Antimicrobial resistance (AMR)

The following pages bring together resources to help prevent antimicrobial resistance (AMR) and reduce its impact on health and care services.

They will be particularly relevant to:

  • directors of infection prevention and control in NHS trusts and integrated care boards (ICBs)
  • NHS staff in specialist AMR prevention roles, including medical microbiology and infectious diseases, infection prevention and control (IPC), antimicrobial stewardship (AMS) and infection diagnostics
  • ICB commissioners, and those responsible for overseeing and delivering their 5-year plans
  • regional teams
  • regional directors of public health

Resources for healthcare systems

Section 1: Roles and responsibilities for delivery of the UK antimicrobial resistance national action plan

This section outlines the roles and responsibilities of NHS structures in delivering AMR prevention, drawing upon the Model Region and Model ICB blueprints. These principles are relevant to the national AMR programme, regional leadership teams, ICB commissioners and trust AMR leadership teams.

Section 2: Guidance on delivery of the antimicrobial prescribing targets of the UK AMR national action plan

This guidance describes the targets for antimicrobial prescribing set out in the UK AMR NAP, translated for individual ICBs and provider trusts. It includes pragmatic strategies for delivering improvement and hyperlinks to supporting resources. The guidance is intended for implementation by specialist antimicrobial stewardship teams and as a reference source for ICB commissioners and NHS England regional teams.

Section 3: Planning the antimicrobial stewardship workforce: a practical guide for trusts and ICBs

This guidance was developed in response to the AMR NAP commitment (5.2) to implement a system-wide approach to strong IPC and AMS in health and social care settings, aligning workforce planning with workforce needs.  This guidance is relevant for directors of infection prevention and control (DIPCs), clinical leads for medical microbiology and infectious diseases and directors of pharmacy. It outlines the capacity and skill mix needed for antimicrobial stewardship (AMS) teams in different healthcare settings to deliver high- and medium-priority AMS activities.

Section 4: Capability framework for antimicrobial stewardship specialists

This resource was developed by the British Society for Antimicrobial Chemotherapy in collaboration with NHS England and in response to the AMR NAP commitment (5.1) for specialist posts, to provide career pathways to promote skills retention and succession planning. The framework sets out the capabilities health professionals need when working in a specialist antimicrobial stewardship role. This resource is designed for use by NHS staff in specialist antimicrobial stewardship roles, their line managers and educational supervisors as well as education providers.

Section 5: Reducing Watch and Reserve antibiotic consumption in hospitals – lessons learned from real-world practice

This best-practice guidance was developed to support NHS hospitals to meet the AMR National Action Plan human health targets: 4a) to reduce total antibiotic use in human populations by 5%; and 4b) to achieve 70% of total use of antibiotics from the World Health Organization (WHO) Access category.

The guidance provides best-practice recommendations derived from a thematic analysis of interviews with NHS staff at hospitals that have successfully reduced prescribing of antibiotics from the WHO Watch and Reserve categories. The guidance is designed for implementation by directors of infection prevention and control and antimicrobial stewardship teams in acute hospital trusts and is also intended as a reference source for ICB commissioners and NHS England regional teams.

Burden of infection and AMR and impact on NHS priorities

Of those attending primary care each year, 25%–30% have respiratory tract infections and 10% of women have urinary tract infections. In secondary care, at any given time, antibiotics are prescribed to 34% of inpatients and over 20% of bed days in 2023-24 were attributable to infectious disease or infections, at a cost to the NHS of £5.9 billion.

In the UK in 2019 there were 87,500 deaths involving bacterial infection, second only to ischaemic heart disease in burden. Of those deaths, 35,200 were associated with AMR; for comparison, there were 15,300 deaths from breast cancer.

AMR leads to treatment failure, resulting in repeat GP appointments, A&E conveyances, hospital admissions, intensive care unit admissions, extended length-of-stay and higher morbidity and mortality for patients. AMR poses a strategic threat to achievement of trust and ICB core objectives: to improve patients’ access to general practice; to reduce the time people wait for elective care; and to improve A&E waiting times and ambulance response times. Resistant infections are associated with a further 9.2 days length of stay and an additional hospitalisation cost of £3441 per patient.

Government commitment to confronting the threat from AMR

The government places a high priority on mitigating the risk of AMR including via the priorities and actions set out in the UK AMR National Action Plan (NAP). The importance of taking action to address AMR has also been emphasised in the Chief Medical Officer’s annual report 2025: infections.  AMR is captured as a chronic risk in the National Risk Register 2025.

AMR National Action Plan (NAP) – performance against targets

The AMR NAP sets out four human health targets for the NHS to reach by 2029:

  • Prevent any increase in a specified set of drug-resistant infections in humans from the 2019 to 2020 financial year (FY) baseline. Performance to March 2026 was 25.7% above the 2019/20 baseline (improvement required).
  • Prevent any increase in Gram-negative bloodstream infections in humans from the 2019 to 2020 financial year baseline. Performance to March 2026 was 8% above the 2019/20 baseline (improvement required).
  • Reduce total antibiotic use in human populations by 5% from the 2019 baseline. Current position. Performance to December 2025 was 5% below the 2019 baseline (on target).
  • Achieve 70% (or more) of total use of antibiotics from the Access category (new UK category) across the human healthcare system. Performance to December 2025 was 67.3% (improvement required).

A set of commitments supports the overall targets, covering action in improving infection prevention and control (IPC), antimicrobial stewardship (AMS), infection diagnostics, clinical leadership, data and analytics and developing the AMR subscription model.

NHS strategic planning for AMR prevention

NHS policy and guidance

Containing, controlling and mitigating AMR is a core enabler of the 10 Year Health Plan for England, supporting the shift towards prevention and population health, earlier and more effective diagnosis, and safer, evidence-based, data-driven care.

This is reflected in the Medium Term Planning Framework commitment to support shifting from sickness to prevention: ICBs must ensure their 5-year plans support the following preventative goals [including] reducing exposure to antibiotics to meet thresholds set out in guidance (see Section 2).

The NHS Oversight Framework includes metrics for primary and secondary care:

  • Percentage of children (aged 0-9) prescribed antibiotics in the last 12 months
  • Rates of healthcare-associated infection (MRSA, difficile and E. coli)

The NHS Standard Contract for 2026/27 includes the following service conditions and national quality requirements that contribute to AMR prevention:

  • Infection Prevention and Control and Seasonal Vaccination (SC21)
  • Assessment and Treatment for Acute Illness (SC22)
  • Zero tolerance of methicillin-resistant Staphylococcus aureus
  • Minimise rates of Clostridium difficile (NHS Trusts / FTs only)
  • Minimise rates of Gram-negative bloodstream infections (NHS Trusts / FTs only)
  • Proportion of Adult Service User inpatients, or presenting as emergencies, who undergo sepsis screening and who, where screening is positive for high risk of severe illness or death from sepsis, receive IV antibiotic treatment within one hour of diagnosis

Schedule 6 of the NHS Standard Contract 2026/27 Particulars, includes Service Development Improvement Plans (SDIPs) for:

  1. UK Standard for Microbiology Investigations S12 – sepsis and systemic or disseminated infections
  2. difficile infection (CDI) ascertainment