NHS England » Capability framework for antimicrobial stewardship specialists

This framework sets out the capabilities health professionals need when working in a specialist antimicrobial stewardship (AMS) role. It applies at all levels of practice and in any NHS setting.

Who is an AMS specialist?

An AMS specialist is a health professional who works in an AMS role or team and delivers an AMS programme. This framework does not apply to generalist or specialist clinicians who don’t have an AMS focus.

How to use the framework

It’s designed for AMS specialists, managers, organisations and education providers. Here’s how it can be used:

AMS specialists: planning your growth

map your current level of practice using the capability descriptions
identify areas for personal and career development
set goals in appraisals and plan training and development using the framework
outline the roles, activities, and responsibilities of members of the AMS team

Managers of AMS specialists: supporting your team

develop job descriptions, person specifications, and job plans that align with the framework
build professional development plans for AMS team members
identify development opportunities during appraisals

Organisations: strengthening AMS delivery

review your AMS programme and team capability against the framework and identify gaps
plan resources and support to build and strengthen your AMS team
All organisations should have an executive lead for AMS with a thorough knowledge of the framework. They should use it to:
identify the capabilities they need to advocate and be accountable for AMS within their organisation
help their AMS team build and maintain the collaborative relationships they need to do their job
support the AMS team get the education and training required to strengthen AMS delivery

Education and training providers: designing relevant learning

use the framework to design and review education and training materials for AMS specialists
align professional development programmes so the AMS workforce meets current and future needs
use the capability statements as learning outcomes for education, training and assessment. The statements are aligned with Bloom’s Taxonomy

Other resources

Use the framework alongside other relevant resources, including the:

Medical royal colleges’ curricula for infectious diseases and medical microbiology
Royal Pharmaceutical Society’s advanced and consultant frameworks
Royal College of Nursing’s enhanced, advanced, and consultant frameworks
National Competency Framework for Primary Care Pharmacy Technicians
UKHSA (2023) Antimicrobial prescribing and stewardship competency framework
WHO Competency Framework for Health Workers’ Education and Training on Antimicrobial Resistance
Establishing core competencies for antimicrobial stewardship teams: a consensus development using the modified Delphi technique—an European Society of Clinical Microbiology and Infectious Diseases Study Group for Antimicrobial Stewardship position paper – Clinical Microbiology and Infection
BSAC (2023) GAMSAS Standards and Good Practice Recommendations for AMS Programmes

Resources to help individuals and organisations implement the framework, for example, information on available courses, example job descriptions, person specifications and job plans are available on the Futures collaboration platform: Workforce Strategy and Planning – Antimicrobial Resistance Programme – Futures

Why this matters

The framework underpins delivery of AMS commitments in the 5-year antimicrobial resistance national action plan, including commitment 5.1 (embedding AMS and infection prevention and control training and providing career pathways for AMS specialists), commitment 5.2 (implementing a system-wide approach and ensuring the workforce is able to respond to and mitigate incidents) and commitment 5.3 (appropriate AMS and infection prevention and control leadership and governance).

The AMS specialist capability framework

The framework has 4 domains, aligned with NHS’s advanced and consultant practice frameworks:

Antimicrobial stewardship professional practice.
Leadership and management.
Education.
Research and quality improvement.

Within each of these domains, we group the capabilities required of AMS specialists thematically (for example, all the capabilities needed to deliver and shape AMS programmes are grouped together in the first section in domain 1) and distinguish between the different capabilities required at 3 levels of practice:

Core – this aligns with the ‘enhanced’ level of practice within the healthcare workforce
Advanced – as described by the corresponding NHS multi-professional framework
Expert – this aligns with consultant-level practice

As practitioners move from core through advanced to expert practice, their knowledge, experience and overall capability increases and they can take on more responsibility. The framework talks about 4 delivery levels – from contributing and supporting, to delivering independently, to designing and developing, and finally to leading and being accountable for outcomes. These delivery levels don’t map simply to the 3 levels of practice but, as practitioners grow, they are expected to be operating at the higher delivery levels.

