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NICE plans for GP antibiotic prescribing reports branded 'pointless'

NICE proposals for GPs to get personal reports on their antibiotic prescribing performance have been branded ‘pointless’, after a sessional GPs group pointed out that data for individual GPs will often include prescriptions by locums in their practice

The National Association for Sessional GPs said NICE did not appreciate the scale of the problem and how this would impact on the plans, pointing out that none of the estimated 17,000 locum GPs in the UK currently has their own prescribing number.

NICE’s draft guidance on antimicrobial stewardship, published last week, includes a recommendation that GPs should receive individual feedback on their antibiotic prescribing, as one of several measures aimed at cutting down on prescribing of the drugs in primary care.

However, NASGP chair Dr Richard Fieldhouse, a sessional GP in Chichester, suggested the reports could do more harm than good, given it is impossible to distinguish individual prescribers at a practice.

Writing on the NASGP website, Dr Fieldhouse said: ‘Just how useful will these reports be? Could they in fact do harm? It doesn’t look like NICE quite appreciate the issues.’

Dr Fieldhouse pointed out that NICE acknowledges in its draft guidance that data for any individual GP would be skewed by other prescribing from the same practice.

The guidelines state: ‘Currently GP prescriber codes are linked to the BSA individual cost centre rather than that of individual prescribers (for example, locums, who are not working permanently in a location, often use a “general” prescriber code in one practice for all of their prescribing).

‘Prescribing data do not therefore always just represent the GP name assigned to that code or cost centre.’

Dr Fieldhouse added that he agreed with feeding back personalised prescribing data to GPs but said locums needed to be put on a ‘level playing field’ first.

He wrote: ‘So, should GPs be given personalised antibiotic prescribing data? Yes, absolutely. But create a level playing field first by enabling our locum GP colleagues to have the same access to those NHS structures and processes that have patient and public safety at heart.’

However, Dr Peter Swinyard, chair of the Family Doctors Association, said he did not agree with publishing individual prescribing data in principle.

Dr Swinyard told Pulse: ‘None of us is prescribing for fun and for an organisation like NICE to say we should start sneaking on each other is quite bizarre, quite counter-productive and is treating us like little children.’

The plans from NICE came after Pulse revealed NHS bosses are looking at introducing incentives for GPs to reduce antibiotic use, through QOF or enhanced services, as well as publishing individuals GP prescribing data.

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Readers' comments (6)

  • GPs did have a personalised prescribing reports, PACT which was useful. But GP access to PACT data has been stopped.

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  • I work in an APMS practice - all our scripts seem to come out reading "Dr name of the surgery Medical Practice", or the names of the original doctors who left ages ago. It is in a very deprived area and we have CCG average or above prescribing virtually across the board, given our population with high chronic disease and long-term disability. It's all a bit of a dogs breakfast really, so we won't be able to produce anything to bash each other with - what a shame!

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  • 5.37pm: I didn't think it had. It's just that practices need to register with the NHSBSA and go and fetch the information themselves [e.g Practice Detailed Prescribing Information] from the Information Services Portal?

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  • perhaps antibiotic prescribing should be taken away from GPs - maybe we should refer patients we think need antibiotics to secondary care as we can't be trusted?

    i'm sure they won't mind eg I've got a two year old with fever 39.0, high resp rate, chest sounds, mild recession - impractical to take crp - can i refer to paeds so they can take over?

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  • Will these figures be adjusted for patient numbers, case mix, type if clinic, sessions worked etc etc?
    Of course not.
    Will a 'good' antibiotic prescribing level be calculated for each doctors' patients?
    No.
    Will these control freaks be present in each consultation to assess the reasonableness of antibiotics?
    No.

    Will they assess the antibiotic use in GPs who have moved into private practice or abroad?

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  • Ex prescribing analyst here. The NASGP is absolutely right - locum prescribers (used A LOT in our area) do not have prescriber numbers so in our practice, for instance, all their prescribing is attributed to our lead GP.

    Combine this with GPs with prescriber numbers working in different practices, or doing a bit of OOH, and their prescribing being allocated to ALL their locations leading to activity and cost duplication, all prescribing data, while a great guide to how things are going, needs to be taken with a pinch of NaCl until it is refined. Given that when I left PCT land the NHS BSA had no development money identified for the ePACT system or any other systems, this doesn't seem very likely to happen.

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