Viewpoint: The real reasons why antibiotics are over-prescribed

A NICE official has suggested GPs should face sanctions for inappropriate antibiotic prescribing. Dr Rebecca Jones explains why this is a bad idea.

Dr Rebecca Jones

NICE guidance published yesterday expressed concerns about the way that we use antibiotics. The theory behind this cannot be disputed; it is recognised that increased use of antibiotics is leading to resistance, which may have enormous implications for modern medicine.

Professor Mark Baker, director of the NICE Centre for Clinical Practice, declares that the waning effects of antibiotics means that we may have to ‘rethink the entire way in which medicine is delivered’. But he also suggested that prescribers who are ‘less disciplined’ should be identified and brought into line, or face GMC processes.

Laying the blame with GPs who may now be punished for their decisions on prescribing is not the way forward. Yes there may be GPs who prescribe more often than others, but perhaps we need to ask why.

Antibiotic education campaigns

Professor Baker admits that large numbers of patients believe that antibiotics should be given to them whenever they want. In my experience there is an even split between those patients who only request antibiotics appropriately and those who demand them for the most trivial of symptoms.

There have been many campaigns trying to educate the public about when antibiotics are not necessary. But despite this, patients still routinely attend practices with a simple cough and cold, or a one-day history of sore throat, expecting that antibiotics will be given – and appear genuinely shocked when told by their GP that antibiotics are not required.

So why do patients find it so hard to trust their doctor’s opinion? Are we not sending the right kind of messages with our current campaigns?

Another issue is the climate of fear and intimidation in which most GPs now routinely work; defensive practice has become the norm. There are threats from all sides, whether it is from CQC visits or the anxiety associated with the growing litigious nature of our work.

Despite having confidence in your own clinical ability, when faced with a patient who is insistent that they know their own body and that they really need antibiotics even an experienced GP may doubt themselves, agreeing to a prescription ‘just in case’.

And then we have the time constraints, with the vast majority of consultations being allocated only 10 minutes. An education session informing a patient about why they do not need antibiotics is difficult to carry out having already spent most of the consultation taking a history and examining a patient.

Providing understandable information, tailored to the person sat in front of you and allowing for questions takes time that most GP just don’t have. Even our valued ‘safety net’ of reassuring a patient that if things don’t improve we will review them again in a matter of days can be undermined by concerns that may not be able to get another appointment.

Identifying 'over-prescribing' GPs is inappropriate

So where do we go from here?

I don’t think identifying ‘over prescribing’ individual GPs is appropriate – it is clear why some may feel pressured into prescribing against their better judgement. However, practices need to have their own policy that unites their GPs so that patients can’t use the argument ‘but the other doctor always gives them to me’.

Perhaps this could then be rolled out regionally, aligning all practices. The government should be backing this message, supporting our decisions so we needn’t fear the repercussions of saying no.

And, as always, we need education, education, education, perhaps even starting as early as the school curriculum. Clearer messages on the walls of our practices, and maybe some of the media coverage of our healthcare system could be directed to informing patients that their doctor does want the best for them, but that is not always in the form of a prescription.

  • Dr Rebecca Jones is a GP in South London and GP Survival’s representative for trainee and newly-qualified GPs

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