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GP targets on antibiotic prescribing would be too risky, warns GP academic

Giving GPs targets on antibiotic prescribing could risk patient care and more research is needed before the profession is blamed for their inappropriate use, according to a leading GP academic who has pioneered successful approaches to cutting the prescribing of antibiotics.

Professor Chris Butler, professor of primary care at the University of Oxford, criticised ‘GP-bashing’ over rising antibiotic use, and called for more funding and education to enable GPs to play their part in cutting unnecessary antibiotic use.

Professor Butler’s comments came as the RCGP joined with other Royal colleges in calling for ‘binding national targets’ to get antibiotic use back down to 2010 levels, after an overall 6% increase in antibiotic prescribing across the NHS between 2010 and 2013.

Public Health England’s ESPAUR report into antimicrobial use and resistance found GP prescribing had gone up the least out of all NHS prescribers, by around 4%, and actually fallen in the past year.

But PHE officials are now in talks with NHS England about how to implement targets for cutting antibiotic use - which could include performance management on antibiotic prescribing through the GP contract.

Speaking to Pulse at a summit on antimicrobial resistance held jointly by the royal colleges, Professor Butler said rising prescribing rates should not be simply attributed to inappropriate GP prescribing, and that introducing targets risked putting GPs under pressure so that they missed serious infections.

Professor Butler said: ‘I don’t believe the rise in antibiotic use is because GPs are becoming more reckless… We need better research into who is actually getting these additional antibiotics – we don’t know that yet, so it’s very premature to start bashing GPs and saying they’re just losing their grip on it.

‘The population is changing, the bugs could be changing, the medicolegal environment is changing and the structure of primary care is changing – GPs are often not looking after their patients 24-7 as they were, patients can move around and Government policy is fragmenting what was once a comprehensive, holistic approach to care – and this is one of the consequences.’

He added: ‘If you’re going for a global reduction in antibiotics, and yours is a practice with many care home patients, that is not so easy to achieve. Particularly as patients are getting older, more frail and sicker.

‘You need more time to assess these patients… If you just say, oh we can’t prescribe antibiotics any more, you might find yourself missing the person who does in fact have pneumonia.’

Professor Butler, whose STAR (Stemming the Tide of Antibiotic Research) educational programme has been shown to enable GPs to safely reduce antibiotic prescribing, emphasised that improving GP consultation skills and increased use of CRP testing – along with public education –  has the potential to markedly reduce unnecessary prescribing, in particular for respiratory tract infections in healthy people.

But he stressed GPs needed more resources and time to implement better consultations and testing.

He said: ‘If we want GPs to be communicating better with patients and doing better assessments and testing, we can’t do that unless we have the resources – and we’re faced with fewer GPs, more patients and less money.’

Despite the RCGP’s call for ‘binding national targets’, chair Dr Maureen Baker told Pulse that targets, particularly through the GP contract, would have to be considered ‘very carefully’.

Dr Baker said ‘That would be something we wold have to think about very carefully in terms of the safety perspective. Any moves to do that sort of thing should be risk assessed so that any safety implications are well understood and properly mitigated.’

She added: ‘What we don’t want is a culture where GPs are worried of exposure or recrimination for prescribing an antibiotic for what they feel are in the best interests of the patient.’

>>>> Clinical Newswire

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