Domain 1: Antimicrobial stewardship professional practice

Domain 1 descriptor

AMS specialists provide specialist AMS knowledge, skills, and practices to shape and deliver AMS in their organisation and healthcare system, for the benefit of individual patients and services. They collaborate with other clinicians, managers, teams, patients, and the public.

Capabilities

Theme: delivers and shapes antimicrobial stewardship programmes

a. Translates national guidance, policy and standards for the diagnosis, treatment, and prevention of infection, including antimicrobial stewardship, into organisational or system policies and guidelines.

Core: Supports the review of local policies and guidelines by identifying differences between local and national guidance, policies, and standards.
Advanced: Collaborates with multidisciplinary teams to ensure national guidelines and policies are incorporated into local guidelines, policies, and strategies, while considering local circumstances.
Expert: Responsible for the setting the strategy for implementing new and updated national policies, guidance, and strategies into local practice. Oversees and establishes stakeholder collaboration within their own organisation and across the health system.

b. Develops guidelines and policies for the prevention, diagnosis and treatment infection, including the optimal use and restriction of antimicrobials, across their organisation and/or system; including where national guidance is absent.

Core: Supports the development and revision of local guidelines and policies by contributing to writing and reviewing draft local guidelines, ensuring local clinical guidelines align with local AMS policies and strategies.
Advanced: Works collaboratively with multidisciplinary teams to develop local guidelines and policies. Uses local data, wider literature, and international guidelines where necessary.
Expert: Responsible for strategy regarding AMS guideline and policy development for organisation/system, including identifying when new guidance is needed. Ensures guidance is evidence-based, responsive to local needs, and follows organisation governance processes.

c. Ensures local guidance and policies for the prevention, diagnosis and treatment of infections include advice on diagnostic testing, including how and when to obtain samples for testing, and interpretation of results; optimising the diagnostic pathway and applying the principles of diagnostic stewardship to promote appropriate, timely diagnostic testing, including specimen collection, and pathogen identification and accurate, timely reporting of results to guide patient treatment. (WHO GLASS Manual)

Core: Contributes to the development of local guidelines and policies by ensuring relevant diagnostic decision-support and tests are included.
Advanced: Designs care pathways, guidelines, and policies that promote the timely and rational use of diagnostic decision-support and tests and the interpretation of results.
Expert: Leads on setting the organisation strategy for optimising the use of diagnostic decision-support and tests within guidelines, pathways, and policies and leads on embedding the principles of diagnostic stewardship within local guideline development.

d. Optimises the communication of microbiology results and susceptibility testing results to clinicians across their organisation or system.

Core: Interprets microbiology and susceptibility testing results and communicates results to other professionals and patients, to support their understanding and interpretation.
Advanced: Collaborates with other healthcare professionals; the laboratory, and IT to ensure results are reported in a way that supports clinical decisions and supports AMS.
Expert: Leads the strategy for communicating results to clinical teams, ensuring it promotes optimal antimicrobial prescribing across the healthcare system. Responsible for the policy and education underpinning this.

e. Uses information technology, and collaborates with data and informatics teams, to design and deliver AMS activities and interventions including audit, monitoring, surveillance, and quality improvement.

Core: Supports surveillance, monitoring, and QI activities by extracting and analysing data from available clinical systems.
Advanced: Analyses and reports AMS data across the organisation and/or system. Collaborates with data and informatics teams to optimise or automate the acquisition, analysis and reporting of data that underpins AMS activities.
Expert: Leads on strategy relating to use of data across the system, including provision of data, software, team members, and skill-mix to ensure the AMS programme is driven by data and evidence.

Theme: provides and supports person-centred care for those with infections, including resistant and challenging infections

f. Provides specialist advice regarding when and how to collect specimens for testing, to guide optimal diagnosis and treatment of infections and use of antimicrobials for individual patients; applying and promoting the principles of diagnostic stewardship.

