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Patients Association - Patient safety compromised as 88% of CCGs not fully implementing antimicrobial guidelines

The Patients Association hascalled for all Clinical Commissioning Groups (CCG s) to implement NICE's 2015 Antimicrobial Stewardship (AMS) guidelines (1) aimed at minimising the risk of antibiotic resistance (AMR) – a huge global health threat and one of the most significant threats to patients' safety in the UK.

This comes after the results of a Freedom of Information (FOI) request from 144 CCGs in England by The Patients Association (2), reveal that:

  • 88 percent haven’t fully implemented NICE’s AMS guidelines as standard
  • Almost a third (31 percent) don’t have a ‘named’ individual responsible for the implementation of AMS programme
  • One in 10 (10%) don’t have a local AMS programme in place at all 

AMS can be defined a set of coordinated strategies to improve the use of antibiotics with the goal of enhancing patient health outcomes, reducing resistance to antibiotics and decreasing unnecessary costs. These strategies could include prescribing antibiotics only when they are needed and reviewing their continued use. Implementing accurate assessment and diagnosis to help guide antibiotic prescribing and ensuring that people receive the right treatment is an important element of an effective AMS strategy

Katherine Murphy, Chief Executive from The Patients Association said; “We cannot underestimate the scale of the threat that AMR represents - it is a key priority for the government and for The Patients Association. Our results however presented a somewhat mixed picture. Whilst there is clearly a considerable amount of good work being done to develop more effective AMS initiatives, a renewed focus is now essential. We need a greater adoption and implementation of current antimicrobial stewardship policy levers particularly in primary care where the majority of prescribing exists, alongside an increased uptake of measures proven to reduce inappropriate antibiotic prescribing. Measures such as cost-effective diagnostics and patient education materials which, if prioritised and implemented correctly, can really help in the fight against AMR.”

Andrea Jenkyns MP, Chair of the All-Party Parliamentary Group for Patient Safety said; “Alongside the ongoing drive to develop new and much needed antimicrobials, we must also ensure that our remaining treatment options are maintained as effectively as possible. The only way this can be achieved is by adhering fully to current guidance and examples of best practice. Today’s findings clearly illustrate that although progress is being made and a number of areas should be commended for their antimicrobial stewardship efforts, other areas lag worryingly behind and much more needs to be done to ensure that those with whom responsibility rests are doing all they can to help minimise the very real dangers that antimicrobial resistance presents.” 

Sister Liz Cross, winner of the National NHS Innovation Acorn Award and advanced nurse practitioner at Attenborough Surgery, in London Road, Bushey within Herts Valleys CCG said: “With budgets tight, it is understandable that CCGs might not prioritise AMS strategies or measures to decrease unnecessary antibiotic prescribing but the long term impact on patient safety is significant and should not be underestimated. 

“When considering our AMS strategy in Bushey, we wanted to look at methods that provided quality, evidence-based and cost-effective care to our patients. With that in mind, we introduced a point of care C-reactive protein test which tells if a patient needs an antibiotic or not. We found that our antibiotic prescribing was reduced by 23 percent during the 3 months of our pilot and the test halved the number of patients re-attending within 28 days for the same condition.”

The FOI results also reveal that over half of the CCGs that took part (51 percent) hadn’t evaluated the cost implications of implementing point of care C-reactive protein tests in primary care for lower respiratory tract infections, as was set out in NICE 2014 guidelines.(3) Additionally, up to 39 percent of CCGs are not using the education materials provided by the Royal College of General Practitioners (RCGP) (4) to help inform patients on the appropriate use of antibiotics (i.e. leaflets, posters and videos). 

AMS is recommended in primary and secondary healthcare care settings however 80 percent of antibiotic prescribing is in primary care.(4) Over half of antibiotics prescribed in primary care are for respiratory tract infections (RTIs).(2) UK antibiotic prescribing rates are considerably higher than the rates of prescribing in other northern European countries.(5,6) In 2013, 41 percent of UK residents had taken antibiotics compared to a European average of 35 percent. (7) 

The results from the FOI requests are included in The Patients Association’s ‘Antimicrobial Resistance: A Patient Safety Issue’ report which is available at http://www.patients-association.org.uk/reports/antimicrobial-resistance/

Notes to Editors:

For more information, please contact:

Katherine Murphy,The Patients Association

Tel: 077 7900 4898 / Email: katherine@patients-association.com

Rita Martins  Munro & Forster

Tel: 0207 089 6104 / Email: rita.martins@munroforster.com

About the Freedom of Information (FOI) results 

Data on current practice around AMS was collected via an FOI request sent by The Patients Association to 209 CCGs across England during April 2016 – 144 responses were received. Data collection, management and analysis was undertaken by Munro & Forster, a communications consultancy commissioned through an educational grant provided by Alere International.

