Fragmented primary care undermining GP efforts to cut antibiotic use

The fragmentation of primary care is undermining GPs' efforts to cut antibiotic prescribing rates, a GPC member has warned, as official data showed prescribing rates fell last year in general practice but rose in other providers.

Dr Andrew Green: warning over fragmentation of primary care
Dr Andrew Green: warning over fragmentation of primary care

Dr Andrew Green, chairman of the GPC’s clinical and prescribing committee, told GP he was pleased to see that GP antibiotic prescribing had begun to decrease after ‘understandable concerns’ that the rate had been increasing over recent years.

His comments followed publication of the Public Health England (PHE) ESPAUR report on Friday, which showed that GP prescribing of antibiotics fell by 3.5% in 2013.

Dr Green warned that GP efforts to drive down prescription rates were being undermined by an increase of antibiotic prescribing in other community settings, suggesting patients can still readily obtain the treatments after being denied them by their GP.

The PHE report showed there had been a 32% increase in antibiotic prescribing in non-GP community settings since 2010, which PHE flagged as requiring extra investigation.

'Inevitable consequence' of fragmentation

Dr Green told GP this was an ‘inevitable consequence of the fragmentation of primary care’.

He said: ‘I am not surprised to see a large increase in prescribing in non-GP community settings. All GPs will have patients who they treat without antibiotics who then go elsewhere to get them, and without a long-term relationship with the patient, good quality care and patient education are much harder to achieve.

‘This is an inevitable consequence of the fragmentation of primary care imposed in the name of convenience.

‘GPs are trying very hard to ensure that antibiotics are not prescribed unnecessarily, and yet are given to those who need them.

‘We live in a blame society where diagnostic uncertainty is not tolerated and we are deprived of the very tool we need to reduce prescribing, namely adequate consultation time for explanation, and yet despite these pressures GPs’ recent prescribing has decreased, the challenge is to ensure this continues.

‘For this to happen the DH needs to invest both in public education and in general practice, so we are able to spend time seeing, talking to, and reviewing our patients.’

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