Core: Interprets local and national guidelines and policies to provide advice regarding acquisition of microbiology samples, including advising on when samples should not be taken.
Advanced: Advises on sampling for complex cases that fall outside of available local and national guidelines. Uses experience to provide feedback to individual clinicians and team on inappropriate sampling, and shapes local guidance in response to this.
Expert: Leads on embedding diagnostic stewardship in guidelines, policies, and pathways across the organisation and system. Provides expert advice for complex cases, for which guidelines and evidence is lacking.

g. Provides specialist, person-centred, advice regarding the rational, safe, and effective prescribing of antimicrobial therapies for individual patients across care settings; including patient risk assessment; the prescribing of restricted, specialist/off-label, and unlicensed antimicrobials; and the use of source control and other non-antimicrobial management options.

Core: Responds to requests for advice and support from other health professionals relating to antimicrobial prescribing; using guidelines to underpin their advice and referring to more experienced colleagues when required. Supports others to prescribe antimicrobials safely.
Advanced: Proactively provides specialist advice to individual clinicians and multidisciplinary teams regarding optimal infection management including source control, antimicrobial therapies, and non-antimicrobial options, including cases for which local and national guidance is lacking.
Expert: Provides clinical expertise for optimal infection management and use of antimicrobial therapies in patients with the most complex clinical needs. Provides clinical leadership regarding the use of specialist and unlicensed therapies.

h. Applies pharmacodynamic and pharmacokinetic principles to optimise the efficacy of antimicrobial therapies while maintaining patient safety; considering methods of drug-administration and monitoring, across care settings.

Core: Provides advise on optimal dosing, and dose-adjustments, in relation to susceptibility results, therapeutic drug monitoring results, and organ dysfunction.
Advanced: Provides recommendations for optimal dosing, and dose-adjustments, in complex cases where guidelines are lacking, including organ-support therapy. Collaborates with the multidisciplinary team to design protocols for unlicensed routes of drug-administration.
Expert: Provides expert pharmacodynamic and pharmacokinetic knowledge for the most complex cases and takes responsibility for designing complex dosing and monitoring strategies for these patients. Provides clinical leadership and support to other clinicians caring for complex patients.

i. Interprets microbiology results and considers other diagnostic/radiology test results to provide person-centred recommendations regarding antimicrobial therapy and non-antimicrobial interventions.

Core: Interprets test results to determine whether antimicrobial therapy is warranted, or not, and provide advice on choice and dose of antimicrobial in line with guidelines.
Advanced: Interprets microbiology results and provides specialist advice on complex patient cases; recommending additional microbiology/pathology tests or imaging to optimise management, referring to relevant specialists where necessary.
Expert: Provides expert advice for the most complex patient cases where guidelines and evidence are lacking. Provides clinical leadership in multidisciplinary teams regarding the use of specialist microbiology tests and non-antimicrobial strategies.

j. Provides specialist advice in relation to contra-indications, cautions, allergies, intolerances, and adverse effects relating to antimicrobial therapies; making person-centred recommendations regarding alternative therapies and allergy de-labelling strategies.

Core: Differentiates between adverse drug reactions and allergies and can perform allergy history to ensure accurate documentation and support de-labelling in line with local policies. Provides advice regarding alternatives for patients with allergies to antimicrobials.
Advanced: Provides advice on antimicrobial choice for patient cases that are complex due to allergies, intolerances and contra-indications, including specialist advice on monitoring and safety-netting in relation to cross-reactivity. Develops and designs de-labelling strategies.
Expert: Leads on de-labelling strategies and services across the healthcare system. Provides clinical expertise for the most complex cases regarding antimicrobial allergies, intolerances and contra-indications.

k. Provides specialist advice in relation to the review of antimicrobial therapies for individual patients; including escalation and de-escalation, therapeutic drug monitoring, and use of outpatient parenteral antimicrobial therapy or virtual ward services.

