Purpose
This guidance outlines the capacity and skill mix needed for antimicrobial stewardship (AMS) teams in different healthcare settings to deliver high- and medium-priority AMS activities. It aims to address the variation in AMS workforce capacity and skill mix across regions and healthcare settings, identified from a baseline survey of the AMS workforce by NHS England in 2022.
Integrated care boards (ICBs) are expected, under NHS England’s Strategic commissioning framework (November 2025), to use population health intelligence, prevention and value for money as the basis for planning and resourcing services, including those that address antimicrobial resistance (AMR).
Who should read this?
This guidance is designed to help ICBs and trusts with strategic planning of their AMS workforce.
For ICBs, this guidance underpins their statutory role as strategic commissioners by providing a structured approach to planning and resourcing AMS as a core component of system‑wide strategies, population health improvement plans and commissioning intentions. For trusts and other providers, it supports collaboration with ICBs to design and deliver AMS services that are aligned with system priorities, contracts and outcomes set through the strategic commissioning process.
AMS staffing frameworks for ICBs and trusts
We ran workshops with stakeholders from across NHS healthcare settings to work out the skill mix and time required for AMS activities and to identify which activities are high-priority. If most workshop participants assigned an activity to a specific health professional role, it was allocated to that role. If most said it was a group activity, it was allocated it to a group activity.
This guidance is based on published evidence and an established health workforce planning methodology. The time required for activities was based on the average time estimated by the workshop participants and expressed as a whole time equivalent (WTE).
The resulting AMS staffing structures and time estimates are designed to be used within ICBs’ strategic commissioning cycle, including integrated needs assessments, priority setting, resource allocation and contracting for AMS services across care settings. Applying a consistent AMS workforce structure helps ICBs reduce unwarranted variation and commission for equitable access, experience and outcomes in line with the Strategic commissioning framework.
AMS staffing in ICBs
An average sized ICB serving a population of 1.5 million people requires 4.6 WTE specialist staff to deliver high- and medium-priority AMS activities, according to the workshop outputs.
An ICB of the same size serving the same population but only delivering high-priority AMS activities would need 3.5 WTE.
The recommended whole‑time equivalent (WTE) requirements and team composition are intended to inform ICBs’ strategic commissioning functions, including population health improvement plans, financial and workforce strategies, and service specifications for AMS.
This guidance enables ICBs to align AMS workforce investment with population size, risk, priorities and available resources, consistent with the Strategic commissioning framework.
Table 1: Recommended AMS team composition for an average-sized ICB (population 1.5 million)
Figures are expressed as whole-time equivalent (WTE) and based on an average of workshop participants’ time estimates.
| Staff types | Time needed for high-priority AMS activity | Time needed for medium-priority AMS activity | Time needed for all AMS activities |
|---|---|---|---|
| Admin or clerical staff | 0.09 | 0.05 | 0.15 |
| Antimicrobial resistance lead or general practitioner with special interest | 0.26 | 0.04 | 0.30 |
| AMS nurse | 0.24 | 0.08 | 0.32 |
| AMS pharmacist | 1.77 | 0.58 | 2.35 |
| AMS pharmacy technician | 0.21 | 0.24 | 0.45 |
| Data analyst | 0.36 | 0.01 | 0.37 |
| Medical microbiologist or infectious diseases physician (or jointly trained team member) | 0.59 | 0.06 | 0.65 |
| All AMS staff | 3.53 | 1.06 | 4.59 |
ICBs can adjust their team composition based on population size and workforce availability. Some activities can be carried out by more than one type of professional – and a breakdown of preferred and alternative health professional roles for each AMS activity in ICBs is included in the Appendix (table 3). For example, an ICB might employ a full-time AMS nurse and a full-time AMS pharmacy technician to reduce the pharmacist WTE requirement for their team. Recommended participants for AMS group activities in ICBs are provided in the Appendix (table 4).
Outpatient antimicrobial therapy (OPAT) services are not included in the core staffing recommendations above. Guidance is provided in the Appendix (table 3) on AMS capacity where these services are in place.
AMS staffing in trusts
An average-sized hospital trust with 500 beds requires 6.0 WTE specialist staff to deliver high and medium priority AMS work.
A hospital trust of the same size (500 beds) would require 5.0 WTE if it only delivered high-priority AMS activities.
Provider organisations, including NHS trusts, should use this AMS staffing guidance in partnership with their integrated care board as part of the wider strategic commissioning approach. The recommended AMS capacity and skill mix can inform business cases, service models and local workforce plans, ensuring that commissioned services have sufficient specialist AMS input to meet regulatory expectations, support Care Quality Commission (CQC) assurance on infection prevention and control, and deliver on system-wide antimicrobial resistance priorities.
