Development and Implementation of an Antimicrobial Stewardship Programme

Workforce shortage and increasing demand in primary care has led many NHS providers to offer alternatives to faceto-face appointments as a means of managing workload and there is an increasing drive towards a total triage model of care for General Practices in England (NHS England and Improvement, 2021)1. NHS Remote consultations (through video, telephone or other online facilities) are now commonplace in NHS primary care. A report by the Royal College of General Practitioners (2021)2 ‘The future role of remote consultations & patient triage’ reported on data from the Research and Surveillance Centre Primary Care Workload Observatory of GP practices in England found that 54% of appointments were delivered remotely. Furthermore, a key recommendation in the report was the need for education and guidance on remote consultations to ensure appropriate treatment and carer. The inability to examine patients when conducting consultations remotely has led to an increase in the amount of antimicrobials/antibiotics being prescribed due to uncertainty and clinicians prescribing for the ‘just in case’ scenario of an infection. Several studies have demonstrated significantly increased likelihood of antibiotic prescribing where patients consult health professionals via telephone or video compared with face- to-face settings. This secondment will allow for an effective collaboration to be developed between the University, Institute of Skin Integrity and Infection Prevention and Oldham Family Practice and will lead to future joint funding applications and publications. We have discussed the proposed project (Development and implementation of an antimicrobial stewardship (AMS) programme) with the practice, and they have stated that the planned development and implementation of the programme can be used across the Integrated Care Service (ICS) in Oldham leading to a large impact across Oldham on appropriate use of antimicrobials. The Practice Manager has guaranteed access to the multidisciplinary team e.g., pharmacists, nurses, and medical staff to ensure they are involved in the co-production of the education and awareness programme. Currently the Practice and ICS have no AMS programmes in place. Dr. Blackburn will develop the awareness programme following discussions with the Oldham Family Practice - this will be an iterative process whereby it will be reviewed and updated based on the needs of the practice The programme plan will be to meet with the practice team on 3 occasions at the practice to:  Discuss current antimicrobial prescribing practices and gaps in knowledge relating to AMR and AMS.  Discuss the WHO and NICE guidance re: AMS programmes and explore how these can be integrated into local guidance  Share development of the AMS awareness package The academic team will meet with the practice team monthly via Microsoft teams to update on progress The plan will be to: Co-produce an awareness programme that can be placed on the intranet for staff to access (use of the intranet has been agreed with Oldham) Develop an awareness poster for the general public/patients that can be situated in public areas re: AMR Following implementation discuss with pharmacists if antimicrobial use has reduced Present to the Integrated Care Service the AMS programme in collaboration with members of Oldham Family Practice Publish a peer reviewed journal article 5 We do not anticipate any major challenges however we are aware that time will be a challenge for the practice staff as such we have ensured that the academic team will undertake development of the programme and practice time is limited to meetings. Ref: Royal College of General Practitioners (2021). The future role of remote consultations & patient ‘triage’ General practice COVID-19. NHS England and Improvement, (March 2021) ‘2021/22 priorities and operational planning guidance’. Available at: https://www.england.nhs.uk/publication/2021-22-priorities-and-operational-planning-guidance/.