Core: Provides advice on intravenous to oral switch, de-escalation, outpatient parenteral antimicrobial therapy and antimicrobial cessation as well as advising on escalation of therapy and referral to other clinicians and services.
Advanced: Performs autonomous clinical review of the patient and their antimicrobial therapy using advanced clinical skills, and has decision-making roles as part of multidisciplinary team structures.
Expert: Reviews and makes person-centred antimicrobial therapy plans for patients with the most complex needs. Provides clinical leadership to clinicians and multidisciplinary teams for reviewing complex antimicrobial therapies.

l. Applies knowledge of health and social care inequalities and risk factors for poor outcomes to optimise the care of patients with infections and to reduce the risk of infection at the individual patient level.

Core: Considers how health inequalities impact on infection risk, antimicrobial use, outcomes from infections, medicines adherence, and access to care.
Advanced: Collaborates with other clinicians and multidisciplinary teams to design individual care plans ensuring shared decision making in infection management, antimicrobial use, risk of infection, and access to care is included.
Expert: Provides clinical expertise and leadership on issues relating to the prevention and management of infections and antimicrobial use for patients with health inequalities and/or complex needs.

Theme: works collaboratively with others on issues relating to infection, resistance and AMS

m. Leads on AMS-related aspects of care and collaborates with the wider multidisciplinary team (including other infection specialists, non-infection specialist clinicians, and laboratory staff) to optimise the care of patients with infections, including antimicrobial-resistant and/or complex infections, across care settings (including outpatient parenteral antimicrobial therapy/virtual ward services).

Core: Supports clinicians and multidisciplinary teams to use antimicrobials optimally and align practice with available policies and guidelines.
Advanced: Leads on AMS within multidisciplinary teams, ward rounds, and clinical meetings; acting as a representative and link to the AMS team and other infection services.
Expert: Provides clinical leadership and oversight to ensure AMS expertise is embedded into relevant services, providing this expertise to teams and meetings for complex and novel situations.

n. Collaborates with the Infection Prevention and Control team to reduce transmission of infection and supports the investigation of, and response to, outbreaks; using resistance and antimicrobial usage data and expertise to underpin this.

Core: Responds to referrals from infection prevention and control to provide advice about antimicrobial use; supports review of transmission and outbreak of infections by using available data and/or collecting new data on antimicrobial use.
Advanced: Collaborates with infection prevention and control to embed AMS within infection prevention and control practice, policies, and guidance. Uses local resistance and antimicrobial use data to inform outbreak response and design ongoing monitoring strategies.
Expert: Leads on collaborative efforts between AMS and infection prevention and control across the health system, using AMS and clinical expertise to identify opportunities for collaboration and identify trends in data that warrant investigation.

o. Engages patients and the public in the understanding and development of AMS policies and guidelines.

Core: Supports shared decision making by discussing treatment guidelines and management plans with patients, family, carers and the public; improving their understanding of tests, treatments and resistance.
Advanced: Engages with patient safety groups to resolve specific incidents relating to antimicrobials and infections. Collaborates with patients and partner groups in the development of policies, guidelines, patient-information, and AMS interventions.
Expert: Responsible for overall strategy of embedding patient and public engagement in the development of policies, guidelines, patient-information, and AMS interventions.

Domain 2: Leadership and management

Domain 2 descriptor

AMS specialists provide leadership across organisations and health and social care systems to optimise the management of infections and use of antimicrobials. They lead on complex issues relating to antimicrobial resistance and behaviours driving antimicrobial use.

Domain 2 capabilities

Theme: provides clinical and strategic leadership and accountability regarding antimicrobial stewardship

a. Implements the UK National Action Plan for Antimicrobial Resistance, including supportive national policies and strategies for antimicrobial stewardship, within their organisation or system.

Core: Promotes and supports achievement of the national action plan by embedding the objectives and supporting embedding of national policies and strategies into local practice.
Advanced: Ensures local practice, policies, guidance, and care pathways align with the goals of the national action plan and incorporate the associated national policies and strategies.
Expert: Leads on system-wide strategy for delivering the objectives of the national action plan; gaining cross-system engagement and collaboration to deliver this in all health and social care settings.

b. Ensures AMS is identified, and sustained, as organisational and/or system priority; working with, and reporting to, senior management/executive/board members.

