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GP antibiotic prescribing drops 3% since introduction of financial incentives

GP antibiotic prescribing for respiratory infections has dropped by 3% since the introduction of the national incentive scheme, according to Public Health England.

The research collaboration between PHE and Imperial College London also found that there was 2% relative reduction in the rate of broad-spectrum antibiotic prescribing, although this was much lower than the 10% target. 

The team set out to assess the impact of the 2015/16 NHS England Quality Premium, which provided a financial incentive for CCGs to reduce antibiotic prescribing in primary care.

The Quality Premium required CCGs to achieve a reduction of 1% in total antibiotic prescribing in primary care and a 10% decrease in the proportion of broad-spectrum antibiotics prescribed, specifically co-amoxiclav, cephalosporins and quinolones, relative to the level of prescribing in 2013/14.

The researchers analysed monthly patient-level consultation and prescribing data obtained from the Clinical Practice Research Datalink between April 2011 and March 2017.

This included 2,198,602 patients registered at 431 GP practices across England, who had 6,480,800 consultations for RTIs.

The team then assessed the rate of antibiotic prescribing in patients with a recorded diagnosis of uncomplicated RTI, before and after the implementation of the financial incentives.

The paper, published in the Journal of Antimicrobial Chemotherapy, said: ‘Prescribing rates decreased over the 6 year study period, with evident seasonality. Notably, there was a 3% drop in the rate of antibiotic prescribing – equating to 14.65 prescriptions per 1000 RTI consultations – in April 2015, coinciding with the introduction of the Quality Premium.

‘This reduction was sustained, such that after 2 years there was a 3% decrease in prescribing relative to that expected had the pre-intervention trend continued. There was also a concurrent 2% relative reduction in the rate of broad-spectrum antibiotic prescribing.’

It added that antibiotic prescribing for RTIs diagnosed in children showed the greatest decline with a 6% relative change two years after the intervention.

PHE’s head of surveillance for healthcare associated infections and antimicrobial resistance Professor Alan Johnson said: ‘As part of a national strategy to tackle antibiotic resistance, this is one of a range of successful interventions used to support GPs to reduce levels of prescribing.

‘It is important that we continue to reduce the levels of inappropriate prescribing if we are to prevent further increases in drug-resistant infections.’

Earlier this year Public Health England announced its ambition to halve the number of antibiotic prescriptions written in primary care by 2020, after research concluded that one in five scripts could be inappropriate.