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NHS England plans for GPs to test patients before prescribing antibiotics

GPs could see point-of-care testing introduced into their practices in the future as part of the drive to reduce inappropriate antibiotic prescribing under a new scheme launched by NHS England.

The new UK Antimicrobial Diagnostic Collaborative programme, launched to coincide with the NHS’s 70th birthday last week, will initially focus on C-Reactive Protein (CRP) testing in primary care.

NHS England’s deputy chief scientific officer said a ‘big piece of policy work’ was underway to understand how to drive point-of-care testing.

However there are few details about how the programme will be rolled out and what resources will be made available for GPs.

Introducing the collaborative at the Antibiotic Guardian Conference a week ahead of its official launch, NHS England’s deputy chief scientific officer Fiona Carragher said: ‘We are missing a trick if we are not using diagnostics as a key part of our stewardship arrangements.’

She said the NHS needed to ‘move from an empirical diagnosis – made particularly in primary care, where they haven’t got diagnostics in the same way as for example in the hospital – to a much more targeted approach, so we understand what the infection is and we are treating it in a very targeted and personalised way.’

‘To do that there’s a huge opportunity to use the rapid point-of-care diagnostics that are coming onto the market at pace…

‘Lord O’Neill [referring to a 2016 review] set out a real challenge to governments not just in the UK but across the world to say actually, we shouldn’t be prescribing if there’s a diagnostic test, we should be using it and we should be prescribing on the basis of that,’ she added.

But when asked by an audience member what support and funding will be put in place for GPs to carry out point-of-care testing, she replied: ‘The big piece of policy work we’re doing at the moment is to understand what the opportunities to drive the point-of-care testing will be.’

The launch comes after research commissioned by Public Health England found one in five GP antibiotic prescriptions are inappropriate, and the body announced its ambition to cut such prescribing by half over the next two years.

Speaking at the launch of the new programme, GP and Sheffield CCG clinical director Dr Andrew McGinty, who has been working with NHS England on the project, said: ‘Long I’ve wished for a test, which will help me understand who needs antibiotics and who doesn’t need antibiotics.

‘Currently, point of care C-reactive protein testing is the closest we have to that. It’s an acute-phase protein, which is raised when there is inflammation strongly associated with bacteria rather than with viruses.’

He continued: ‘Through an accelerated learning event, with the pilots and pioneers who are using CRP testing in the primary care setting, we have begun to understand some of the challenges that exist…

‘However by working together through the antimicrobial resistance collaborative, we can start to develop a policy to ensure that the test is done in a clinically suitable and financially sustainable manner, to help patients.’

NHS England told Pulse the programme was in its early stages and that further details would be announced in the future.

Responding, BMA GP Committee chair Dr Richard Vautrey said: ‘We would be interested in exploring improved diagnostics to help support clinical decision making, however when those in general practice are dealing with large numbers of patients with a limited amount of time per consultation, any tests suggested must be almost instantaneous and consistently reliable to be practically useful.’

Attempts to reduce antibiotics prescribing

In 2016 PHE announced that GP antibiotic prescribing had decreased by 6% over three years, although research commissioned by the body has stated that between 8% and 23% of all antibiotic prescriptions in primary care were still inappropriate.

PHE have since announced this number as ‘at least’ 20% and set a target to cut it in half.

Simultaneously, there has been increasing pressure on GPs to spot and prescribe antibiotics for sepsis, with NICE telling doctors that antibiotic should be administered within an hour of sepsis being suspected and diagnosed.

sepsis campaign has also been launched in Scotland, which aims to increase awareness and ensure that patients receive antibiotics ‘as quickly as possible’.

And in April, nearly 9,000 GPs were sent personalised letters by the Chief Medical Office Professor Dame Sally Davies warning them about their antibiotic prescribing.


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