Core: Produces and presents AMS reports for relevant committees and stakeholders
Advanced: Presents AMS strategy and reports to senior clinicians and management across the organisation, and gains support with collaboratively addressing AMS issues.
Expert: Provides AMS leadership and expertise to executive/board and ensures AMS objectives and measures are embedded within organisation/system strategies.

c. Collaborates with senior management/executive/board to ensure key performance indicators (KPI) and goals relating to AMS are included in the organisation and/or system’s annual plan; contributes to the development and delivery of this annual plan to tackle antimicrobial resistance and improve AMS.

Core: Collects and analyses KPI data and contributes to organisational reports. Supports the initiatives that will deliver the annual plan.
Advanced: Collaborates on the delivery of initiatives that align with the annual plan and ensures outcomes and KPIs are monitored and reported. Makes recommendations regarding future KPIs and annual plans.
Expert: Ensures KPIs relating to AMS are included in the organisation/system annual plan(s) and provides leadership in the monitoring of AMS initiatives, guiding the organisation’s strategic direction to improve antimicrobial use and mitigate antimicrobial resistance..

d. Provides specialist advice to the organisation and/or system antimicrobial resistance lead(s); acting as this lead where appropriate.

Core: Supports the antimicrobial resistance leads and contributes to the provision of data and specialist advice to the organisation/system leads
Advanced: Provide specialist advice to the antimicrobial resistance leads and develops strategies to address AMS priorities across the organisation or healthcare system.
Expert: Leads on complex priorities relating to antimicrobial resistance on behalf of the organisation and/or system.

e. Engages in multi-professional AMS committee(s) within their organisation and/or system, to provide expertise and strategic leadership.

Core: Attends and supports the activities of the organisation AMS committee(s).
Advanced: Actively contributes to the organisation or system AMS committee(s) and leads on specific activities. Deputises or chairs AMS committee(s) where necessary.
Expert: Leads organisation and/or system AMS committee(s) and is responsible for member engagement and the development and delivery of committee workplans.

f. Advocates and creates plans for embedding and evaluating digital solutions to improve the delivery of the AMS programme; including data collection, analysis, and reporting.

Core: Collects data to support the evaluation of electronic systems and contributes to the development and testing of new electronic solutions.
Advanced: Collaborates with IT experts to design and implement AMS functionality within electronic systems; leading the evaluation and improvement of AMS functionality.
Expert: Provides strategic leadership on implementing, developing electronic systems that support the AMS programme. Responsible for the evaluation and governance of AMS solutions in electronic systems.

Theme: manages complex governance issues relating to antimicrobial resistance and antimicrobial usage to improve patient safety and outcomes

g. Ensures local formularies, guidelines, and policies meet the needs of the local population, focusing on local epidemiology of infectious diseases and AMR, upholding the principles of AMS (including cost-effectiveness) and addressing health inequalities.

Core: Contributes the development of policies and guidelines by ensuring these align with local formularies and consider cost implications.
Advanced: Uses local microbiology and AMR data to review guidelines and policies and identify new formulary applications. Ensures guidelines meet the needs of local populations and address health inequalities.
Expert: Sets the strategy for embedding AMS principles into local formularies, guidance and policies, and ensures local resistance and infection epidemiology, population statistics and health inequalities are incorporated into organisation and system guidelines and policies.

h. Leads on issues relating to the antimicrobial supply chain within their organisation and/or system, to ensure continuity of patient care while upholding the principles of AMS, including cost-effectiveness.

Core: Supports stock management of antimicrobials, including during periods of shortage and contributes to mitigations that reduce impact on patient care.
Advanced: Leads on strategies to mitigate the impact of stock shortages in their organisation and collaborates with supply teams to identify alternative antimicrobials.
Expert: Uses expert knowledge to leads on strategies that anticipate and mitigate the impact of stock shortages across the system. Takes responsibility for governance when required for procuring alternative antimicrobials.

i. Uses local and national incidents and safety reports relating to infection, AMR, and antimicrobials to review local guidance, policy, and practice; applying the principles of clinical governance.

