This section sets out the roles and responsibilities of the Department of Health and Social Care (DHSC) and NHS structures in delivering antimicrobial resistance (AMR) prevention, drawing upon the Model Region and Model integrated care board (ICB) blueprints and work to date on the new target operating model for the integrated DHSC. It has been developed collaboratively with system partners to support organisational design and planning, aligned to future NHS operating models, recognising the need to deliver AMR prevention effectively and acknowledging significant future resource constraints.

Effective AMR prevention involves systemwide partnership working to deliver an integrated, whole-pathway approach that embeds robust infection prevention and management, with effective diagnostics and antimicrobial stewardship, alongside proactive sepsis prevention, recognition and intervention across all care settings.

AMR prevention roles and responsibilities

1. National

At national level, the focus must be on strategic planning of resources and interventions to combat the threat to public health and patient safety posed by AMR, promoting best practice, reducing duplication of effort, setting expectations and providing oversight of delivery. Roles and responsibilities held centrally will include:

• Setting the strategic direction, national priorities and standards for AMR prevention, while maximising impact and sustainability by embedding AMR priorities across wider policies, programmes and reforms at national, regional and local levels to deliver AMR prevention outcomes.
• Monitoring and assuring NHS performance against AMR NAP targets.
• Supporting capability and capacity building for AMR prevention across the system, including providing guidance, developing evidence and promoting sharing and adoption of best practice.
• Building partnerships with investors, industry, local government, professional bodies and voluntary organisations to support action on AMR prevention.
• Providing professional leadership on AMR prevention and bringing together expert knowledge to support service improvement.
• Ensuring AMR prevention is embedded in national contractual, commissioning and incentive frameworks, avoiding unintended disincentives and supporting systemwide action.
• Developing national ‘use once’ infrastructure – data benchmarking, standards and digital architecture, clinical tools, evidence base for emerging diagnostic technologies and innovation, training offers and antimicrobial subscription model implementation.
• Commissioning and drawing upon research and innovation programmes relevant to ensure evidence-based decisions can be made about policy and practice
• Provide strategic leadership for the UK’s international AMR engagement, drawing upon domestic expertise to shape global norms, mobilise partnerships and support international commitments that reduce the risk and burden of AMR.

2. Regional

Regions will play an important role in shaping and supporting the delivery of the national AMR prevention programmes through their system leadership, insight and engagement. The Model Region Blueprint describes how regions are expected to work in the future and, for AMR, roles held regionally are to:

• Provide strategic leadership for AMR prevention across the region, making AMR prevention a core part of the regional quality and public health agendas; driving cross-system collaboration and partnership across ICB boundaries; and aligning AMR prevention activity with wider regional transformation, digital strategy, research networks, reform and innovation, to reduce the unequal impact of AMR across communities.
• Oversee performance and risk management for AMR prevention, including assurance of commissioner and provider delivery against AMR NAP commitments and targets; assessment of board and leadership capability; and identification and management of emerging AMR and wider infection risks.
• Enable a coordinated approach to AMR prevention improvement, support and intervention, ensuring consistent identification of high-risk patients, targeted prevention and timely access to high-quality infection care across all settings, while strengthening system capability, addressing underperformance and un-warranted variation, and overseeing Code of Practice regulatory interventions where required.

3. Integrated care boards

The Medium Term Planning Framework requires that, as ICBs continue to develop their five-year plans, they should ensure they support preventative priorities, including reducing unnecessary exposure to antibiotics. As set out in the Model ICB Blueprint, and as their medium term plans continue to be developed, ICBs are expected to provide system leadership for improving population health, with strategic commissioning as their central function. This will be achieved by using commissioning, contracting and system levers to embed AMR prevention and promote appropriate antimicrobial use. This means as plans are developed, ICBs will be undertaking the following steps:

• Understand local context by building a deep understanding of the safety, effectiveness and experience of AMR prevention across the system. This includes analysis of preventable infections and resistance, optimal infection management, appropriate antimicrobial use and the costs of suboptimal care of the standard of provision. This will be achieved through benchmarking, trend analysis audit and assurance.
• Patient centred system design: ensure local systems for infection management and AMR prevention are co-designed, developed and commissioned with local patients, meeting the needs and challenges of the local community and population.
• Develop a long-term population health strategy for AMR prevention, working in partnership with providers, local government and other stakeholders to design best-practice care pathways, supporting appropriate use of diagnostics, and establishing a sustained, data-driven approach to minimising AMR, including improved interoperability of digital systems.
• Deliver the strategy through system levers, using strategic commissioning, contracting, incentives and resource allocation to align improvement activity with local need to support AMR prevention.
• Build upon the success of systemwide AMR prevention and antimicrobial stewardship networks, with named AMR leads and transparent governance and accountability.
• Leverage digital health technologies to support AMR prevention, integrate care across pathways, strengthen surveillance and reporting, and enable effective workforce deployment.Evaluate impact by understanding trends in infections and prescribing and monitoring the impact of actions taken to improve AMR prevention.
• Ensure sufficient leadership capacity, subject matter expertise and workforce capability to deliver effective AMR prevention across the system.

4. Providers

Providers across all settings are responsible for AMR prevention, delivering safe, effective and high-quality patient care, supported by national AMR tools and compliant with NICE guidance.

This includes:

• Preventing infection and AMR across care pathways, delivering safe, high-quality care supported by effective infection prevention and control programmes, including the prevention of infections linked to procedures and invasive devices.
• Building and sustaining workforce capability and capacity to support effective AMR prevention, including education and training, skills and competency development, workforce and capacity planning.
• Designing and delivering patient-centred AMR prevention and infection management services, co-produced with local patients and communities to meet local needs and address health inequalities.
• Reducing the transmission of infection – including drug resistant organisms – across all settings, including community and outpatient care.
• Meeting national AMR targets, standards and reporting requirements, proportionate to care settings and informed by robust diagnostics and surveillance.
• Ensuring judicious use of diagnostic testing to support diagnosis, clinical decision-making and prompt effective infection management and control.
• Optimising infection management to reduce the frequency and severity of complications, including AMR and sepsis.
• Supporting appropriate antimicrobial use, underpinned by system partnership working and clear antimicrobial stewardship governance.
• Using data, benchmarking and audit to monitor compliance and drive continuous local improvement in AMR prevention.

Publication reference: PRN02449ii