Sore throats, you’d think we’d know how to treat them by now wouldn’t you? In truth I think we do. For many years we have encouraged patients to look upon an occasional sore throat as a small price to pay for the privilege of being alive. We’ve encouraged self-care, but accepted that we will see a few patients who don’t fit the usual picture, who do occasionally need attention for quinsy, glandular fever, or even the odd malignancy.
But now, under the smokescreen of NHS innovation, this is to change, with patients being encouraged not to self-care, but instead to attend a healthcare professional (a pharmacist) for testing and treatment. This has been based on a small study purporting to show that that antigen testing might reduce the need for antibiotics, but without asking the fundamental question, which is whether patients need treating even if they are carrying streptococci.
By encouraging attendance instead of self-care the actual number of antibiotics may increase rather than decrease, and by further reducing the confidence of the public in their ability to manage a simple self-limiting disease we do nobody any favours. Except perhaps the pharmacy chains who may be commissioned to provide this service. One of these, Boots, just happens to have funded the study in the first place. This potential conflict of interest should have sent people rushing to the evidence base, and if you do, you can find a larger study showing no additional benefit from antigen testing over a clinical assessment.
Proving that a patient with a sore throat has bacteria present is very different from proving that they need treatment, and with antibiotics making no difference at day three to the majority of patients, and in wealthy societies not affecting complication rates, many GPs would prefer to follow the SIGN guidance which states that antibiotics should not be used to secure symptom relief for sore throats.
It is ironic in the extreme that this initiative has come at the start of self-care week. Perhaps what we really need in the NHS is more joined-up thinking, more application of existing knowledge, and a bit less innovation.