Core: Contributes to the investigation of local incidents and supports the identification and reporting of patterns from incident reports.
Advanced: Designs and delivers initiatives to address patient safety issues and monitoring their impact; collaborating with multidisciplinary teams within the organisation.
Expert: Provides professional leadership in analysis of complex and serious patient safety incidents and develops a system-wide approach to mitigating and monitoring risks to patients.

j. Assures the accuracy of AMR surveillance and antimicrobial consumption data from an organisation, system, and/or national level so practice and care are changed in response to robust and reliable data.

Core: Reviews data to identify and correct issues with data analysis; ensuring original data is accurate and limitations are identified.
Advanced: Uses advanced knowledge to identify errors with data or analysis and design processes to overcome or mitigate these errors, including when new systems are implemented.
Expert: Responsible for ensuring AMS data and resistance patterns are reported accurately within the organisation and/or system and leads on using these data to change practice.

Theme: acts as a role model and supports others to change their behaviours

k. Promotes the use of local, national, and international guidelines and policies for the prevention, diagnosis, and treatment of infectious diseases and optimal use of antimicrobials; ensuring these are easily accessible to clinicians across the organisation and/or system.

Core: Refers to, and promotes the use of, relevant AMS policies and guidelines when providing clinical advice and undertaking AMS activities.
Advanced: Co-produces guidelines and polices with multidisciplinary teams and co-develops initiatives to monitor and increase use and accessibility.
Expert: Responsible for strategy of disseminating and increasing use of guidelines and policies across the organisation and/or system.

l. Provides feedback and recommendations, as an individual or as part of a team, to other clinicians and teams within the organisation and/or system regarding their management of infections and use of antimicrobials.

Core: Uses data to support provision of feedback and recommendations to services and is able to provide feedback to individual clinicians during clinical and AMS activities.
Advanced: Uses data and reports to provide feedback to clinicians, teams, and services and can identify and agree actions in difficult and challenging situations.
Expert: Supports others in identifying and managing concerns and is responsible for the strategy by which feedback is shared and escalated.

m. Applies behaviour change principles and methodologies to AMS programmes, strategies, and interventions.

Core: Applies behaviour change theory when providing clinical advice and when contributing to policies, guidelines, and pathways.
Advanced: Applies behaviour change theory when designing AMS activities and improvement programmes.
Expert: Leads the development and implementation of behaviour change strategies to improve antimicrobial use across the organisation and/or system.

Domain 3: Education

Domain 3 descriptor

AMS specialists develop and improve the knowledge, attitudes, and practices of others regarding the optimal use of antimicrobials and use their own professional development to improve AMS programmes and patient care.

Domain 3 capabilities

Theme: ensures own capability and competence remains at the forefront of practice and science

a. Undertakes horizon scanning of investigatory and newly approved antimicrobials, vaccines, drug-administration methods, diagnostic tests, and biomarkers (including genomics).

Core: Locates and appraises current literature regarding newly licensed antimicrobials and guidance relating to the prevention, diagnosis and management of infections.
Advanced: Establishes processes to receive updates from healthcare and regulatory bodies, relevant journals, and specialist networks.
Expert: Responsible for horizon scanning of ongoing studies and consultations and determining how this may impact on local policies, guidance, and practice within the organisation and/or system.

b. Is aware of emerging trends in infection and resistance epidemiology locally, nationally, and internationally; identifying how and when this may impact on the health and care of the local population, including impact on AMS strategies.

Core: Has an awareness of trends in infection and resistance epidemiology using surveillance data available locally, regionally, and nationally.
Advanced: Uses available literature, conferences, and networks to remain abreast of emerging trends and assesses how these may impact on local policy, guidance, and practice.
Expert: Establishes process by which the AMS team remains informed of emerging trends and leads the process for engaging with stakeholder to evaluate and mitigate the impact.

c. Remains abreast of the literature and evidence regarding novel AMS initiatives, strategies, and interventions, including their impact on infection management and resistance.

