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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)

  • Many comments say that antibiotic prescribing is not the fault of GPs, nor can they do anything about it. I accept that this is only one angle to attack on AB over-prescribing but if it doesn't start with GPs (and dentists and other prescribers) where should it start? Patients may request it but if a patient requested some other inappropriate treatment, would GPs simply roll-over? I don't think so.

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  • Took Early Retirement

    It needs some clever people to devise bedside tests to see if an infection is truly "viral" or not. As many bugs are still undiscovered, this will be difficult. (Ask a Microbiologist- in the sputum of CF patients they find all sorts of DNA/RNA from as yet unknown organisms. Personal communication from a chest physician)

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  • Go on NHSE: Carry on bullying......

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  • I find myself in the most unusual position of disagreeing with most posters on here about this. There is no doubt that we do prescribe too many antibiotics. It is also true that the reasons for this are multifactorial and complex and the is no simple solution. I am a working GP and I understand the nature of the Dr-Patient relationship and the problems of pressure and expectation, and I understand the threat of litigation.

    However, being angry and telling The Man to leave us alone and blame the vets instead doesn't really help. We can all do our bit, and clearly the system isn't working well. Perhaps it is reasonable to somehow incentivise people to think about this more?

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  • In the former Soviet Union much useful work was done on the use of Bacteriophage viruses to combat bacterial infection . With modern production methods surely this must be considered an alternative .

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  • why is everyone worried. I think best policy from govt would be to employ cqc and statisticians and NHS England chiefs to run gp surgeries and throw away the evil gp. then they can refuse abx to 9 out of 10 patients and then give abx to the 10th patient. stats will look good. NHS england can rund gp surgeries and employ consultants and not scare anyone into gp world as they wont need gp anymore. cqc can monitor itself and will come out sparkling and shining as they know how to run gp surgeries. every one happy.

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