Don’t incentivise withholding of antibiotics!

Don’t prescribe too many antibiotics. And just to make sure you behave, we’ll pay you not to. That’s the latest message GPs are being given by the government. I personally find this very irritating.

GPs are well aware of the public health implications of prescribing too many antibiotics, and the consequent risks of antibiotic resistance. And importantly, many patients are also aware of this problem. However, it is also well recognised that consultations with patients presenting with relatively mild infections can be challenging, with clinicians feeling pressurised into prescribing unnecessarily. Interestingly, this is often at odds with the patient’s expectations, although we’ve previously demonstrated that GP surgeries that prescribe more antibiotics also have greater patient satisfaction.

So what this latest incentive simply does is make an already difficult consultation even more challenging. Dr Smith is no longer withholding amoxicillin for good public health reasons, but is making money out of it too. There is the potential to undermine trust in the doctor, and even have the perverse effect of aggravating inappropriate prescribing, with prescribing decisions being unduly influenced by a difficult conversation rather than by clinical need.

Perhaps it would be better if the Department of Health incentivised training in consultations skills focusing on difficult consultations and better understanding patients’ expectations around antibiotic use? Improving patient education around this area would also be welcome. However, ill-conceived incentives are not the way forward.

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