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Antibiotic over-prescribing guidelines: yet more proof that NICE is out of touch



Last month’s myocardial-infarction-inducing headline was ‘GPs should be referred to GMC for persistently over-prescribing antibiotics says NICE’. Forget the farming industry (which uses 45% of the antibiotics in the UK) and forget hospital specialists who only seem to know how to spell ‘co-amoxiclav’ and ‘cefalexin’: the real culprits are those pesky GPs again!

Fortunately the GMC laughed off the suggestion, with Niall Dickinson releasing a statement saying that ‘we see this as being more about changing the norms of practice generally than pursuing individual doctors.’

NICE seems increasingly out of touch with real world general practice. It has withdrawn another draft of its diabetes guidelines, and released guidelines on chronic kidney disease which rely on tests that don’t exist yet in primary care. Then there are the new suspected cancer guidelines. Has anyone managed to learn these or been able to implement them without collapsing the health economy?

But what struck me most was that this story highlighted once again that those in power want to hold GPs to account for their prescribing, yet there is no way for us to know what drugs we actually prescribed, and which are simply carried over from a GP who retired fifty years ago.

I want to know whether I’m a safe prescriber because (and this is the important bit) I actually really like my job and I like my patients. It may sound twee, but I want to do a good job and if I’m not, then I want to know about it. However, in my prescribing data are items prescribed by our nurse practitioners, our locums, our registrars, GPs who no longer work with us and quite a lot of items which we’ve been ‘asked’ to prescribe by secondary care. It is a complete mess.

At last year’s BMA Annual Representative Meeting there was even a motion passed on this subject as it affects both primary and secondary care. Trainees as well as staff and associate specialist surgeons have their outcomes recorded as if the consultant in charge performed the surgery. We rely on good data to improve our practice and improve patient care. How can we do this, when there is so much useless data in the eco-system?

My proposal is simple. Every item prescribed should be linked to the person who prescribed it previously. Every fully registered doctor who is able to prescribe should be given an identification key to enable this. We should be able to access our performance data in a user friendly website which compares our prescribing to similar professionals working in similar populations and environments.

Until then, for each appraisal, I will continue my efforts to reflect on data that isn’t really about me.

Dr Phil Williams is a First5 GP in Lincoln, and former RCGP National Lead for the First5 initiative