Skip to 0 minutes and 9 secondsSo we've gathered here today to discuss antibiotic prescribing. And I think there are three good reasons why you should be interested as a practitioner in antibiotic prescribing. The first one is nationally the antibiotic resistance we know that reducing prescribing will reduce resistance. The second one is that we know that the antibiotic usage will have profound effects on your normal flora. And the science is becoming increasingly compelling, I think, that has potentially serious consequences on health-- everything from allergy to obesity. And I think that's a story that will develop.
Skip to 0 minutes and 50 secondsI think the biggest reason for you to be interested at the moment, given that we're all drowning in workload, is that there is very strong evidence now that if you can reduce antibiotic prescribing you can reduce your workload. And there's also some reassuring data coming out that low prescribing practices do not see higher complication rates. So I think there's many good reasons why antibiotics are a thing that, as a practice, you should be interested in. So just out of interest, do you know how you do as a practice relative to other practices? We did get prescribing figures through from Ian, and we can relate those to the national prescribing figures and also local prescribing figures.
Skip to 1 minute and 33 secondsI wouldn't know anywhere else to look apart from that. And I wouldn't know actually where to get them myself. But I know if we requested the from you that they are readily available. Are there any websites we could get data if we needed to? Or anywhere we could go that you could sign post us to? Sure. So there's a couple of websites which use feed from all prescriptions. So there's the Fingertips website, which is Public Health England which is relatively simple way of seeing some high level benchmarking data. Do we need a log in for that? Or anyone can access that? Anybody can access that. Any member of the public can access that.
Skip to 2 minutes and 14 secondsAnd I can take you through how that works, briefly. On the other side, that I'm increasingly using as the Open Prescribing web site, which is set up by Ben Goldacre. And will that give us data that's actually appropriate to us as prescribing individuals? This is practice level, so you can't get it below practice level. So then to ask even more focussed questions you need to approach your prescribing advisor and start thinking about what those questions would be. And then going down using your practice management systems to generate that data. So the next level down would be that practice level data where we can look at individual conditions.
Skip to 2 minutes and 51 secondsAnd it could look at it in a great deal of detail as to what prescribing is happening in that particular practice. Right. OK. So I think one thing that's interesting to think about is what data sources are available to us. And there's some good national level data, which we can easily access. If we just look at some of that now for you for Litchdon. And so this is the Fingertips website that is provided by Public Health England.
Skip to 3 minutes and 18 secondsSo if you just go to https://fingertips.phe.org.uk/ So then we click on the AMR local indicators here. We go and click on the antibiotic prescribing. So here we've got GP Northern, Eastern, and Western, Devon CCG and Litchdon Medical Centre. So you can see that you gave out 124.2 prescriptions per 1,000 registered patients by quarter. And that colour puts you into, I think that's the second quintile. So relatively low prescribers. So I think one has to look at this completely non-judgmentally. Because we know that Lynton has got a very different demographic to you here in Litchdon. But it's a starting point for discussion, isn't it?
Skip to 4 minutes and 1 secondIf we click here on the area profiles, you can see your practice here just represented in a slightly different way. Whereas you have to all England practices, and you can see that you're sitting slightly so that's the median there for each of these three things. And you can see that are sitting slightly below the median for all of these indicators. The next place like I quite like is the Open Prescribing website. So they got this look at your GP practice which I quite like. So you can just-- this has got a dashboard of things that the team there felt was sort of markers of good quality. So here's you're prescribing dashboard. And here, we can see cephalosporins per oral antibiotic.
Skip to 4 minutes and 39 secondsSo this is, in the blue here you can see what's happening across England. And the red, this is you practice level data. And you can see Litchdon's very much in line with national trends for that. So you could, for instance, look at the number of antibiotics we are prescribing and see how much co-amoxiclav we're prescribing as opposed to any other antibiotic? So let's do that. So what we can do, if we look for say amoxyl and we do it versus co-amoxiclav. And will that pick up all the ways amoxicillin can be prescribed? So with suspension, and the caps, and the tabs, and the generic, and the branded? Yeah. Right.
Skip to 5 minutes and 23 secondsParticularly, in North Devon where we've got co-amoxiclav almost entirely off the formulary we should be using very little of it. So here you can see. Yes. You want to be at the top end of this graph. This is over time, where do you compare to all other practices in Devon? And you can see that Litchdon is at the top of that. And if you want to see on a map.
Skip to 5 minutes and 47 secondsSo you want to be these, you want to be these dark blues. So dark blues are what you'd expect to see. So narrow spectrum prescribing. So I guess, looking at this data, I get the impression that Litchdon is already in a fairly good place. You are not prescribing a lot of antibiotics compared to other practices. And when you are prescribing, they're relatively narrow spectrum. So that's a good place to start with.
Understanding Data Sources Available to Primary Care
The video is a Clinician Practice Meeting at Litchdon Medical Practice, Barnstaple, Devon. The discussion was led by Dr Tom Lewis a hospital based consultant microbiologist and lead clinician for antimicrobial stewardship with a particular interest in primary care.
Other members of the team included: Dr Sally Hunt, a clinician at the practice with a special interest in antibiotics; Kathy Osborne, a practice nurse prescriber with an interest in respiratory nursing; Jan Edwards, a nurse practitioner working in the same-day team dealing with minor illnesses; and Iain Carr, the Clinical Commissioning Group (CCG) pharmacist prescribing advisor who works with practices to review their antibiotic prescribing data.
The meeting is involving the whole team discussing the sources of data that can help them to understand antibiotic usage in their practice and how this compares to others.
Watch the video and then read the article in the next step which contains useful links to the resources mentioned in the video.
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