Are NICE not being nice to GPs about antibiotics?

The new Antimicrobial Stewardship guidance was published this month by NICE, looking at organisational and system-wide approaches to optimising antimicrobial use. And the main message coming out of various news agencies today is that GPs will be “struck off” for not prescribing antibiotics appropriately.

There is, of course, huge concern around the rising amount of antimicrobial resistance which, coupled to a lack of development of new pharmaceutical products, has worrying public health implications. So I think these guidelines are, in general, very sensible, providing helpful advice for organisations and clinicians.

And in terms of sanctions? According to the Daily Mail, “GPs face axe for handing out too many pills”. The Telegraph tells us of a “Threat to GPs over antibiotics”. In an interview with the BBC, Mark Baker from NICE did indeed mention referral to the regulatory authorities as an ultimate sanction, but it is hardly the main approach being suggested for tackling the problem. The guidance instead suggests setting up local systems for peer review of antimicrobial prescribing, providing feedback on useage, and benchmarking against local and national prescribing rates. Indeed, this already happens to a degree for many aspects of prescribing.

But will these processes help? After all, the vast majority of GPs are already fully aware of the public health hazards of overuse of antimicrobials. As Tim Ballard of the RCGP is reported as saying, what is needed is a “societal change”. However, it is important not to interpret that as meaning “too many patients wrongly think they need antibiotics”. It is certainly true that some patients do request antibiotics inappropriately. But many patients fully understand that antibiotics are not a panacea, and see their GP simply seeking reassurance that a packet of penicillin is not required for their sore throat. So patient education is not the only solution, and improving doctor-patient communication in order that GPs are better equipped to deal with patient concerns and expectations around antibiotics is at least equally important.

These issues are unfortunately not adequately addressed by the new guidance, and instead there is a significant risk of harm to the doctor-patient relationship, with patients perceiving refusal of an antibiotic as the doctor avoiding the wrath of the GMC, rather than actually doing what is in the interest of both patient and public alike.

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