Antimicrobial Stewardship Programmes in Primary care What’s the issue? Antibiotics are key to modern medicine and treatment. However, an increasing number of common infections are becoming resistant to the drugs designed to treat them. This is called antimicrobial resistance (AMR). Antimicrobial stewardship (AMS) is part of the fight against AMR. The purpose of AMS is to ensure ‘the right antibiotic for the right patient, at the right time, with the right dose, and the right route, causing the least harm to the patient and future patients’.(1) AMS programmes might include improving prescribing of antibiotics, promoting data collection and raising public awareness of AMR. Why is it important? AMR is a significant, and growing, threat to public health in the UK and around the world. Antimicrobial-resistant infections are estimated to cause 700,000 deaths each year globally. That figure is predicted to rise to 10 million, with a cumulative cost of $100 trillion, by 2050 if no action is taken. Estimates predict a three-fold rise in global antibiotic consumption by 2030, but no new class of antibiotics has been discovered and made available since the 1980s.(2) The COVID-19 global pandemic also brings AMR into sharper focus. While COVID-19 is a virus, and so antibiotics are not effective against it, people may develop secondary bacterial infections, or may find it harder to get drugs as global supplies are disrupted. What were we trying to find out? The Patients Association wanted to find out how well local clinical commissioning groups (CCGs) were implementing government policy and guidance on AMS, and how much progress they had made in recent years. How did we do it? We sent freedom of information requests to all CCGs in England with a range of questions on AMS programmes. We had done this previously in 2016, so we had some information with which we could judge progress. We also reviewed current UK policy and research to understand the context for AMS and current thinking on AMR. What did we find? We found some progress, and some areas for improvement. Key findings include: More CCGs had had an AMS programme for longer in 2019 compared to 2016. However, around 10% reported having no AMS programme at all – about the same as in 2016 In 2016, one third of respondents reported having no named individual responsible for the implementation of their AMS programme. Results from 2019 show considerable improvement, with only 17% reporting the same Only 5% of CCGs that responded (a total of 95) told us they had a ringfenced budget for AMS programmes 64% of respondents said they were currently achieving their antibiotics reduction target. 9% said they did not have a target Only 15% reported having a policy to promote the use of point of care tests to determine whether antibiotics were necessary for certain conditions. More than double the respondents – just over half - reported implementing the full TARGET toolkit for AMS programmes in primary care in 2019 compared to 2016. 9% of respondents overall had not implemented any of the toolkit. 73% of respondents to the question ‘do you believe that your CCG could practically do more to achieve the aims of its AMS programme?’ replied yes. What’s next? We think there are some steps different organisations can take to improve AMS even further, including: Conducting further research with the 17 new CCGs created in 2020 to monitor and evaluate how they develop high quality integrated AMS programmes Researching why some CCGs do not appear to have AMS programmes Researching why some areas of England are better than others at reducing antibiotic prescribing, and if this relates to ethnicity, poverty or other factors Encouraging CCGs and Health and Wellbeing Boards to include measures of AMR in their local Joint Strategic Needs Assessments Establishing dedicated local funds to help GPs and others raise awareness of AMR and AMS among professionals and the general public Establishing a local AMR innovation fund, to pilot and purchase new technology Developing a better understanding of the barriers and solutions to introducing point of care testing for certain bacterial infections in primary care in England Establishing evidence-based national guidance on use and monitoring of diagnostic tests to help prescribing. You can find a full copy of the report here. Where can I find out more? The Patients Association’s previous report on AMS (2016) World Health Organisation antimicrobial resistance fact sheet (2018) NHS information page on antibiotic resistance (2019) Become a Public Health England Antibiotic Guardian (2019).