Core: Locates and appraises literature regarding AMS programmes, interventions, and activities, and considers how reported outcomes could impact the local AMS programme and organisation.
Advanced: Critically evaluates emerging evidence of novel AMS strategies and, where appropriate, can develop a local implementation and evaluation strategy.
Expert: Leads the process for considering novel AMS strategies and is responsible for engaging stakeholder across the organisation and system to implement change.

Theme: develops the AMS capabilities of health professionals and other staff

d. Develops and delivers AMS-related training to all health professional groups at induction and regularly thereafter, across their organisation and/or system; including to other infection and AMS specialists.

Core: Delivers AMS training and assessment for healthcare staff within their organisation.
Advanced: Designs AMS training and assessment for all healthcare professionals in their organisation and/or system and evaluates the impact of the education.
Expert: Uses clinical and pedagogical expertise to assure the quality and impact of AMS training within the organisation and/or system.

e. Develops and implements an education strategy and programme for all staff who prescribe, review, supply, administer, and monitor antimicrobial therapy; including for other infection and AMS specialists.

Core: Contributes to the review and implementation of the AMS education strategy in their organisation.
Advanced: Develops the organisation AMS education strategy in line with organisational AMS goals and health professional curricula.
Expert: Responsible for the organisation and/or system AMS education programme, ensuring this is underpinned by pedagogy, informed by local training needs, and supports AMS and organisation priorities.

f. Acts as a mentor and coach to other healthcare professionals developing their AMS practice and/or undertaking projects relating to AMS.

Core: Supports and coaches junior staff to develop their AMS capabilities.
Advanced: Mentors less experienced members of the AMS team and coaches and supports individuals undertaking specific AMS activities and projects.
Expert: Establishes a culture of support and coaching within the AMS team; providing mentorship and support and identifying development needs for individuals across the organisation, system, and beyond.

g. Supports training providers (e.g. universities, learned societies, clinical training locations, etc.) to embed and deliver AMR and AMS education and training within multi-disciplinary curricula and assessment strategies.

Core: Supports other educators within their organisation to incorporate AMS knowledge and skills within established training and assessment programmes.
Advanced: Develops and delivers AMR and AMS education for local higher education institutes and supports academics to incorporate AMS into their education sessions.
Expert: Collaborates with universities, learned societies, and/or other external training providers to embed AMR and AMS into education and training programmes and curricula.

Theme: educates and engages patients and the public on issues relating to AMR and AMS

h. Delivers and/or supports the delivery of public awareness and engagement campaigns and patient and public education relating to antimicrobial resistance, optimal use of antimicrobials, and infection prevention.

Core: Delivers public awareness campaigns within organisation.
Advanced: Leads the organisation strategy for public awareness and engagement, and collaborates on campaigns to be delivered across the system.
Expert: Responsible for the overall strategy and governance regarding public engagement and education within the organisation and/or system.

i. Develops and disseminates information relating to AMR and optimal use of antimicrobials for patients, family, and carers; engaging patients and the public in this process.

Core: Co-designs patient information materials and supports the dissemination of these materials to patients and public.
Advanced: Leads on identifying the need for patient information and takes responsibility for establishing collaborations to develop and disseminate the materials.
Expert: Responsible for the strategy and governance relating to development and dissemination of patient information within the organisation and/or system; establishing collaborations with new stakeholders where necessary.

Domain 4: Research and quality improvement

Domain 4 descriptor

AMS specialists undertake surveillance and monitoring of antimicrobial use across services, organisations, and systems. They develop and apply evidence to improve AMS programmes and interventions and optimise the use of antimicrobials.

Domain 4 capabilities

Theme: applies data, evidence, and research to improve AMS

a. Uses microbiology laboratory data to support the development of organisation and/or system antibiograms; ensuring these influence guidance and policy, and the optimal management of infections and use of antimicrobials.

Core: Interprets microbiology data to contribute to the development of antibiograms within the organisation.
Advanced: Produces antibiograms for specific situations and the whole organisation and uses these to inform local policies and guidelines.
Expert: Leads the development of organisation and system-wide antibiograms and is responsible for investigating and addressing trends.

b. Uses data from local, regional, and national surveillance of resistance patterns and monitoring of antimicrobial prescribing and consumption to engage with clinicians and managers, to improve AMS within their organisation and/or system.