Table 2: Recommended AMS team composition for an average-sized hospital trust (500 beds)
Figures are expressed as whole-time equivalent (WTE) and based on an average of workshop participants’ time estimates.
| Staffing for AMS activities | Time needed for high-priority AMS activity | Time needed for medium-priority AMS activity | Time needed for all AMS activities |
|---|---|---|---|
| Admin or clerical staff | 0.08 | 0.05 | 0.13 |
| Antimicrobial resistance lead | 0.16 | 0.00 | 0.16 |
| AMS nurse | 0.49 | 0.08 | 0.57 |
| AMS pharmacist | 1.98 | 0.51 | 2.49 |
| AMS pharmacy technician | 0.43 | 0.17 | 0.59 |
| Biomedical scientist | 0.01 | 0.00 | 0.01 |
| Data analyst | 0.51 | 0.14 | 0.64 |
| Finance or business manager | 0.00 | 0.05 | 0.05 |
| Medical microbiologist or infectious diseases physician (or jointly trained team member) | 1.32 | 0.17 | 1.49 |
| All AMS staff | 4.98 | 1.16 | 6.14 |
Hospital trusts can adapt the composition of their AMS team composition because of workforce availability. For example, an AMS consultant pharmacist may be employed to undertake some of the microbiology and leadership responsibilities. A full breakdown of recommended roles can be found in the Appendix (table 5).
Specialist trusts and those treating more complex patients may require more AMS interventions. For example, trusts with large cohorts needing antifungals, extra-corporeal membrane oxygenation, or higher dependency infectious diseases services will need more time from specialist AMS staff. These trusts should look at the higher end of the estimated staffing requirements, rather than the reported average. Recommended participants for AMS group activities in trusts are provided in the Appendix (table 6).
Outpatient antimicrobial therapy (OPAT) services are not included in these estimates. Guidance is provided in the Appendix (table 5) on staffing where these services are in place.
This guidance will help hospital trusts plan the right specialist AMS team based on their size, priorities, and resources.
Antibiotic champions
Clinicians who volunteer as antibiotic champions play an important role alongside AMS specialist teams.
They model good practice and provide local leadership and peer support, and their job plans should include protected time for AMS committees, co-ordinating stakeholder feedback, delivering training and education on AMS, sharing AMS learning with peers, and contributing to AMS audits and quality improvement.
The RCGP Prescribing and Medicines Optimisation Subgroup has stressed the need for more resources for GP prescriber champions, better networking of locality leads, active involvement by them in AMS initiatives, support and protected time for peer discussion to improve prescribing confidence (RCGP response to the Antimicrobial resistance national action plan: Call for evidence).
ICBs, as strategic commissioners, should recognise antibiotic champions as a key part of the multidisciplinary clinical and care professional leadership that the Strategic commissioning framework expects at every stage of the commissioning cycle. This includes commissioning sufficient protected time and support for GP and other prescriber champions to participate in AMS committees, locality networks and peer learning, so that their frontline prescribing leadership directly informs system wide AMS priorities, pathways and resource decisions.
Supporting resources
A capability framework for the AMS specialist workforce to facilitate training needs assessment and career development pathways has been developed by the British Society for Antimicrobial Chemotherapy in collaboration with NHS England and is provided in Section 4: Capability framework for antimicrobial stewardship specialists
These resources are intended to support ICBs and provider organisations to implement the AMS capability framework within the wider NHS strategic commissioning framework. By using the capability framework, together with this AMS staffing guidance, systems can build AMS specialist capacity into their strategic commissioning cycle – from identifying need and setting priorities through to making investment decisions, shaping provider markets and evaluating the impact of AMS programmes.
Appendix
Table 3: AMS activities in an ICB
Shows each activity’s priority, whether it depends on population size, estimated weekly time required and the health professional roles most often assigned to it by workshop participants (n=10).
Table 4. AMS group activities in ICBs
Shows estimated time per week, and the required attendees for group activities identified by workshop participants.
Table 5: AMS activities in a hospital trust
Shows each activity’s priority, whether it depends on population size, estimated weekly time required and the health professional roles most often assigned to it by workshop participants (n=39).
Table 6. AMS group activities in a hospital trust
Shows estimated time per week, and the required attendees for group activities identified by workshop participants – view as a word document.
Publication reference: PRN02449iv