMC and face sanctions under new measures to systematically monitor their individual prescribing of antimicrobials, NICE experts have said.

The threat came as NICE published final guidance on antimicrobial stewardship, recommending GPs have their individual antibiotic prescribing monitored and reviewed at least once a year.

The guideline recommends ‘local systems and processes for peer review of prescribing’ to ‘encourage a culture’ where colleagues question one another where their prescribing practices are ‘not in line with… guidelines and no reason is documented’.

Professor Mark Baker, director of the centre for clinical practice at NICE, explained this could mean that most inappropriate prescribing of antibiotics could be dealt through GPs’ normal appraisal and continuing professional development and a minority of ‘persistent offenders’ could face referral to the GMC and sanctions.

However, the RCGP warned it could be ‘counter-productive’ to threaten hard-pressed GPs with sanctions for inappropriate prescribing.

The guidelines were unveiled in draft form earlier this year and recommend local ‘antimicrobial stewardship teams’ review and provide regular feedback on individual GPs’ prescribing data, as well as local antibiotic resistance rates, to try to tackle areas where inappropriate prescribing is driving the development of resistance.

NICE said it developed the guidance following continuing unexplained growth in antibiotic prescribing, and in line with the Government’s strategy for tackling the threat of antimicrobial resistance – through which public health officials have said GPs should face targets on antibiotic prescribing through the QOF or other contractual measures. GPs in some areas are already being given locally agreed targets as part of their CCG’s quality premium measures.

However, the draft came under criticism after GPs pointed out it would be technically impossible to monitor individual prescriber data under the current system, and called for wider efforts to tackle antimicrobial resistance including better education for the public.

The final NICE recommendations remain largely unchanged from draft, but NICE experts have now revealed that they expect the local stewardship teams to feed the data into the revalidation process and pick up those GPs who are ‘outliers’.

Professor Baker told Pulse: ‘If the measures we’re proposing are put in place, then the prescribing of antimicrobials practiced by every practitioner will be available to form part of their annual appraisal documentation – and outliers can be identified and in some cases will be taken further at a local level.’

Professor Baker added: ‘For “persistent offenders” the ultimate sanction would be a referral to the GMC under its performance procedures. But it’s only very rarely that they ever get to a panel as the vast majority of doctors are wise enough to change their practice before it gets that far.’

Mr Niall Dickson, chief executive of the GMC, said that annual appraisals, as part of the revalidation cycle, offer a ‘valuable opportunity’ for GPs to reflect on all aspects of practice including their prescribing – and that ‘we would expect that doctors would undertake any further training that might be identified as part of that process’.

Mr Dickson added: ‘Doctors can, and do, face sanctions for mis-prescribing, although the law dictates that each case has to be considered on its merits to determine whether the doctor’s actions pose a risk to patients or confidence in doctors.’

However Professor Tim Ballard, vice chair of the RCGP said a ‘societal change’ was needed towards the use of antibiotics and that ‘any suggestion that hard pressed GPs - who are already trying to do their jobs in increasingly difficult circumstances - will be reported to the regulator is counter-productive and unhelpful’.

Professor Ballard added: ‘If this were to happen, we would be looking to the General Medical Council to support any GP or other health professional who finds themselves on the receiving end of complaints or criticism about decisions made over the prescribing of antibiotics.’


Unsure of the best methods for reducing antibiotic prescribing? Pulse Learning offers tips (£) on how you can implement evidence-based strategies in practice.

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Readers' comments (93)

  • They don't treat doctors in other countries like this.
    And by 'this,' I mean shit.

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  • Less than 198 working days to go.....

    .....but maybe a lot less if this continues

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  • Hate how there is never any recognition of the good work that we do carry out.
    Top antibiotic in the US? Azithromycin, because its OD and only needs 3 days.
    We're doing vastly better than a lot of folk out there...

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  • From now on

    1. Refuse any AB prescription from anywhere unless patients are seen by you.
    2. Refuse any prophylactic AB prescribing - adv secondary care to do this themselves
    3. Stop all COPD rescue packs
    4. Admit every single cellulitis
    5. If AED fails to provide full course of AB, advice patient to re-present to AED (and report the AED doctor to GMC whilst at it for failing to treat a patient adequately)
    6. Refer every patient with leg ulcer
    7. FBC, CRP on every patient with any vague Hx of possible infection who might need AB. Mark all of them urgent.

    This should reduce our AB prescribing dramatically. Of course it might over burden the rest of the system but that's not our problem. Two can play the same game.

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  • Are they out of their F----ing minds!!

    Have they so completely lost it.

    Has anyone one of these bloody idiots ever sat in a GP Surgery consultation rooms?

    Push this one into law you clowns and you'll have collapse of general practicein no time at all!!