Core: Uses local resistance and antimicrobial prescribing data when providing advice or feedback to clinicians regarding antimicrobial prescribing.
Advanced: Uses data and trends to identify priorities then collaborates with clinicians and managers to design and deliver AMS activities that improve antimicrobial use.
Expert: Presents data at senior level in organisation and/or system, and uses this data to overcome barriers to secure engagement and support from senior leaders regarding priorities relating to AMS.

c. Uses the latest research and evidence to review and inform guidelines, policy, and services relating to the management of infections and use of antimicrobials.

Core: Supports literature review, critical appraisal, and evidence synthesis during guideline review processes.
Advanced: Appraises and synthesises literature in the context of their organisation and local data, to design policies, guidelines, and services.
Expert: Responsible for ensuring the latest research is used appropriately in the development of guidelines, policies, and services across the organisation and/or system.

Theme: undertakes and leads on audit, evaluation, quality improvement, and research in relation to AMS

d. Undertakes and leads audits and quality improvement (QI) initiatives relating to antimicrobial prescribing and stewardship across their organisation and/or system; facilitating and supporting others to engage in these projects.

Core: Designs and undertakes audit and QI projects across the organisation, including the delivery of national audits.
Advanced: Leads audit and QI projects, and takes responsibility for engaging and supporting relevant stakeholders and teams.
Expert: Responsible for overall audit and QI strategy and programme(s), including securing senior clinical and management engagement.

e. Develops and delivers a programme of regular audits and point-prevalence surveys of antimicrobial prescribing and guideline adherence across their organisation and/or system.

Core: Undertakes data collection, analysis, and reporting for organisation point-prevalence-surveys and audits.
Advanced: Leads the organisation point-prevalence-survey and AMS audits and is responsible for supporting others delivering audits and point-prevalence-surveys.
Expert: Responsible for strategy and governance relating to point-prevalence-surveys and AMS audits and ensuring the design aligns with organisation, system, and national priorities.

f. Collaborates on research relating to the management of infections and optimal use of antimicrobials.

Core: Supports the delivery of research and contributes to organisational research processes and governance, such as review of research protocols.
Advanced: Designs and undertakes research in collaboration with others across the organisation, system, and/or nationally; including the review of research protocols to be implemented in the organisation.
Expert: Provides leadership on national and/or international research and is responsible within organisation and/or system for AMS research strategy, delivery, and governance; acting as principal investigator.

g. Contributes to regional, national, and international surveillance of resistance and monitoring of antimicrobial consumption.

Core: Supports data collection, analysis, and reporting for resistance surveillance and antimicrobial monitoring within the organisation.
Advanced: Undertakes AMR surveillance and antimicrobial monitoring activities within the organisation and/or system, including external data submission.
Expert: Responsible for surveillance and monitoring activities, including data submission to national systems, and contributes to the development of national and/or system strategies.

h. Disseminates results and recommendations from AMS projects within own organisation and/or system, and beyond where appropriate.

Core: Communicates the results and recommendations from audits, QI projects, and research to other clinicians, teams, and committees within the organisation.
Advanced: Disseminates the results and recommendations from audits, QI projects, and research to stakeholders across the system, regionally, or nationally.
Expert: Responsible for setting and delivering the strategy for disseminating projects, including at a national and international level.

How this framework was developed

NHS England commissioned the British Society for Antimicrobial Chemotherapy (BSAC) to develop a capability framework for healthcare professionals in antimicrobial stewardship (AMS) roles. It was developed using a modified Delphi process, including a review of existing AMS frameworks and standards and iterative Delphi surveys to refine and agree capability statements. Each statement was mapped by level of delivery and practice, then tested through wider consultation with relevant professional bodies and AMS practitioners across all professions and levels of practice, representing healthcare organisations throughout England, Scotland and Wales.

Publication reference: PRN02449_vii

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