Establishing an R+D collaboration to improve antimicrobial prescribing in primary care

Lead Research Organisation: Public Health England
Department Name: UNLISTED


Resistance to antimicrobials (eg antibiotics) is a significant health problem and is driven by antimicrobial prescribing patterns. The majority of antimicrobial prescribing for humans in the UK is by GPs, but efforts to change prescribing patterns have so far met with limited success. A R+D collaboration is to be established between the key functions of the Health Protection Agency and 3 Universities with complimentary expertise relevant to improving antimicrobial prescribing in primary care. The collaboration will achieve its objectives via 4 mechanisms:
- ensuring that best practice guidance on antimicrobial prescribing is available to GPs and other primary care staff and regularly updated.
- ensuring that best practice on how to change prescribing in primary care is identified, publicised and regularly updated.
- developing and establishing a system for routinely monitoring antimicrobial prescribing in primary care to assess implementation of recommendations and to act as a tool for furure research.
- acting as a focus for further research bids in this area.
This bid is for a project manager to implement the collaboration and organise bids for funding to develop the 4 strands of work.

Technical Summary

The emergence of bacterial strains that are increasingly resistant to antimicrobial agents is of growing national and worldwide concern. The spread of antimicrobial resistance has been driven by the widespread use of antibiotics, either appropriately or inappropriately, and is costly in both human and financial terms. Furthermore, countries with higher community antibiotic prescribing have been shown to have higher antibiotic resistance rates in several pathogens. The Standing Medical Advissory Committee report published by the Department of Health in 1998 made recommendations to limit inappropriate prescribing as a means of reducing the emergence of antimicrobial resistance and since then a range of initiatives have been undertaken. However, although some changes in behaviour have occurred, translating these recommendations into clinical practice has so far had only limited success.
This proposal is to establish a collaboration of expert sections of the Health Protection Agency with University Departments with complementary expertise and aims to improve prescribing by addressing gaps in the following 4 areas:
?< What should GPs be prescribing on the basis of current evidence to minimise antimicrobial resistance without unacceptable clinical consequences?
?< How do we achieve appropriate prescribing behaviour in primary care?
?< How do we measure what is being prescribed, whether it is appropriate and whether change is being achieved?
?< What further research needs to be done?
Description Presented to Government's ESPAUR (antibiotic restsitance) Committee
Geographic Reach National 
Policy Influence Type Gave evidence to a government review
Impact Incorporated into national advice documents
Description The prescribing guidelines that form part of the work of this collaboration have been taken to the DH advisory committee on ARHAI which recommended that their prescribing sub group review them. This advisory committee informs national policy.
Geographic Reach National 
Policy Influence Type Participation in advisory committee
Impact (i) These guidelines when reviewed could influence national policy and thus widely influence prescribing practice in primary care. (ii) The outcome of the research ( reviewing Amsurv (resistance) data) could lead to improved prescribing practices when fed back to healthcare professionals. ; (i) None yet. (ii) None yet.
Description British Society for antimicrobial chemotherapy educational grant
Amount £30,000 (GBP)
Organisation British Society for Antimicrobial Chemotherapy 
Sector Charity/Non Profit
Country United Kingdom
Start 04/2009 
End 03/2011
Description HPA R&D Development fund
Amount £50,504 (GBP)
Organisation Public Health England 
Sector Public
Country United Kingdom
Start 04/2010 
End 03/2013
Description Media interest following paper in J Antimicrob Chemother 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact Published paper led to widespread media interest, including by BBC, ITV, Sky and Channel 4 TV; Range of local radio interviews and Radio5 discussion; Articles in all UK broadsheet papers and many tabloids; articles/interviews in various public and professional magazines and written reports in international papers (eg Times of India).

Increased discussion by public + professionals on their role in reducing prescribing of antimicrobial drus.
Year(s) Of Engagement Activity 2014
Description Published on Health Protection Agency Web site 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Health professionals
Results and Impact Better recommendations to General Practitioners on prescribing. Improved compliance.

Further funded project to evaluate clinician response to recommendations.
Year(s) Of Engagement Activity 2008