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The waiting game

Health chiefs considering putting antibiotic prescribing targets into GP contract

Exclusive Public health officials are in talks with NHS England about the possibility of introducing targets to cut antibiotic prescribing into the GP contract and publishing individual GP antibiotic prescribing rates, Pulse can reveal.

The move comes as a new report into antimicrobial resistance and antibiotic use from Public Health England (PHE) shows there was actually a 3.5% drop in the total number of antibiotics prescribed by GPs between 2012 and 2013 – compared with around a 3.5% increase in hospitals.

PHE chiefs said the recent drop in GP antibiotic prescribing was encouraging but that more needed to be done to make sure the trend continued and to reduce wide variation in prescribing between practices in different areas – which they say corresponds with antibiotic resistance levels.

They plan to make GP practice-level data on antibiotic prescribing publicly available on the PHE website from next April, with a view to publishing individual GP prescribing data as well as hospital data in the future.

In addition, PHE and NHS England are exploring ‘contractual arrangements’ to performance-manage antimicrobial stewardship, including ‘potentially’ introducing targets in the GP contract, they told Pulse.

This comes as the Government is focusing on prescribing rates, with warnings from the UK’s chief medical officer, Dame Sally Davies and the prime minister that the current attitude to prescribing could cast the world back to a ‘dark age of medicine’.

Only this week, Pulse reported that the CQC is considering publishing individual practices’ data on GP prescribing of antibiotics and benzodiazepines, in a move GP leaders describe as ‘dangerous and simplistic’.

The PHE report – the English surveillance programme for antimicrobial utilisation and resistance (ESPAUR) – brings together community and hospital data on prescribing and antibiotic resistance for the first time, as part of the wider Government strategy for tackling antimicrobial resistance.

It shows:

  • There was an overall 4.1% increase in total antibiotic prescribing by GPs over the four-year period between 2010 and 2013, but there has been a drop of 3.5% from 2012 to 2013;
  • By comparison, antibiotic prescriptions to hospital inpatients increased steadily by 3.5% year-on-year, with a much bigger 12% rise seen over the same period;
  • Total prescriptions from other services in the community – which included walk-in centres and dentists – rocketed by 32%;
  • GP antibiotic prescriptions were highest in the north-east, where they were 40% higher than in London.

PHE leaders stressed some variation across the country could simply be down to the way patients access healthcare – with more patients attending hospitals instead of GP practices in London, where hospital prescribing levels were highest nationally.

But they said areas with the highest antibiotic prescribing rates were also those with the highest levels of antibiotic resistance, as evidenced by rates of antibiotic-resistant bloodstream infections.

Professor Anthony Kessel, director of international public health at PHE, and a former GP, told Pulse cutting antibiotic use in the highest-prescribing areas should therefore bring down resistance – and publishing the data would be the first step to making sure doctors and local health leaders could be held to account on how they go about this.

Professor Kessel said: ‘It makes sense to try and drive down the total amount of prescribing, especially in areas where it’s particularly high, because we will anticipate seeing a fall in resistance as a result.’

He added: ‘This is the start - our intention is to make this data available more frequently than annually, and at practice – even ultimately, although we can’t get there yet – individual practitioner, prescriber level.’

PHE is looking at increasing education and peer support to change prescribers’ practice, which includes refining the TARGET toolkit on the RCGP website, and new NICE antimicrobial stewardship guidelines coming out next year.

Professor Kessel added: ‘There will be new mechanisms, especially through work we’re doing with NHS England, around holding local health economies to account through contract arrangements and so forth.’

Asked if these mechanisms would include measures introduced into the GP contract, Professor Kessel said: ‘Potentially, yes.’

Dr Richard Vautrey, GPC deputy chair and a GP in Leeds, said the report showed GPs were already the most responsible NHS prescribers, and dismissed the idea of introducing targets for antibiotic prescribing into the GP contract.

Dr Vautrey said: ‘These figures suggest GPs are really working hard to try and address this issue and others have got to catch up with them. It’s something we’re very aware of and GPs particularly have had a focus on their prescribing for a generation – and that’s probably why we are doing that bit better than in other areas.’

He added: ‘I don’t think it would be a good idea [to put this in the GP contract]. I think we want to move away from those sorts of targets. We know what our professional and prescribing responsibilities are, I don’t think targets would be particularly helpful.’

Public Health England - ESPAUR Report 2014

>>>> Clinical Newswire

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Readers' comments (36)

  • Gp rise 4% , hopsital rise 12% other community prescriber 32%.
    do they not see that GP constrait on use is driving patient to access AED/WIC and other sources where lack of familiarity with the patient and less experienced staff are more likely to issue antibiotic.
    For once bite the bullet and tackle the issue- a consumerist drive for "a pill for every ill" fuelled by political ideology.
    I wear my multiple complaints about declining Antibiotic with pride- everyone is alive and able to complain despite my declination- up to the point where the weight of paper means the GMC will strike me off because they believe" theres no smoke without fire"

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  • This country is becoming a joke to work as a doctor. I have worked in other places and nowhere I have seen so much doctor bashing culture. There is something fundamentally wrong here. There is so much emphasis on bashing GPs and it's going crazy. In my experience having worked in other countries is that people there were not at all interested in what doctor's were doing. We worked hard, earned good money and that's it. But here, there is something in the press everyday for us!!

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  • Peter Swinyard

    When you get over the anger of another GP-bashing from others in the profession who should know better backed up by the lazy journalism of the BBC, you look at the figures which show that GP prescribing is rising much less fast than that of OOH, Walk in Centres and A&E. Could this be because continuity of care reduces prescribing and health care costs.
    And the elephant in the room on this occasion (apart from the CQCs mad publish everything culture) is veterinary use in animal husbandry.

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  • Enough with the targets!
    Whatever happened to prescribing for the patient?

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  • And have you noticed the nice ENT surgeons saying they'd be grateful for scripts for 3/12 clarithromicin? If it works - why not? Just don't blame me.

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  • Great excuse for not prescribing!

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  • I suggest referring every patient who might need antibiotics to hospital for a full blood count and chest xray. One can never be too sure.

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  • Time to draw a line in the sand. Have we no clinical autonomy ? This is a matter for GPC/RCGP to resist. Shame on any CCG which supports it.

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  • David Brownridge | Sessional/Locum GP | 10 October 2014 2:27pm
    Time to draw a line in the sand. Have we no clinical autonomy ? This is a matter for GPC/RCGP to resist. Shame on any CCG which supports it.

    Well there has to be a first time for everything, but you are peeing into the wind if you think the GPC will stand up firmly and stop this. GPC rolls over to everything.

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  • So how much does secondary care prescribe for their bacteiral irradication pre-op?

    It's unethical (?illegal) to pay people to not do something.

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