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Nursery schools pressure GPs to prescribe antibiotics needlessly

Nursery schools are putting GPs under pressure to prescribe antibiotics to infants with conjunctivitis when they are not needed, a study has revealed.

The study, published in the BJGP, found nine out of ten nursery schools have policies to exclude children with acute conjunctivitis, of which half specified a requirement for antibiotic treatment.

In addition, more than two out five GPs and nurse prescribers said they were influenced by these policies when it came to prescribing the topical antibiotics.

GP leaders said the schools’ policies undermined the hard work GPs were doing to cut down on unwarranted use of antibiotics, and called on public health chiefs to work with other organisations to make sure they brought them in line with current national guidelines.

Public Health England guidance states that children with acute infective conjunctivitis do not have to be excluded from school or nursery school, and do not necessarily need to be treated with antibiotics.

However, University of Birmingham researchers found that of 164 nursery schools across the UK, 142 (87%) had sickness policies that required children to be excluded.

Of these 81 (49%) stated that a child must be treated with antibiotics before being readmitted to nursery.

The team also found that out of 200 GPs and nurse prescribers who responded to a survey on the issue, 43% said childcare provider policies influenced their prescribing – and 25% said the policies were the main reason they had prescribed antibiotics.

The authors concluded: ‘Many GPs will be aware of this issue already but this research highlights the potential impact of clinically unjustifiable sickness exclusion practices.

‘Even though antibiotics are rarely clinically indicated for acute infective conjunctivitis, it is easy to see why clinicians may feel that a prescription is required.’

They added that the policies needed to be ‘influenced at a national level’.

Dr Maureen Baker, chair of the RCGP, said: ‘We would encourage closer working between health bodies, such as Public Health England and NICE, and childcare providers to develop more joined up policies, based in evidence, in the best interests of both individual patients and society at large.’

Dr Cliodna McNulty, head of the PHE primary care unit, said: 'We would encourage GPs, nurses and pharmacists to do a thorough clinical assessment of the need for antibiotics before advising them, addressing the needs and concerns of parents or caters, and also give self-care and safety-netting advice. They should really try not to be influenced by local nursery policies.'

Br J Gen Pr 2016; available online 6 July

GP antibiotic prescribing under the microscope

The study comes as GPs are coming under ever intense scrutiny over antibiotic prescriptions. Most recently the Government announced that GPs would be tasked with cutting inappropriate antibiotic prescriptions by half - although the Department of Health was unclear exactly how many prescriptions this would amount to.

Having praised GPs with for their efforts in reducing the amount of antibiotics prescribed in primary care, NHS England recently set out new targets to cut back prescriptions further through the quality premium scheme.

NICE has also called for GPs who persistently over-prescribe antibiotics to be referred to the GMC, and a pilot scheme where the Chief Medical Officer wrote personal letters to GPs at high-prescribing practices was hailed as a success.

Despite the tough rhetoric, Public Health England's own evidence has shown GPs are the most judicious prescribers of antibiotics in the NHS, while studies have highlighted the pressure that patients put on GPs to prescribe antibiotics, and researchers have reported that GPs at practices that do not give out antibiotics so easily are likely to receive lower patient satisfaction scores on the GP Patient Survey.

Readers' comments (7)

  • The nursery schools don't sign the prescriptions. I usually find a phone call to the school advising them of PHE guidance solves the problem.

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  • I have had this for years so have sent a letter and copy of HPA guidance to local nurseries - this seems to have worked.

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  • I send nothing. I just say no. Many of us have firotten that we gave authority which commands respect. Society and politicians treat us like crap cause we walk with our heads down and our shoulders stooped. Time stand up and be counted or become poorly paid and guideline-dependent salaried slaves.

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  • Any doctor that feels pressured by nursery school staff to prescribe antibiotics when inappropriate needs to rethink their position and medical degree.Enough said.

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  • Good grief, just grow a pair, Folks. I tell parents to get the nusery to ring me if they are not happy because I won't prescribe. Still waiting for the first call.

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  • 8.29 is right. We just need to kick back. The vast majority are not even conjunctivitis and are just colds with a blocked nasolacrimnal duct.

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  • while I agree with previous posters, spare a thought for the nurseries who are required by Ofsted to have an exclusion policy for illness. This is a typical extract
    "■Should a child have an infectious disease, such as an eye/ear infection or sickness and diarrhoea, they should not return to nursery until they have been clear for at least 48 hours
    ■We follow strictly the advice given to us by our registering authority and exclude specific contagious conditions, e.g. sickness and diarrhoea, conjunctivitis and chicken pox to protect other children in the nursery. Illnesses of this nature are very contagious and it is exceedingly unfair to expose other children to the risk of an infection."

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