RCGP speaks out against disciplinary action for overprescribing antibiotics

CALLS for regulators to act against GPs who overprescribe antibiotics are "counter productive and unhelpful," says the Royal College of GPs.

The College was commenting on new NICE guidance to help doctors, nurses and pharmacists promote and monitor the sensible use of antimicrobials.

Overall antibiotic prescribing has been steadily increasing over several years. In England over 41 million antibiotic prescriptions were issued in 2013-14 at a cost to the NHS of £192 million. Despite considerable guidance that prescribing rates of antibiotics should be reduced, 9 out of 10 GPs say they feel pressured to prescribe antibiotics and 97 percent of patients who ask for antibiotics are prescribed them.

This has prompted calls for "soft-touch" and "hazardous" doctors to be disciplined for prescribing too many antibiotics.

The NICE guidance highlights the need for local antimicrobial stewardship programmes and recommends setting up multidisciplinary antimicrobial stewardship teams working across all care settings. These teams should be able to review prescribing and resistance data frequently and feed this information back to prescribers. They should also be able to work with prescribers to understand the reasons for very high, increasing or very low volumes of antimicrobial prescribing, as well as provide feedback and assistance to those who prescribe antimicrobials outside of local guidelines where this is not justified.

Professor Mark Baker, director of the Centre for Clinical Practice at NICE, said: "We need to encourage an open and transparent culture that allows health professionals to question antimicrobial prescribing practices of colleagues when these are not in line with local and national guidelines and no reason is documented."

The RCGP says it shares concerns over the serious consequences of growing resistance to antibiotics and the importance of getting this message through to patients but is calling for understanding in regard to the pressures GPs face.

Dr Tim Ballard, Vice Chair of the Royal College of GPs, 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. People must realise that this is dangerous for each and every one of us, not just 'other people'.

“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.

"If this were to happen, we would be looking to the General Medical Council to support any GP or other health professional who finds themselves on the receiving end of complaints or criticism about decisions made over the prescribing of antibiotics."

Dr Ballard later met with officials from NICE, along with colleagues from the BMA’s General Practice Committee, on the issue, after which NICE swiftly issued a statement clarifying their position.

NICE said: "Inappropriate prescribing of antibiotics is not in the interests of patients and contributes to antimicrobial resistance. Our new guideline is designed to help doctors make the right choices with their patients.

"The great majority of GPs take care in prescribing antibiotics and for them we hope our guideline will be a useful reinforcement of their existing practice. Our recommendations are aimed at those who need to change and improve their practice. We want to support, not admonish them and we are clear that our advice on good clinical practice and the professional standards responsibilities of the General Medical Council are distinct and separate."

The RCGP is keen to point out that there is a lot of useful information and suggestions for good practice in the new guidelines and that any perceived negativity should not dissuade GPs from reading and implementing them.