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More than 8,000 individual GPs warned over their antibiotics prescribing

Exclusive The Chief Medical Officer has sent personalised letters to more than 8,000 GPs telling them that they are overprescribing antibiotics.

The letters were targeted at all GPs in the 20% highest prescribing practices, as well as GPs in practices who have seen their numbers rise by at least 4% each year.

Public Health England has said that they are designed to respectfully support antibiotic stewardship.

The BMA's GP Committee said there were several factors involved in prescribing rates, while local leaders told Pulse these measures are conveniently ignoring the drive to increase prescribing in areas such as sepsis.

Over 6,000 GPs working in 1,414 practices received a letter explaining that their practice was in the top 20% prescribing antibiotics, following a similar letter in previous years. These included practices which have seen rates decline but are still in the top 10%.

However, unlike previous years, a new version of the letter has also been sent to half of the 4,796 GPs working in the 930 practices where prescribing rates have increased every year by more than 4%. These did not include those in the top 20% or bottom 5%.

PHE has confirmed that this is a controlled trial to test its effectiveness, which has increased the total number of letters sent from approximately 6,300 in 2016/17 to around 8,800 in 2017/18.

A spokesperson said: ‘These annual letters are designed to support and encourage practice-based stewardship as we know antimicrobial resistance is an issue of serious concern.

‘We hope that the letters will respectfully support GPs to improve their antibiotic stewardship.'

They added that this will ‘contribute to a significant reduction in the population risk of antimicrobial resistance.’

Researchers have claimed that antibiotic prescribing was reduced by 3.3% in targeted practices, within the six months following the first batch of letters in 2014/15, when compared with other high-prescribers who did not receive a letter.

This equated to approximately 73,406 fewer items dispensed, and led to the letters being implemented annually.

GPC clinical and prescribing policy lead Dr Andrew Green said: ‘It is vital that all opportunities are taken to reduce the risk of anti-microbial resistance, and these letters have in general been welcomed by GPs who are interested in how their prescribing compares to their peers or their previous levels.

‘It is important to realise that there may be very good reasons why practices have the prescribing rates that they do, but it is nevertheless important that practices are aware of any differences that exist.’

But Dr Zishan Syed, who is the Kent LMC rep for West Kent, argued that GPs are being held to a ‘completely unrealistic expectation’.

He said: ‘Frequently experts who have little experience of frontline pressures of general practice blame GPs for "high rates" of antibiotics and conveniently ignore the drive to prescribe to reduce sepsis rates.

‘GPs work in a toxic litigious climate. If a patient does develop serious complications, then it is almost certain that an "expert witness" will happily blame a GP in their report for not prescribing antibiotics which could potentially end that GP’s career.'

Attempts to reduce antibiotics prescribing

PHE launched a national campaign to ‘Keep Antibiotics Working’ last year, including advertisements aimed at the public.

CMO Professor Dame Sally Davies wrote to GPs to ask for their support, stating that the aim is to encourage the public to ‘take their doctor or nurse’s advice’ regarding when antibiotics are appropriate.

In 2016 PHE announced that GP antibiotic prescribing had decreased by 6% over three years, although research commissioned by the body has stated that between 8% and 23% of all antibiotic prescriptions in primary care were still inappropriate.

PHE have since announced this number as 'at least' 20% and set a target to cut it in half.

Simultaneously, there has been increasing pressure on GPs to spot and prescribe antibiotics for sepsis, with NICE telling doctors that antibiotic should be administered within an hour of sepsis being suspected and diagnosed.

sepsis campaign has also been launched in Scotland, which aims to increase awareness and ensure that patients receive antibiotics ‘as quickly as possible’.

Readers' comments (40)

  • I got a letter and ......binned it:)

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  • Dr Syed got it spot on
    well said

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  • And will the CMO be also issuing a ‘Get out of Jail Free’ card so that when someone dies of sepsis as a consequence there will be no repercussions for the doctor?
    Will the CMO be writing to our hospital colleagues, who appear to prescribe antibiotics with much more abandon than we do?
    And will the CMO be writing to online providers to hold them to the same standards we are being held to - which will mean an end to 5 Star reviews and to them giving patients everything they want as it is significantly easier?

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  • How about sending old people home from the ED with a “UTI” on a weeks antibiotics because they had a trace of leucocytes on urinalysis after falling over because they’re frail and demented, and really need admission and a proper MDT?

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  • And will the CMO be ensuring better practice in the agricultural industry, and also in other countries around the world who we are already performing much better than?
    We remain lions lead by donkeys.
    Hee haw Mr CMO.

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  • Aplogies: 'Mrs' CMO.

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  • Just an addendum to Northwestdoc’s comments which I totally support- how many times are we told an elderly relative was discharged from hospital at 3 or 4 am with, of course, Co-Amoxiclav for the UTI epidemic -well it should at least help the constipation!

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  • The sepsis campaigners won and antibiotic era is coming to an end. I suspect most of the prescribing rates will vary according to demographics - retirement towns and poor areas will use more. If they were serious, the CMO would support calls for regulatory reform and increased resources so we can spend more time with patients. Instead they have chosen to blame GPs for political expediency.

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  • Dear All,
    Please define "prescribed". Does this mean a computer record extracted from a GP system about a prescription issued or does it mean a prescription received by a chemist, dispensed and then processed by the PPA?
    One has some validity the other not.
    Rgeards
    Paul C

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  • Agree with Dr syed. I was persued for years by a solicitor and an " expert witness" and criticised for not issuing antibiotics when they were clearly not indicated. Although this finally was thrown out the process dragged on for 3/4 years.

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