BMA holds emergency talks with NICE over antibiotics sanctions threat

BMA leaders held emergency talks with NICE on Monday after its officials called for GPs to face sanctions for over-prescribing antibiotics.

BMA: NICE should support GPs over antibiotics prescribing (Photo: JH Lancy)

GPC chairman Dr Chaand Nagpaul said the call for sanctions was 'unfortunate' and took attention away from helpful guidance on use of antibiotics.

Medico-legal experts also criticised NICE, warning that calls for GMC investigations were 'unhelpful' and added to pressure on a profession already facing hugely challenging working conditions.

NICE guidance published on Tuesday urged GPs to take a harder line with patients who insist upon unnecessary antibiotic treatments, to help curb rising resistance to the drugs. Launching the advice, director of the NICE Centre for Clinical Practice Professor Mark Baker suggested GPs who hand out too many antibiotics should face sanctions.

GP antibiotic prescribing

But Dr Nagpaul warned: 'The BMA has met urgently with NICE today and expressed our concern at reports that GPs should face sanctions including GMC referral for "over-prescribing" antibiotics. This claim unfortunately has distracted from the launch of new guidance which we believe is helpful, especially as the BMA has been pushing for GPs to have better individual prescribing ‎data for some time.

'We are pleased that following our meeting, NICE has clarified that inappropriate prescribing is not widespread amongst GPs and have made it clear that they wish to support all GPs, and not admonish them in public.

'GPs are aware of the need to be prudent with antibiotic use, but they do work in a difficult environment, seeing patients early in their illnesses, with limited access to ‎diagnostic tests and follow up. GPs are often prescribing for people with complex medical or social needs. They are also under pressure to avoid patients with infections being admitted to hospital, and these factors need to be taken into account.

'There are now multiple routes for patients to access antibiotics, many of which are not centrally recorded. Given this climate, we need to support GPs in using their clinical judgment, which is what the vast majority of GPs do, for the benefit of their patients.'

GP workload

Senior medico-legal adviser at the Medical Protection Society, Dr Pallavi Bradshaw, said: ‘GPs work in a challenging environment, with increased workloads, rising patient expectations, and limited resources. NICE calling for the GMC to investigate GPs who prescribe inappropriately is unhelpful and only serves to punish GPs, yet again.

‘GP prescribing is already closely scrutinised by NHS England. If there is a wider issue with inappropriate prescribing, this should be addressed as a cultural issue and GPs should receive the support necessary.'

NICE said its guidance was 'designed to help doctors make the right choices with their patients'.

'Inappropriate prescribing of antibiotics is not in the interests of patients and contributes to antimicrobial resistance,' a spokesman said.

'The great majority of GPs take care in prescribing antibiotics and for them we hope our guideline will be a useful reinforcement of their existing practice. Our recommendations are aimed at those who need to change and improve their practice. We want to support, not admonish them and we are clear that our advice on good clinical practice and the professional standards responsibilities of the GMC are distinct and separate.'

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