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MPs demand end to ‘perverse’ cost to GPs of testing before antibiotic prescribing



Leading MPs have called for changes to the ‘perverse’ financial arrangements that stop GPs from using point-of-care testing before prescribing antibiotics.

The House of Commons Health and Social Care Committee report on antimicrobial resistance, published today, said that ‘encouraging the development of rapid diagnostic testing’ should be looked at as a way of reducing prescribing, but only where it is clinically appropriate and recommended by NICE.

But it added that GPs are being discouraged from using point-of-care testing because they are expected to pick up the bill rather than the CCG.

The report said: ‘Rapid diagnostic tests are already recommended by NICE for certain infections, but we heard that often these are not used because the cost of the test—which is far higher than the cost of antibiotics—falls on individual GP practices rather than the CCG…

‘Where testing is clinically appropriate and recommended by NICE, action should be taken to address the perverse financial incentives which may discourage their use.’

In evidence given to the committee, University of Southampton Professor of primary health care research Michael Moore said: ‘What happens is that the costs of those tests are met in primary care, and the antibiotics are paid for at the CCG level.’

He explained that if GPs carry out 100 c-reactive protein (CRP) tests, ‘you are asking them to spend £1,000 on that testing’.

‘That is an implementation problem. It is about getting the resource in the right place to get these things implemented,’ Professor Moore added.

The report concluded that encouraging the development of rapid diagnostic testing should be considered alongside the action to promote the development of new antimicrobials, but use of diagnostic tests should be based on NICE guidance’.

This comes after NHS England revealed plans for c-reactive protein diagnostic testing in primary care, as part of its new UK Antimicrobial Diagnostic Collaborative programme.

Some GP practices have already started to implement CRP testing, although the cost has proved a barrier in cases where the CCG refused to fund it.