NICE guidance published on Tuesday urges GPs to take a harder line with patients who insist upon unnecessary antibiotic treatments, to help curb rising resistance to the drugs.
GPs should let patients know the details of their illness, how long they should expect it to last and what to do if it lingers for longer, the NICE guidance says. They should emphasise that antibiotics ‘are not harmless drugs’ and can cause an array of individual health problems.
Proposed changes to IT systems will remind GPs when they should not prescribe antibiotics, and allow individual GP prescribing histories to be reviewed to see whether they need to cut down on the number of antibiotics they hand out.
GP antibiotic prescribing
Professor Mark Baker, director of the NICE Centre for Clinical Practice, said it was ‘vital’ that antibiotics were used ‘more sensibly’ than they currently are, and suggested that GPs who hand out too many should face sanctions.
‘I don’t think there's a lot of bad practice [among GPs],’ he said. ‘But we have not seen the reductions in antibiotic prescribing that we expected.’
He pointed to recent NICE respiratory infection guidance. If implemented correctly, there should have been a 22% drop in antibiotic prescribing for these conditions, he said. But in reality, there has since been a rise of 3%.
Some of this is down to pressure on GPs to prescribe antibiotics, he said – in some cases when the patient may not actually benefit. ‘If you can reduce usage, you can reduce resistance. Good medicine will prolong the lifespan of these drugs.’
The guidance emphasises that patients should be given ‘the right dose at the right time’ to avoid a serious threat of antibiotic-resistant infections.
GP clinical assessment
GPs should undertake a clinical assessment when prescribing any antimicrobial and always document the clinical diagnosis in the patient’s record.
The guidance recommends audit tools be integrated into GP IT systems – which will flag up whenever prescribing an antibiotic would be inappropriate based on a patient’s symptoms.
But if a GP went ahead and gave an insistent patient the treatment, the guidance states that this should be recorded.
Future ‘tweaks’ to GP IT systems will allow GPs to enter patient data through set templates depending on what condition the patient has, making it easy to see incidences of inappropriate prescribing.
GPs will then be able pull up a review of their prescribing habits, including a record of whenever they should not have prescribed the treatment.
GP prescribing rates
This data could also be used by external parties to compare the prescribing rates of individual GPs and practices across the country. Practices with extreme data – prescribing a lot more or a lot less than average – could face action taken against them.
NICE officials previously told GPonline that GPs could also be incentivised through the QOF to limit antibiotic prescribing as part of a future measure to cut down on unnecessary prescriptions.
NICE will publish another set of antibiotic guidance next year – this time aimed at patients. This will form the second stage of a ‘pincer movement’ to tackle the problem, acknowledging that a change in patient habits must also be addressed.
‘The more we use antibiotics, the less effective they become,’ warned GP Dr Tessa Lewis, who helped devise the guidelines. ‘Resistance to antibiotics is increasing and there have been very few new antibiotics developed in recent years, so we need to make sure that, as well as searching for new antimicrobial medicines we use the ones we currently have in the most effective way.’
Dr Tim Ballard, vice chairman of the RCGP, said: ‘The guidance today to prescribe the right antibiotic at the right dose at the right time is a sensible mantra and one that GPs try to abide to wherever possible.
‘But we can come under enormous pressure from patients to prescribe antibiotics, even when we know they are not the best course of action. These can be very difficult and stressful conversations for GPs to have and we know that NICE acknowledges this.
'We need a societal change in attitudes towards the use of antibiotics and any suggestion that hard pressed GPs - who are already trying to do their jobs in increasingly difficult circumstances - will be reported to the regulator is counter-productive and unhelpful.’