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Call to discipline GPs for over-prescribing antibiotics 'unhelpful'

Published 18/08/2015

Nice has published new guidance for health professionals on tackling the growing threat of antibiotic resistance
Nice has published new guidance for health professionals on tackling the growing threat of antibiotic resistance

Calls for GPs to face disciplinary action for over-prescribing antibiotics have been criticised as "counter-productive and unhelpful" by doctors' leaders.

The Royal College of GPs said it welcomed the guidance but was against the suggestion that GPs be reported if they are found to prescribe antibiotics unnecessarily.

As many as 10 million prescriptions for antibiotics are being dished out unnecessarily every year, with patients partly to blame for purposely seeking out doctors who will prescribe the drug, the National Institute for Health and Care Excellence (Nice) said.

Professor Mark Baker, director of Nice, said "soft-touch" doctors who "fail to come into line" by continuing to unnecessarily prescribe antibiotics could be reported to the health regulator.

Nice today published guidance for doctors, nurses and pharmacists to help tackle the problem, while it plans to issue advice for patients next year.

Dr Tim Ballard, vice chairman of the Royal College of GPs, said family doctors prescribe antibiotics even when it is not the best course of action following "very difficult and stressful" conversations with patients.

"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," he said.

"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."

Health officials have warned of a growing "crisis" of antimicrobial resistance which could change the whole basis of medicine, with infections having to be treated surgically if drugs no longer work.

Prof Baker said many patients expect antibiotics for common conditions such as colds, coughs, sore throats and even hay fever.

He told the BBC: "Most doctors prescribe sensibly and competently.

"For the relatively small number who are less disciplined, first we need to identify them, and that's what today's guidance deals with, and secondly I think there need to be processes locally to deal with them and make sure that either through education or other sanction that they behave in the same way as those who practice sensibly.

"Ultimately if they fail to come into line there is always recourse to the professional regulator and there are a number of performance processes that the General Medical Council or in the case of dentists the General Dental Council can use to improve the clinical performance of practitioners."

Research has found that nine out of 10 GPs say they feel pressurised to prescribe antibiotics and nearly all (97%) patients who ask for them get them.

Prof Baker added: "It's entrenched in our society.

"There are people who are addicted to the idea of having antibiotics.

"If they know there's a soft-touch doctor then they go to them. Often they'll go to their GP and then try another one (if they do not prescribe them)."

Antibiotics have been the mainstay of treating infections for more than 60 years but although a new infectious disease has been discovered nearly every year over the past 30 years, very few new antibiotics have been developed.

This means existing antibiotics are used to treat an ever greater variety of infections and infectious diseases.

Dr Tessa Lewis, a GP and vice chair of the Guideline Development Group, said: "The more we use antibiotics, the less effective they become. Infections can evolve and become resistant to existing medicines.

"Resistance to antibiotics is increasing and there have been very few new antibiotics developed in recent years, so we need to make sure that as well as searching for new antimicrobial medicines, we use the ones we currently have in the most effective way."

Nationally 41.6 million antibiotic prescriptions were issued in 2013/14 at a cost to the NHS of £192 million.

Nice said it is down to other bodies such as Public Health England and NHS England to now translate the latest Nice guidance into "tools that will result in real action and a change in the level of antibiotic prescribing".

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