About antimicrobial stewardship (AMS)

Antimicrobial stewardship is an organisational or healthcare-system-wide approach to promoting and monitoring judicious use of antimicrobial drugs to preserve their future effectiveness.8 NICE’s ‘Antimicrobial stewardship: systems and processes for effective antimicrobial medicine use’ guidelines (8) state that ‘commissioners should ensure that antimicrobial stewardship operates across all care settings as part of an antimicrobial stewardship programme’.

About antimicrobial resistance (AMR)

Antimicrobial resistance is resistance of a microorganism to an antimicrobial drug that was originally effective for treatment of infections caused by it. Antimicrobial resistance threatens the effective prevention and treatment of an ever-increasing range of infections caused by bacteria, parasites, viruses and fungi. It is an increasingly serious threat to global public health that requires action across all government sectors and society.(9) 

About point of care C-reactive protein testing

A point of care C-reactive protein test is a quick finger prick blood test which helps primary care practitioners to determine whether a patient needs antibiotics for an RTI, helping doctors to target the use antibiotics, reducing both the number of antibiotics that are used and also the potential for misdiagnosis. It has been shown to be a cost-effective intervention compared with current management of patients presenting to GP clinics with symptoms of RTI.(10) Some of the point of care C-reactive protein tests use the same devices as other tests, such as lipids (NHS Health Check), HbA1c and urine albumin-to-creatinine ratio.

About The Patients Association

The Patients Association is an independent national health and social care charity established over 52 years ago, which has a long history of campaigning to ensure the voice of patients is heard within the UK Health and Social care system. The Patients Association launched an All Party Parliamentary Group for Patient Safety in July 2015 with Andrea Jenkyns MP as Chair. It brings together interested Parliamentarians, members of the public and healthcare experts to address all issues affecting patients in the care sector. 


  1. NICE. Antimicrobial stewardship: systems and processes for effective antimicrobial medicine use. NICE guidelines [NG15] August 2015. Available at: https://www.nice.org.uk/guidance/NG15/chapter/1-Recommendations#termsused-in-this-guideline. Last accessed May 2016
  2. The Patients Association. ‘‘Antimicrobial Resistance – a Patient Safety Issue’ Report. http://www.patients-association.org.uk/reports/antimicrobial-resistance/ . Last accessed May 2016
  3. NICE. Pneumonia in adults: diagnosis and management. NICE guidelines [CG191]. December 2014. Available at https://www.nice.org.uk/guidance/cg191. Last accessed May 2016
  4. Royal College of General Practitioners. TARGET Antibiotics Toolkit. Available at http://www.rcgp.org.uk/targetantibiotics/. Last accessed May 2016
  5. European Centre for Disease Prevention and Control (ECDC). ECDC Surveillance report. Surveillance of antimicrobial consumption in Europe. Stockholm: 2014
  6. DCDC/EMEA. Joint Technical Report: The bacterial challenge: time to react. EMEA/576176/2009
  7. Bhattacharya A, Budd E, Ashiru-Oredope D. European Antibiotic Awareness Day (EAAD) 2013 Evaluation Report. Available at www.gov.uk/government/uploads/system/uploads/attachment_data/file/318933/European_Antibiotic_Awareness_ Day_2013_Evaluation_Report.pdf. Last accessed May 2016
  8. NICE. Quality statement 1: Antimicrobial stewardship. Available at https://www.nice.org.uk/guidance/qs61/chapter/quality-statement-1-antimicrobial-stewardship. Last accessed May 2016
  9. WHO. Antimicrobial resistance. Available at: http://www.who.int/mediacentre/factsheets/fs194/en/. Last accessed May 2016
  10. Cooke J et al. Narrative review of primary care point-of-care testing (POCT) and antibacterial use in respiratory tract infection (RTI). BMJ Open Resp Res. 2015. Available at http://bmjopenrespres.bmj.com/content/2/1/e000086.full. Last accessed May 2016 
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