'Soft touch doctors should be disciplined for over-prescribing antibiotics

'Soft touch doctors should be disciplined for over-prescribing antibiotics

‘Soft touch’ doctors should face disciplinary action for handing out too many antibiotics, the director of the health watchdog has said, as he warned that unnecessary prescribing has now reached crisis point.

GPs are writing 10 million prescriptions of antibiotics annually for coughs, colds and minor infections, even though they do more harm than good and are fuelling antimicrobial resistance.

Professor Mark Baker, director of the Centre for Clinical Practice at the National Institute for Health and Care Excellence (NICE) said millions of ‘frequent flyer’ patients were becoming addicted to the idea of antibiotics, often touring surgeries and A&E wards until they received a prescription.

Today Nice launches a new raft of guidelines telling doctors to delay treatment to see if symptoms clear up on their own and stop giving drugs for minor illnesses like sore throats and urinary tract infections.

Professor Baker said those who fail to adhere to the guidance should be brought before the General Medical Council. While disciplinary action would most likely lead to retraining, doctors who continued to willfully misprescribe antibiotics could face being struck off the medical register. Prof Baker said prescriptions should start carrying diagnoses so that pharmacists could challenge doctors’ instructions and so needless prescribing could be monitored.

“This is really hazardous practice, and if necessary, of course (they should be brought before the GMC)” he said.

“It's entrenched in our society. There are people who are addicted to the idea of having antibiotics.

"If they know there's a soft-touch doctor then they go to them. Often they'll go to their GP and then try another one, and then go on to an A&E department.”

Research has found that nine out of 10 GPs feel pressurised to prescribe antibiotics and nearly all (97 per cent) patients who ask for them get them, many for conditions like colds and hayfever. Some resort to buying pills over the internet if they cannot get them from a doctor.

Nationally 41.6 million antibiotic prescriptions were issued in 2013/14 at a cost to the NHS of £192 million. But a quarter of them are likely to be inappropriate or unnecessary.

In 2013, Nice issued guidance asking doctors to stop prescribing antibiotics for respiratory tract infections like colds or sore throats. It was supposed to bring down the number of prescriptions by 22 per cent, but the past two years prescriptions have actually risen by around three million each year.

Prof Baker said it is down to other bodies such as Public Health England and NHS England to now translate the latest Nice guidance into "tools that will result in real action and a change in the level of antibiotic prescribing".

"If we don't do it now then we'll have to rethink the whole basis of medicine because we've spent 60 years assuming that most infections will be cured by antibiotic drugs," he told a briefing in central London. "If they no longer work then we'll have to rediscover and relearn how to treat infections surgically and I don't think anyone wants to be in that position."

However doctors hit back at the suggestion they could face disciplinary action for handing out too many drugs, claiming they were under a huge amount of pressure from patients.

“These can be very difficult and stressful conversations for GPs to have,” said Dr Tim Ballard, Vice Chair of the Royal College of GPs.

“We need a societal change in attitudes towards the use of antibiotics and any suggestion that hard pressed GPs - who are already trying to do their jobs in increasingly difficult circumstances - will be reported to the regulator is counter-productive and unhelpful.

“If this were to happen, we would be looking to the General Medical Council to support any GP or other health professional who finds themselves on the receiving end of complaints or criticism about decisions made over the prescribing of antibiotics.”

The GMC said that sanctions were already in place to prevent doctors wrongly prescribing drugs but was unable to confirm that anyone had ever faced disciplinary action for over prescribing antibiotics.

“Doctors can, and do, face sanctions for misprescribing, although the law dictates that each case has to be considered on its merits to determine whether the doctor’s actions pose a risk to patients or confidence in doctors,” said Niall Dickson, Chief Executive of the General Medical Council.

The Nice guideline recommends that GPs and other health professionals discuss the harms and benefits of taking antibiotics with patients, and explain why prescribing an antimicrobial may not be the best option for them.

Next year the watchdog intends to issue guidance for members of the public.

Antibiotics have been the mainstay of treating infections for more than 60 years but although a new infectious disease has been discovered nearly every year over the past 30 years, no new antibiotics have come to market for 15 years.

The chief medical officer Dame Sally Davies has warned that antibiotic resistance as big a risk to Britain as terrorism.

Dr Tessa Lewis, a GP and vice chair of the Guideline Development Group, said: "The more we use antibiotics, the less effective they become. Infections can evolve and become resistant to existing medicines.

"Resistance to antibiotics is increasing and there have been very few new antibiotics developed in recent years, so we need to make sure that as well as searching for new antimicrobial medicines, we use the ones we currently have in the most effective way.”

A Department of Health spokesperson said that the overuse of antibiotics effects was the responsibility of patients, doctors, dentists and vets, not just GPs.

“In order to make sure we have effective antibiotics for generations to come, we are raising global awareness of the dangers of resistance to antibiotics and providing tools for GPs to support prescribing decisions,” added a spokesman.

By Sarah Knapton

The Telegraph, 18th August 2015

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