Widespread CRP testing in general practice ‘could cut 10m antibiotic prescriptions a year’
Giving GPs widespread access to point-of-care tests for C-reactive protein could cut up to 10 million prescriptions for antibiotics and save the NHS £56m a year, a report claims.
The consensus report – endorsed by leading GP antibiotic prescribing researchers and backed by industry – called for CCGs to ‘find innovative ways’ to fund point-of-care (POC) C-reactive protein (CRP) testing, in line with NICE and Public Health England guidance on management of respiratory infections and antimicrobial stewardship.
Professor Chris Butler, professor of primary care at the University of Oxford, who contributed to the report, said his team had shown POC CRP testing was ‘cost-effective’ and ‘can be incorporated into the workflow in most practices’.
He added that increasing uptake of CRP testing in primary care ‘will provide clinicians with additional diagnostic information to help them make crucial antibiotic prescribing decisions, especially where there are high levels of diagnostic and prognostic doubt’, adding that ‘a low CRP result available at the point of care can safely rule out benefit from an antibiotic’.
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Readers' comments (12)
Anonymous | GP Partner30 Jun 2015 6:31pm
No time - we have to drop something before we take on anything else plus I have doubts about how "crucial" this might be in decision making. Will it be rolled out to hospitals, walk-in centres, out-of-hours centres, vets, farmers, etc or will it be - again - just GPs?
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Anonymous | Sessional/Locum GP30 Jun 2015 6:34pm
I think this is a great idea, as long as it does not cost a practice money.
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Anonymous | GP Partner30 Jun 2015 8:05pm
The problem will be that CRP could be low on day one of say a URTI, but it could be raised by day two or three. So patients will still keep calling for another consultation. We all know that any viral infection can in itself become overwhelming or develop into a serious bacterial infection at a later date. In fact a normal CRP early on in the course of an infection could negate a patient contacting us when symptoms deteriorate at a later date
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Anonymous | GP registrar30 Jun 2015 8:31pm
i dont agree.it will just add to the costs.
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Anonymous | Salaried GP30 Jun 2015 10:37pm
If we tell patients that they will have to bear the pain of a needle prick if they want the antibiotics they are asking for - most of them would probably refuse the antibiotic
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Anonymous | Sessional/Locum GP01 Jul 2015 1:18am
whats wrong with a chest xray. that's what I do if there is concern over pneumonia. rapid antigen tests for strep would be useful but even then you don't need to treat most strep strep just if patient unwell.
what level of CRP suggests a significant bacterial infection needing treatment?
I don't understand the comments that mention what if it gets worse. Well of course the test will only help with diagnosis at he current time. as always patients have to return if significantly more unwell
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Anonymous | GP registrar01 Jul 2015 10:46am
Think it's a very valuable idea.
At the end of the day - if you feel your patient needs abx you're going to give them regardless, whereas this provides a valuable tool in the "it's just a cough" scenario.
Sometimes think people are averse to change for the sake of it, whereas this is probably one of the few good news stories we see. (as long as it doesn't cost a fortune, and even then we just don't use it)
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paul cundy | GP Partner01 Jul 2015 11:29am
Cost of a CRP test? £25 - £40 in the high street, maybe £10-15 in an NHS lab.
So using their numbers to avoid 10 million scripts for ABs thats at least 10 million CRP tests. £100 million at best and £250 million at worst added cost to save £56 million.
Work out the figures.
and thats even before you've started to cost our time.
a perfect example of why the NHS needs GPs.
Regards
Paul C
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Vinci Ho | GP Partner01 Jul 2015 12:26pm
(1) the words 'point of care' are probably illustrative . Hence, it only tells what the reading was at that point. It is never diagnostic . Overall clinical picture still matters the most , it clearly cannot stipulate the imposition ,' you must not use antibiotics if CRP is normal or low.' I think academics need to be quite sensitive to this argument.
(2) The cost of using this (with maintainence of machines )in every patient with URTI symptoms(assuming one cannot tell whether complications have already arisen) is still questionable. May be this is only applicable for a group of GPs to share.
(3) Depending on how quickly your local lab is processing routine blood test these days( my local hospital lab returns routine CRP results same day), request CRP on selected cases with discretion is still important in your clinical judgement .
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Anonymous | Salaried GP01 Jul 2015 1:21pm
which POC testing company should i get shares in?
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