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NHS England plans for GPs to test patients before prescribing antibiotics

GPs could see point-of-care testing introduced into their practices in the future as part of the drive to reduce inappropriate antibiotic prescribing under a new scheme launched by NHS England.

The new UK Antimicrobial Diagnostic Collaborative programme, launched to coincide with the NHS’s 70th birthday last week, will initially focus on C-Reactive Protein (CRP) testing in primary care.

NHS England’s deputy chief scientific officer said a ‘big piece of policy work’ was underway to understand how to drive point-of-care testing.

However there are few details about how the programme will be rolled out and what resources will be made available for GPs.

Introducing the collaborative at the Antibiotic Guardian Conference a week ahead of its official launch, NHS England’s deputy chief scientific officer Fiona Carragher said: 'We are missing a trick if we are not using diagnostics as a key part of our stewardship arrangements.'

She said the NHS needed to 'move from an empirical diagnosis – made particularly in primary care, where they haven’t got diagnostics in the same way as for example in the hospital - to a much more targeted approach, so we understand what the infection is and we are treating it in a very targeted and personalised way.'

‘To do that there’s a huge opportunity to use the rapid point-of-care diagnostics that are coming onto the market at pace...

‘Lord O'Neill [referring to a 2016 review] set out a real challenge to governments not just in the UK but across the world to say actually, we shouldn’t be prescribing if there’s a diagnostic test, we should be using it and we should be prescribing on the basis of that,’ she added.

But when asked by an audience member what support and funding will be put in place for GPs to carry out point-of-care testing, she replied: ‘The big piece of policy work we’re doing at the moment is to understand what the opportunities to drive the point-of-care testing will be.'

The launch comes after research commissioned by Public Health England found one in five GP antibiotic prescriptions are inappropriate, and the body announced its ambition to cut such prescribing by half over the next two years.

Speaking at the launch of the new programme, GP and Sheffield CCG clinical director Dr Andrew McGinty, who has been working with NHS England on the project, said: ‘Long I’ve wished for a test, which will help me understand who needs antibiotics and who doesn’t need antibiotics.

'Currently, point of care C-reactive protein testing is the closest we have to that. It’s an acute-phase protein, which is raised when there is inflammation strongly associated with bacteria rather than with viruses.’

He continued: ‘Through an accelerated learning event, with the pilots and pioneers who are using CRP testing in the primary care setting, we have begun to understand some of the challenges that exist...

‘However by working together through the antimicrobial resistance collaborative, we can start to develop a policy to ensure that the test is done in a clinically suitable and financially sustainable manner, to help patients.’

NHS England told Pulse the programme was in its early stages and that further details would be announced in the future.

Responding, BMA GP Committee chair Dr Richard Vautrey said: ‘We would be interested in exploring improved diagnostics to help support clinical decision making, however when those in general practice are dealing with large numbers of patients with a limited amount of time per consultation, any tests suggested must be almost instantaneous and consistently reliable to be practically useful.’

Attempts to reduce antibiotics prescribing

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’.

And in April, nearly 9,000 GPs were sent personalised letters by the Chief Medical Office Professor Dame Sally Davies warning them about their antibiotic prescribing.

Readers' comments (28)

  • excellent. this is great news. well done and we should fully support this. it is excellent patient care and will reduce risk all round.
    well done guys. I am really happy that a GP is also involved in developing this as well so that General practice is represented in this process.

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  • Pity there is or at least was when we scored it for investment 12 months ago no compelling evidence. So much wrong with this as CRP isn't absolute - I dont have time to do the test either. Since GP isnt the problem with antibiotics please stop beating us about it.

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  • Agree with DrDr. It is often misleading. One patient in whom I did CRP (slightly above normal range) was off the scale when admitted to hospital some 12 hours later. Happily I had given that person appropriate antibiotics anyway. They have been doing this for years in Sweden in primary care: the evidence from there is not convincing with their antibiotic prescribing higher than in the UK. We should perhaps see what they are doing in the Netherlands where antibiotic prescribing and resistance is the lowest in the world. This is just another Public health England stunt which will have everyone following guidelines by using a tests which is not fit for purpose, not allowing doctors to use their professional discretion.

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  • You don’t diagnose bacterial infections with a CRP

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  • A practice I locumed at tried this. The kit and consumables are expensive; the time involved is significant, "rapid" is misleading. The outcome was a very modest reduction in antibiotic prescribing, and a huge increase in demand for staff time to perform the test and discuss with patients. Barge pole guys, unless large sums of money for increased staffing costs, adequate training and for on-going consumables.

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  • It’s obvious we’re not very good at this. Take the funding we get for acute infective illness and use it to see them in a and e. That will work much better

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  • -CRP testing simply isn’t specific nor sensitive enough for routine use in the current medico-legal climate
    - who pays for the kits? (GPs? Then forget it!)
    - the “test to see if you need an antibiotic” could increase the number of patients attending, rather than waiting for their virus to pass
    - previous guidelines have suggested that a negative or borderline result be repeated in 24 hrs if no better. Just where is all this extra capacity coming from?
    - your appointments are full, but a dozen mothers of little Johnnies with temperatures and snotty noses want the “antibiotic test”. Do you risk not even seeing them??
    - clinically you think it’s a virus, but CRP raised, so you give an antibiotic where previously you did not
    - clinically you think it’s bacterial, but CRP normal, you give an antibiotic any way. If the country still wants prosecutions for missing sepsis, I’m not relying on an inadequate test.

    I’m all in favour of better diagnostic tools, but CRP just doesn’t cut the mustard. It’s been around for ages, there’s a good reason it has never been adopted, but this current obsession with cutting GP antibiotic prescribing (when the real problem is in farming and other countries selling them on the High Street) is forcing it on to practices who simply cannot cope with the time, expense and medico-legal fallout of an inadequate test.

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  • GP antibiotic prescribing will reduce when-

    1) we have more time for patients
    2) we can follow them up if needed
    3) we aren’t terrified of complaints/gmc witch hunt

    Ideally some common sense and backbone for the population as well but that won’t happen

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  • The stingy NHS will soon work out testing CRP is more expensive than antibiotics and it will be scrapped. It is not a reliable test anyway and we have no time.

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  • Only good news is that it will probably destroy the GP@Hand model of care ...

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