Exclusive The Chief Medical Officer has sent personalised letters to more than 8,000 GPs telling them that they are overprescribing antibiotics.
The letters were targeted at all GPs in the 20% highest prescribing practices, as well as GPs in practices who have seen their numbers rise by at least 4% each year.
Public Health England has said that they are designed to respectfully support antibiotic stewardship.
The BMA’s GP Committee said there were several factors involved in prescribing rates, while local leaders told Pulse these measures are conveniently ignoring the drive to increase prescribing in areas such as sepsis.
Over 6,000 GPs working in 1,414 practices received a letter explaining that their practice was in the top 20% prescribing antibiotics, following a similar letter in previous years. These included practices which have seen rates decline but are still in the top 10%.
However, unlike previous years, a new version of the letter has also been sent to half of the 4,796 GPs working in the 930 practices where prescribing rates have increased every year by more than 4%. These did not include those in the top 20% or bottom 5%.
PHE has confirmed that this is a controlled trial to test its effectiveness, which has increased the total number of letters sent from approximately 6,300 in 2016/17 to around 8,800 in 2017/18.
A spokesperson said: ‘These annual letters are designed to support and encourage practice-based stewardship as we know antimicrobial resistance is an issue of serious concern.
‘We hope that the letters will respectfully support GPs to improve their antibiotic stewardship.’
They added that this will ‘contribute to a significant reduction in the population risk of antimicrobial resistance.’
Researchers have claimed that antibiotic prescribing was reduced by 3.3% in targeted practices, within the six months following the first batch of letters in 2014/15, when compared with other high-prescribers who did not receive a letter.
This equated to approximately 73,406 fewer items dispensed, and led to the letters being implemented annually.
GPC clinical and prescribing policy lead Dr Andrew Green said: ‘It is vital that all opportunities are taken to reduce the risk of anti-microbial resistance, and these letters have in general been welcomed by GPs who are interested in how their prescribing compares to their peers or their previous levels.
‘It is important to realise that there may be very good reasons why practices have the prescribing rates that they do, but it is nevertheless important that practices are aware of any differences that exist.’
But Dr Zishan Syed, who is the Kent LMC rep for West Kent, argued that GPs are being held to a ‘completely unrealistic expectation’.
He said: ‘Frequently experts who have little experience of frontline pressures of general practice blame GPs for “high rates” of antibiotics and conveniently ignore the drive to prescribe to reduce sepsis rates.
‘GPs work in a toxic litigious climate. If a patient does develop serious complications, then it is almost certain that an “expert witness” will happily blame a GP in their report for not prescribing antibiotics which could potentially end that GP’s career.’
Attempts to reduce antibiotics prescribing
PHE launched a national campaign to ‘Keep Antibiotics Working’ last year, including advertisements aimed at the public.
CMO Professor Dame Sally Davies wrote to GPs to ask for their support, stating that the aim is to encourage the public to ‘take their doctor or nurse’s advice’ regarding when antibiotics are appropriate.
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.
A sepsis campaign has also been launched in Scotland, which aims to increase awareness and ensure that patients receive antibiotics ‘as quickly as possible’.