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GP practices face further pressure to reduce antibiotic prescribing

CCGs have been told to agree antibiotic prescribing targets with member practices or face losing out on funding worth an average of £110,000 as a result of NHS England guidance released this week.

NHS England this week released its guidance for CCGs for achieving ‘Quality Premium’ payments - worth £5 per patient for CCGs - which included a requirement to reduce overall antibiotic prescriptions by 1% and lower prescribing of broad-spectrum antibiotics by 10% on the 2013/14 achievement, regardless of current performance.

To achieve these, the guidance puts in place a measure for ‘individual practice reduction to be agreed by the CCG with each practice’.

This is the latest scheme to target GP antibiotic prescribing, and comes after NICE recommended that practices should be given annual reports on their antibiotic prescribing, while Pulse reported last year that health chiefs were considering putting targets into the GP contract.

Introduced in 2013 the Quality Premium is used to fund CCGs for improving patient care, at the time NHS England ruled out the money being paid direct to practices as a GP ‘bonus’ could not be used to fund practices directly.

The full Quality Premium payment is worth a maximum of £5 per patient to CCGs, and this year it also requires them to meet targets on mental health, and urgent and emergency care as well as hitting operational targets, such as achieving a planned budget.

The antibiotic prescribing targets are worth 10% of the total payments, and sets three measures for CCGs:

  • ‘A reduction in the number of antibiotics prescribed in primary care by 1% (or greater) from each CCG’s 2013/14 value. Individual practice reduction to be agreed by the CCG with each practice.’ (50% of the total antibiotic prescribing target)
  • ‘The number of co-amoxiclav, cephalosporins and quinolones as a percentage of the total number of selected antibiotics prescribed in primary care to be reduced by 10% from each CCG’s 2013/14 value, or to be below the 2013/14 median proportion for English CCGs (11.3%), whichever represents the smallest reduction for the CCG in question.’ (30% of the antibiotic prescribing target)
  • And a requirement for secondary care to ‘validate’ their total prescribing. (20% of the antibiotic prescribing target)

Dr Andy Mimnagh, vice-chair of NHS Sefton CCG, said that prescribing targets are useless without examining appropriate prescribing.

He said: ‘The problem with applying this as a metric of “x amount per thousand registered patient” is there’s no such thing. Because infections by their nature are mini-outbreaks, if you get an outbreak of something that is resistant and requires [antibiotics] then you’re going to blow the target.

‘If you really want to talk quality, you would actually have to be looking and auditing if this was an appropriate antibiotic for the appropriate infection.’

But the GPC said CCGs didn’t have to power to force practices to do anything, adding ‘any CCG that tries to do that will not get good engagement from practices’.

They said incentive payments would be more effective as long as they remunerated GPs for the additional work the scheme requires.

Dr Nigel Watson, former chair of the GPC’s commissioning subcommittee told Pulse: ‘What they might do is encourage practices to develop an antibiotic policy, and then when the Quality Premium comes, then some of the quality premium goes to practices.’

He added: ‘I don’t think it’s a bad thing with [antibiotic prescribing] being discussed nationally, to look at this, but as with any of the other measures if there is additional work required to do it, it needs to be resourced, and if there is a reward element there is no use in a CCG taking it on as a target and then putting great pressure on practices to deliver it for no benefit.’

Earlier this year, NICE guidelines said local ‘antimicrobial stewardship teams’ should review GP antibiotic prescribing and target areas where inappropriate prescribing may be driving the development of drug resistance.

Pulse revealed last year that public health officials were in talks with NHS England about the possibility of introducing targets to cut antibiotic prescribing into the GP contract.

Readers' comments (20)

  • Not given antibtiocs, punters go to ooh/a+E/ other service/all the above and will get it eventually. Cost the NHS 1000% more than the cost of anitbtiocs, punters gets what he wants. Doctor gets a complaint irrespective. Time spent on writing reply/talking to mdu/mps/mddus 100000% more than writing the script in the firsts place. Referral to the GMC. loss of income. 100000000% more than it would have cost to give the antibiotic in the first place. I'm not signing onto this scheme already. I hope my fellow GP's will all agree and carry on just as they are doing....prescribing appropriately and not looking at targets.

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  • Schemes like this will only work if the managers who introduce them have a guaranteed way to intercept ALL complaints from patients about not receiving antibiotic treatment, and a guarantee to intercept and underwrite any claims for negligence.
    Otherwise, forget it.

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  • Hilariously the story below this at the moment is the one about reporting sepsis incidents. Surely at least one person in DOH has enough brain cells to see a connection between the two.....

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  • Do H is a monosynaptic organism

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  • If governments are really serious about this (and they should be given AMR), then farming use and OTC availability in many (EU) countries must be grasped. This is a bit like green energy efficiency in the West when China has been opening (brown) coal -fired power stations at a rate of knots.

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  • John Glasspool

    Watch the death rate from sepsis rise!

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  • Just spend £10000 make an advert and show it after EastEnders and Football matches to stop well people bothering us about sore throats , 2 day coughs and antibiotics. But no. You can't be bothered - let's make protocols and policies and jump through loops.

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  • What happens if the practice has already cut antibiotic prescribing by x% over 2 years following a CCG led QIPP antibiotic prescribing initiative.
    How do cut again by another x% without endangering patient's lives??
    In the next breath NHS England blames GPs for not recognising and treating sepsis in a timely manner.
    Then PHE adds insult to injury and implores us to treat any suspected case of scarlet fever with 10 days worth of penicillin. How many viral rashes have we been treating un-necessarily while waiting for the negative throat swab to come back?

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  • Talk about MICROMANAGING.
    Why don't we just phone up Hunt everytime we want to prescribe an antibiotic to ask his permission.
    I despair, really I do....
    Only answer seems to be RLE..

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  • Great - more dumbed down medicine by numbers. What's the point of training professionals if all they do is hit targets and tick boxes?

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