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GP practices face further pressure to reduce antibiotic prescribing

CCGs have been told to agree antibiotic prescribing targets with member practices or face losing out on funding worth an average of £110,000 as a result of NHS England guidance released this week.

NHS England this week released its guidance for CCGs for achieving ‘Quality Premium’ payments – worth £5 per patient for CCGs – which included a requirement to reduce overall antibiotic prescriptions by 1% and lower prescribing of broad-spectrum antibiotics by 10% on the 2013/14 achievement, regardless of current performance.

To achieve these, the guidance puts in place a measure for ‘individual practice reduction to be agreed by the CCG with each practice’.

This is the latest scheme to target GP antibiotic prescribing, and comes after NICE recommended that practices should be given annual reports on their antibiotic prescribing, while Pulse reported last year that health chiefs were considering putting targets into the GP contract.

Introduced in 2013 the Quality Premium is used to fund CCGs for improving patient care, at the time NHS England ruled out the money being paid direct to practices as a GP ‘bonus’ could not be used to fund practices directly.

The full Quality Premium payment is worth a maximum of £5 per patient to CCGs, and this year it also requires them to meet targets on mental health, and urgent and emergency care as well as hitting operational targets, such as achieving a planned budget.

The antibiotic prescribing targets are worth 10% of the total payments, and sets three measures for CCGs:

  • ‘A reduction in the number of antibiotics prescribed in primary care by 1% (or greater) from each CCG’s 2013/14 value. Individual practice reduction to be agreed by the CCG with each practice.’ (50% of the total antibiotic prescribing target)
  • ‘The number of co-amoxiclav, cephalosporins and quinolones as a percentage of the total number of selected antibiotics prescribed in primary care to be reduced by 10% from each CCG’s 2013/14 value, or to be below the 2013/14 median proportion for English CCGs (11.3%), whichever represents the smallest reduction for the CCG in question.’ (30% of the antibiotic prescribing target)
  • And a requirement for secondary care to ‘validate’ their total prescribing. (20% of the antibiotic prescribing target)

Dr Andy Mimnagh, vice-chair of NHS Sefton CCG, said that prescribing targets are useless without examining appropriate prescribing.

He said: ‘The problem with applying this as a metric of “x amount per thousand registered patient” is there’s no such thing. Because infections by their nature are mini-outbreaks, if you get an outbreak of something that is resistant and requires [antibiotics] then you’re going to blow the target.

‘If you really want to talk quality, you would actually have to be looking and auditing if this was an appropriate antibiotic for the appropriate infection.’

But the GPC said CCGs didn’t have to power to force practices to do anything, adding ‘any CCG that tries to do that will not get good engagement from practices’.

They said incentive payments would be more effective as long as they remunerated GPs for the additional work the scheme requires.

Dr Nigel Watson, former chair of the GPC’s commissioning subcommittee told Pulse: ‘What they might do is encourage practices to develop an antibiotic policy, and then when the Quality Premium comes, then some of the quality premium goes to practices.’

He added: ‘I don’t think it’s a bad thing with [antibiotic prescribing] being discussed nationally, to look at this, but as with any of the other measures if there is additional work required to do it, it needs to be resourced, and if there is a reward element there is no use in a CCG taking it on as a target and then putting great pressure on practices to deliver it for no benefit.’

Earlier this year, NICE guidelines said local ‘antimicrobial stewardship teams’ should review GP antibiotic prescribing and target areas where inappropriate prescribing may be driving the development of drug resistance.

Pulse revealed last year that public health officials were in talks with NHS England about the possibility of introducing targets to cut antibiotic prescribing into the GP contract.