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CMO’s personal letters to ‘overprescribing’ practices cut prescriptions by 3%

The Chief Medical Officer sent letters to individual GPs warning them about their practice’s overuse of antibiotics, which public health chiefs claim resulted in 3.3% reduction in antibiotics dispensed by the highest-prescribing practices.

The letter – addressed to named individuals and signed off personally by Dame Sally Davies – was sent to half of practices that were among the top 20% of prescribers in their region (totalling 1,584 practices in all), with the other half receiving no such letter, as part of a randomised trial.

It warned the GPs that the majority of practices in their area prescribed fewer antibiotics than their own practice.

Researchers at Public Health England (PHE) said that six months after the letter was sent out, the rate of antibiotic prescribing had reduced by a statistically significant 3.3% at these practices when compared with the other high-prescribing practices where GPs did not receive it.

This would equate to more than 73,000 fewer antibiotic prescription items overall.

The letter said ‘reducing unnecessary prescriptions of antibiotics in primary care may help prevent a public health catastrophe’.

And in the second line, in bold, it tells the addressee that ‘80% of practices in your area prescribe fewer antibiotics per head than yours’.

It goes on to give information and instructions on cutting down antibiotics, including use of the TARGET toolkit, while a TARGET patient leaflet was also provided with the letter.

Lead researcher Dr Tim Chadborn, behavioural insights lead at PHE, said the letter helped bolster ‘GPs’ belief in the consequences of over-prescribing’, while emphasising ‘the link between their personal prescribing behaviour and the impact of antibiotic resistance’.

The findings come after a leading NICE expert said GPs who persistently overprescribe antibiotics should be referred to the GMC, while GPs are under pressure from their CCGs to meet targets on reductions in antibiotics prescribing.

The NHS Atlas of Variation in Healthcare, published today by PHE, highlights a 2.5-fold variation across CCGs in the percentage of key antibiotics prescribed in primary care, and calls on the highest-prescribing CCGs to cut prescribing.

Dr Andrew Green, chair of the GPC’s clinical and prescribing subcommittee, said the PHE initiative was ‘encouraging’ and that letters would be preferable to threats or sanctions, as this gave GPs support to change their prescribing rather than ‘naming and shaming’ them in public.

He said: ‘GPs in general are interested in how their work compares to that of their colleagues, and keen to improve if that is needed. The key thing here is not that they were informed that their prescribing was above average (and of course there may well be valid reasons for this) but they were also provided with tools that enabled change.’

Dr Green added: ‘I believe it is the combining of the provision of relevant data with the toolkits that has produced the change in prescribing, and that this approach is more productive than public naming and shaming, or threats of GMC referral.’

Dr John Cosgrove, RCGP Council member and a GP in Birmingham, said he ‘sympathised with colleagues who will have received such a letter’ as ‘GPs are now facing threats from all sides when what is sorely needed is collaboration and understanding’.

He said that some GPs ‘may have high antibiotic prescription rates through no fault of their own’, for example because of a more vulnerable or anxious local population, and that ‘as such, their workload may already be unusually high and sending such a letter therefore risks putting under further pressure those least able to bear it’.

Dr Cosgrove added that the approach could nonetheless be of ‘considerable benefit’ to GPs by cutting down future consultations, and countering ‘anxiety-provoking’ campaigns around sepsis, but that he ‘would want to see it backed up with adequately resourced support and efforts at a population level to allay health anxieties rather than stoke them in a non-evidence based quest for ever earlier diagnosis’.


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