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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’.

Related images

  • Antibiotics - online

Readers' comments (40)

  • Think this letter bypassed headspace,bypassed pending tray(pre bin)and went straight into the bin where it belongs,more junk mail.

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  • A stern letter will solve the challenging demographic, poor funding, burnt out staff and mass health anxiety related hysteria followed by relentless litigators. Good luck.

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  • We practice in a litigious culture. Before it was just the patients but now the NHS CCG AND THE GMC who hound the GPs like vultures to punish you for one mistake. If your hands are tied and you are still expected by the GMC and the CQC to be able to swim or rescue someone from fire it’s time to stop practicing medicine in the UK.

    I have seen many GP struggling with complaints for months purely for doing the right thing.
    As some one pointed out once you reduce the patients go to OOH and A&E to be given abx and the next thing you get is a spat in your face from your patient.

    Until the public are educated
    Until there is a test to dx viral / bacterial infections we are subject to pressure from patients
    Until there is crown indemnity
    Until the CMO gives clear reassurance of protection of doctors against complaints or unfortunate death from sepsis the ABX prescribing is not going down I am afraid.

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  • Imagine your prescribing rate when the GMCs rate your doctor app goes live. Where patients will be able to submit the satisfaction of GP consultations via mobile app as soon as they come out of your consulting room.
    Welcome to brave new world.

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  • AlanAlmond

    It’s so good that paramedics will soon be allowed to prescribe isn’t it. Does anyone believe they will be less inclined to prescribe antibiotics than fully trained GPs? Where does this fit in in the bigger picture? Similarly where does this fit in with the current politically driven crusade focusing on sepsis?. (Jeremy Hunt’s very personal passion) Is there any overall medical coordination of anything in our wonderful centralised healthcare system? Seems not. I wonder why.

    Perhaps it’s got something to do with the fact this wonderfully centralised health care system is coordinated and lead by people with degrees in things like history, politics, economics and with work experience in things like marketing, public relations, local radio and organising sporting events (Steven Brine, Jeremy Hunt) Why would these people know how to appropriately coordinate, design and tinker with the health provision of an entire population? Is this task child’s play? Is all you need a ‘good classical education’ , ‘a quick mind’ and ‘the right connections’? Urrr no it isn’t. Some basic back ground in bioscience and/or medical issues should, I think, be pretty much compulsory. What is the point of all the training, experience and research when we pay so little attention to who’s in over all control.

    UK healthcare provision in a mess? QED

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  • Binned it.

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  • Took Early Retirement

    I suggest that you either:-

    1. Wipe your bottom with the letter and return it to Dame Sally.

    or

    2. As the DoH has said it is a "controlled trial" ask as a FOA enquiry which ethical committee approved it,and, if answer comes there none, refer the said Dame to the GMC.

    I would do this myself but:-

    1. I'm retired; specifically to avoid this sort of faeces.

    2. On holiday on a cruise.

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  • I received a letter along with all my colleagues. I found the wording of the letter insulting. We have a very elderly population. There was no indication that they had taken demographics into account which in my mind makes this meaningless. I have increased prescribing in those elderly patients who have been admitted with sepsis and then show resp/urinary symptoms again. Like others, I don’t want litigation about missing or not acting on early signs when there is a history of sepsis. I will not be changing by prescribing on receipt of this letter.

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  • I got one of those letters.

    I saw that it was signed by the same CMO who, a couple of years ago, made a fuss in the papers about how clothes shops that used dummies the size of actual human beings were fuelling the Obesity Crisis.

    I made lots of copies, and now hand them out to my patients along with those insulting "non-prescriptions" that our prescribing lead keeps dumping on my desk.

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  • doctordog.

    If it can be proven with or without hindsight that the antibiotics I prescribe are unnecessary , then I will pay more attention to this letter.

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