Changing our thinking on antibiotics

The Midlands and East Regions for NHS England and NHS Improvement look at how we all have a role to play in tackling antimicrobial resistance:

Unlike my parents, I cannot remember a time when effective antibiotics were not available.

Like most people, I have been able to lead my life comfortable in the knowledge that when I’ve needed to go into hospital for an operation, or been unwell because of an infection, I’ve been able to rely on antibiotics to protect me or make me better.

This is no longer the case.

The way that we have relied on and used antibiotics, often inappropriately, means that we have allowed the widespread development of antimicrobial resistance. Many of our antibiotics no longer work as they should and we have been too slow to develop new ones.

Tackling this issue is not going to be easy and will need each of us to change the ways that we think and behave.

The NHS Long Term Plan acknowledges the need for further progress on antimicrobial resistance and refers to the recently published 20 year vision and five year action plan for tackling it.

It talks about optimising the use of and reducing the need for antibiotics, and supporting the development of new antibiotics, and it promotes a greater focus on preventative measures, such as vaccination and infection prevention and on tools such as electronic prescribing and improved diagnostics.

The pharmaceutical industry will be expected to take more responsibility for antibiotic resistance. NICE and NHS England will explore a new payment model that pays pharmaceutical companies based on how valuable their medicines are to the NHS, rather than on the quantity of antibiotics sold. This will incentivise companies to invest in the development of drugs that will treat high priority resistant infections.

However, if you read into it more deeply, the plan also opens a wide range of exciting, new opportunities for tackling antimicrobial resistance.

Imagine these scenarios:

  • A call adviser in a local urgent care centre refers a patient with a sore throat for a consultation with a community pharmacist who is also able to provide opportunistic advice on infection prevention and offer a flu vaccination.
  • A clinical pharmacist in a primary care network working as part of a multidisciplinary team providing expert advice on antimicrobial stewardship in care homes.
  • A pharmacist prescriber in general practice who reviews and optimises a patient’s COPD medication to prevent an exacerbation and the need for antibiotics or a hospital admission.
  • A consultant antimicrobial pharmacist running an integrated parenteral antibiotic therapy service across local healthcare organisations.
  • A pharmacist at a STP/ICS using open-access databases to analyse local resistance patterns and to identify and reduce unwarranted variation in the implementation of antibiotic prescribing guidelines.

All seven chapters in the Plan can be linked in one way or another to tackling antimicrobial resistance; the challenge for all of us is to use the opportunities it provides to get on with it.

Richard Seal

Richard Seal is Regional Pharmacist (Midlands and East), for NHS England and NHS Improvement.

His role includes advising on pharmacy and medicines use, the implementation of national policy on pharmacy and medicines issues, providing senior professional leadership for medicines optimisation across the region and working as part of the Chief Pharmaceutical Officer’s wider pharmacy leadership team.

He is a member of Public Health England’s English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR) and is responsible for the Midlands and East Regional Medicines Optimisation Committee’s lead role on antimicrobial resistance.

Richard is a Fellow of The Royal Pharmaceutical Society and recently completed his two-year tenure as a Fellow of the National Institute for Health and Care Excellence (NICE).

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