Viewpoint: Stop scapegoating GPs over misuse of antibiotics

GPs face significant pressure from patients to prescribe antibiotics, says Hull GP Dr Thomas Abraham, and the NHS must not adopt a punitive approach to tackle the issue.

Last month, headlines warned of threats to GPs who prescribe too many antibiotics. GPonline reported that a NICE official had warned GPs should face sanctions for over-prescribing.

The Daily Telegraph quoted the director of NICE's centre for clinical practice Professor Mark Baker as saying: ‘It is entrenched in our society. There are people who are addicted to the idea of having antibiotics. Often they will go to their GP and then try another one and then go on to an A&E department.'

Announcing new guidelines for antibiotic prescribing, he made a threat that those who fail to adhere to the guidance should be brought before the GMC.

Way back in 1998, when the House of Lords released a report on antibiotics, chairman of the inquiry Lord Soulsby remarked that anything from 20% to 50% of antibiotics prescribed are possibly unnecessary.

GP antibiotic prescribing

The BMA and the government's chief medical officer backed up the report and tried to address the problem. So this is nothing new. Curbing prescriptions, in theory, is a good idea - but what about the plight of grassroots GPs?

May I invite Professor Baker to do a full day of locum work in an inner-city practice to get to grips with the turmoil and perplexities in this issue GPs face, and then give his honest opinion? The reality will dawn upon him: in many instances, GPs prescribe under duress.

In the past doctors prescribed only a few items - mercury for syphilis, quinine for malaria, aspirin for fever etc. Their main role was to share the burden of illness and reassure patients. Now, on the other hand, in the consumer-led NHS, patients feel that 'if ill, need a pill'.

Medical treatment

Armed with Google, many claim extensive knowledge in medicine that we professionals took many years to gain.

The situation is further complicated by EC treaties that give people freedom of movement between countries and the right to medical treatment in member states. The policies of other countries within the EC need to be taken into consideration by GPs. Some legal advice muddies the waters still further - Mason and McCall Smith's the Law and Medical Ethics cites 'now universal acceptance of a patient's right to decide on his or her own treatment'.

In light of this, it would be prudent and pragmatic not to adapt a punitive approach. Instead, in his wisdom, Professor Baker could advise CCGs to rejuvenate health education as well as supportive measures for GPs to tackle overuse of antibiotics.

Much more needs to be done in educating the public to control this ongoing societal malady. The problem can't just be dumped at the doorsteps of GPs.

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