Who is this toolkit for?

The toolkit is designed for integrated care board (ICB) antimicrobial resistance (AMR) leads to use in self-assessments or peer reviews.

It supports compliance with ICBs’ statutory duty under section 14Z34 of the NHS Act 2006 to continuously improve service quality and can be used to inform antimicrobial stewardship assurance reporting as part of CQC assessments of integrated care systems.

ICB responsibilities

NHS England’s Quality functions: responsibilities of providers, integrated care boards and NHS England (log in required) sets out the responsibilities of ICBs in addressing antimicrobial resistance, including:

• identifying an antimicrobial resistance lead with overall responsibility for co-ordinating the ICB’s antimicrobial resistance response and with a clear position in the ICB’s governance structure
• developing an understanding of infection and antimicrobial prescribing trends, of variation in their localities, and therefore of where action should be focussed
• addressing the issues in their areas and supporting national plans
• developing pathway-based approaches across primary and secondary care
• ensuring that antimicrobial resistance forms part of the ICB prevention plans and that there is an integrated approach to individuals and communities at greater risk of ill-health
• supporting place-based partnerships and primary care networks to identify actions to address antimicrobial resistance

Antimicrobial resistance guidance and regulation

The Care Quality Commission (CQC) assesses the quality and safety, integration and leadership of integrated care system services under the Health and Care Act 2022. It considers the 2008 code of practice on the prevention and control of infections when assessing compliance with infection prevention and control requirements. Criterion 3 of the code says registered providers must demonstrate appropriate antimicrobial use and stewardship to optimise outcomes and minimise the risks of adverse events and antimicrobial resistance.

Download an editable version of the Antimicrobial stewardship – ICB situation report

Improving the toolkit

The toolkit will be reviewed in August 2025. Email us with comments or suggestions for improvements: england.amrprescribingworkstream@nhs.net.

We would like to thank the Care Quality Commission’s Medicines Optimisation and Ionising Radiation (Medical Exposer Regulations team for their work with us in developing the toolkit.

Health inequalities

Throughout the development of the toolkit, we have considered the need to:

• eliminate discrimination, harassment and victimisation, advance equality of opportunity, and foster good relations between people with protected characteristics (under the Equality Act 2010) and those without
• reduce inequalities in patients’ access to, and outcomes from, healthcare services and ensure services are provided in an integrated way when this will reduce health inequality

Publication reference: PRN01608