Prize-winning GP practice cuts antibiotic scrips 25% and frees appointments

A GP and nurse practitioner team from Hertfordshire has won an NHS innovation prize for a C-reactive protein (CRP) testing scheme that cut antibiotic prescribing 25% and sharply reduced repeat appointments for coughs.

Nurse practitioner Liz Cross and GP Dr David Zemmel (both centre) receive the Acorn Prize
Nurse practitioner Liz Cross and GP Dr David Zemmel (both centre) receive the Acorn Prize

Nurse practitioner Liz Cross and GP Dr David Zemmel told GPonline they are looking to use their £10,000 prize to see the scheme rolled out across their local West Herts CCG and, ultimately, nationwide.

Rolling similar schemes out nationally has the potential to save millions of pounds on antibiotic prescribing and free up significant numbers of appointments at GP practices struggling to cope with soaring workload.

The scheme saw the practice's nurse practitioner service cut antibiotic prescribing by 25% from November/December 2014 to November/December 2015. The practice's nurse practitioner service sees around 100 urgent care appointments a week, and estimates that in winter around half are for coughs that have lasted less than three weeks.

GP appointments

The proportion of patients re-attending for the same complaint fell from 24% to just 4% – freeing up dozens of extra appointments.

Meanwhile, recent studies have suggested that prescribing fewer antibiotics is directly linked to lower patient satisfaction scores. But Ms Cross told GPonline that receiving a definitive test result advising against antibiotics helped patients feel more satisfied with not receiving antibiotics. She followed every patient up a month later either by checking their record or telephoning them.

Based at the Attenborough Surgery, Hertfordshire, the team offered a finger prick blood test for CRP – a key marker of bacterial infection – to eligible patients with acute cough symptoms.

Antibiotics have historically been prescribed for many patients with an acute uncomplicated respiratory tract infection. Some of these may be caused by serious bacterial infections, but many are viral or self-limiting.

Even though prescription of antibiotics may be inappropriate, doctors can be concerned about delaying treatment for significant bacterial infections that will not clear up naturally. The CRP test gives results within four minutes to determine whether antibiotic treatment is appropriate.

Antibiotic prescribing

Ms Cross said: ‘I was kind of expecting [antibiotic prescribing to drop], but the most interesting part for me was if I don’t prescribe antibiotics – last winter, if I didn’t prescribe antibiotics when patients came in with their chesty coughs, a quarter would come back and they would present to a GP, out-of-hours, or A&E.

‘And now, if I don’t prescribe and have done the CRP test, 4% come back. So my re-attendance rates are really reduced and my cost savings are through that.

‘I save about £100 a month, after paying for the tests, on prescribing and reduced follow up appointments. It doesn't sound much but it means the project is sustainable and patients get better quality care.’

Ms Cross will roll out the scheme across eight GP practice sites and two urgent care hubs over the next four months.

GP efforts across the country last year saw antibiotic prescribing fall to a five-year low of 0.64 per head, according to primary care prescribing data, but officials have warned that prescribing needs to drop further.

CCGs spent £427m on antibiotics in the first quarter of the 2015/16 financial year alone, suggesting that wider use of CRP testing could generate savings worth hundreds of millions of pounds nationally.

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