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  • It's all very well venting your spleens on here, but it counts for nothing. What is your useless Union doing to counter-attack and have the mad Professor disciplined for making such inflammatory public statements?

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  • Vinci Ho

    Interesting that BBC health news reported a case study in its article on this news and more or less supporting our arguments:

    Professor Mark Baker, NICE: "People who overuse antibiotics are creating a problem for patients with life-threatening infections"
    "Soft-touch" and "hazardous" doctors should be disciplined for prescribing too many antibiotics, a leading NHS figure says.
    The National Institute for Health and Care Excellence's Prof Mark Baker said 10 million prescriptions a year in England were inappropriate.
    He said regulators need to deal with overprescribing doctors who failed to change their ways.
    The Royal College of GPs said the call was "counter-productive and unhelpful".
    There is universal consensus that the very basis of modern medicine is under threat due to rising numbers of infections that are resistant to drugs.
    The "antibiotic apocalypse" not only means that long-forgotten infections could kill again, but jeopardises procedures including surgery and chemotherapy.
    Using antibiotics inappropriately for sore throats and colds increases the risk of resistance. Yet the number of prescriptions continues to rise.
    Some bacteria are becoming resistant to our best drugs
    NICE has prepared fresh guidelines on antibiotic prescribing for the NHS in England, which can be adopted by other parts of the UK.
    The guidelines acknowledge that there is huge pressure from some patients for the drugs.
    Antibiotics - what are they good for?
    Antibiotics can treat bacterial infections, but they are useless against viruses or other types of infection
    Colds and most coughs and sore throats are caused by viruses
    And our bodies are good at fighting off many common infections, including ear infections, on their own
    Your doctor should only prescribe antibiotics when you need them, for example for a kidney infection or pneumonia. Antibiotics may be life-saving for infections such as meningitis
    By not using them unnecessarily, they are more likely to work when we need them
    You could talk to your pharmacist or GP if you want to learn more
    Prof Baker even said some people were "addicted" to the idea of getting antibiotics, even for conditions that would clear up on their own.
    He added 97% of patients who asked for antibiotics ended up getting them, often by identifying a "soft-touch" doctor.
    The guidelines say doctors should tell patients when antibiotics are inappropriate and refuse to write prescriptions.
    Prof Mark Baker, director of the organisation's centre for clinical practice, said: "We are proposing that evidence is collected so the finger can be pointed at people who are a soft touch."
    He said antibiotics could cause more harm than good in some patients, so overprescribing was "really hazardous practice".
    And, he said, doctors should be encouraged to change their habits. But ultimately some cases should be dealt with by the General Medical Council, which has the power to withdraw a doctor's right to practise, "if necessary".
    Klebsiella pneumonia bacteria
    NICE admits that if previous guidelines on respiratory tract infections, which include colds, were actually followed then prescriptions would be 22% lower.
    The latest rules for doctors should cut the 42 million prescriptions given each year by around a quarter.
    Dr Tim Ballard, from the Royal College of GPs, said the focus needed to be on "societal change" - not doctors.
    He said: "Any suggestion that hard-pressed GPs - who are already trying to do their jobs in increasingly difficult circumstances - will be reported to the regulator is counter-productive and unhelpful."
    Case study
    Robert, from Dorset, says some doctors are too restrictive.
    "My daughter was ill for many weeks because the doctor refused an antibiotic.
    "She was very poorly and the doctor said it was just viral and told us to go away. We took her back again and got the same response. We took her for a third time and asked him to test her mucus. He phoned us - rather embarrassed - to say that she had pneumonia.
    "He prescribed her antibiotics and she got better quite quickly.
    "Weeks of needless suffering!
    "I'm sure he was under pressure not to prescribe antibiotics."
    NICE will be publishing guidelines on educating the public next year.
    Other recommendations include the use of "delayed prescribing" where a patient can only use a prescription if his condition gets worse and creating "antimicrobial stewards" who identify high levels of prescribing.
    Niall Dickson, the chief executive of the General Medical Council, said doctors should reflect on their prescribing habits as part of an annual appraisal.
    He said "doctors can, and do, face sanctions for mis-prescribing." But the message is "more about changing the norms of practice generally than pursuing individual doctors".

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  • I leave and work in the world (but not yet in the U.K).
    An answer:
    Do the beautiful minds that are working at NICE see patients ? I've idea that they are forgetting what it means to care patients. But I understand they have to justify their high incomes. So, no comment

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  • i think its very unfair to blame GPs-all my colleagues are very prudent prescribers specially when it comes to antibiotics-but there are occasions specially Fridays when its a dilemma-i usually use the deferred scripts but does that guarantee that the patient will not misuse this

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  • This policy would end the practice of delayed scripts as they would count towards an individual doctor's total whether dispensed or not.

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