The project aims to provide timely, up-to-date progress reports on antibiotic prescribing at practice and individual prescriber level. This allows prescribers to review recent activity in a format which minimises workload for both GP practice staff and CCG Medicine Management teams and supports the national monitoring provided by NHS England's antibiotic Quality Premium (QP) and CCG Improvement and Assessment Framework (IAF).
The reports are published and emailed to practice managers before the 14th of each month. The reports contain all antibiotics prescribed up to the last day of the previous month; up to two months earlier than the ePACT data for the same period, giving practices the opportunity to reflect on recent prescribing and adapt if necessary.
The project was devised by the joint Medicines Management team at Ashford CCG and Canterbury and Coastal CCG in answer to practice queries about their progress towards the NHS England QP and IAF targets. Data was available from both NHS England and PrescQIPP which suggested that both CCGs had a high number of antibiotic items/STAR PU when compared to the rest of the country.
However these reports have some limitations;
While the NHS England and PrescQIPP reports provide an excellent national overview, there was a need for a prompt, localised, granular summary to supplement the national reports.
Realising that the most accurate, up-to-date data is held on the practice clinical systems (EMIS Web and Vision), the Medicines Management team created searches on these systems to find all antibiotic items prescribed in the previous month. These searches are run at each practice on the first of each month and the results are sent to the Medicines Management team.
The EMIS search results are set up to only include the EMIS identification number and age (in years) for each patient. Patient Identifiable Data is included in the Vision results, but is deleted in practice before the results are sent to Medicines Management (only the Vision identification number and age in years are included). Both searches include the name of the antibiotic, quantity and unit, dose, date of issue, authorising GP and issuing user.
(please see full project pack for screenshot)
Two Excel workbooks were created by the Medicines Management team, one for each CCG, to collate all of the monthly search results. The search results by themselves do not provide a clear overview of the prescribing that has taken place, the workbooks are vital to collating, reviewing and presenting the data.
Once the monthly search results have been received they are copied into the corresponding workbook. Excel formulas were written to calculate each practice's progress towards the QP and IAF targets. These formulas are run against every prescription included in the monthly search results and involve;
The report templates were created with input from the CCG's GP prescribing leads and local Antimicrobial Stewardship Group. The reports are built directly into the Excel files and so update when new data is added.
(please see full project pack for screenshot)
As the data is extracted directly from the clinical systems, a prescriber-level report is also available to practices. The Excel formulas assign any repeat prescription issued by a non-prescriber back to the original authorising prescriber, allowing the prescriber-level report to show each prescriber's progress towards the targets without including a long list of non-prescribing staff.
(please see full project pack for screenshot)
The reports automatically update when new monthly data is added; it is a simple matter to save PDF files each month and email the files to the practice managers/key contacts. One of the CCG's Pharmacists reviews the data before it is published, double-checking the trends and identifying the reasons behind any unusual prescribing. This provides practices with another level of assurance, answering questions before they arise.
There are some limitations to the data when provided in this format:
With the exception of the last point, these limitations are estimated to only result in minor variations from the national figures. We also planned to review the difference between the clinical system data and the corresponding ePACT results once the full year's ePACT data was available (results are available in the 'additional information' section below).
Additionally, analysis of prescriber-level data requires an awareness of each prescriber's varying working patterns and the complexity of the patients under their care.
The team's Prescribing Support Technicians have quarterly meetings with the practice management team and GP prescribing leads at each practice. The monthly reports now form a key part of those meetings, alongside the data provided by PrescQIPP and NHS England. The Technicians discuss the practice's progress and challenge areas where the practice appears to be an outlier. The Technicians offer guidance on accessing local guidance and the templates we have devised for the clinical systems (for use in urinary tract infection and sore throat consultations).
At the end of the year (March 18) each practice was sent an action plan showing their progress towards the targets, advising on the following year's targets (if available) and asking practices to reflect on the figures. Anonymised examples of these reports are included with this submission.
The main beneficiaries of the project are the prescribers at each GP surgery, although any subsequent reduction in inappropriate antibiotic prescribing may also have a positive effect on patient safety (helping to combat the global challenge of antimicrobial resistance).
The reports allow the CCG, practices and prescribers to analyse trends far earlier than reports based on ePACT data, allowing action plans to be put in place without delay and potentially reducing inappropriate antimicrobial prescribing.
Prescribers:
Practices:
CCGs:
On a broader scale, there is national public health benefit to implementing a similar project. There is a clear benefit to highlighting individual prescribing trends as it generates increased ownership and reflection.
The first report was published in September 2017 and has been published on a monthly basis since. Outcomes for the project are difficult to measure as any changes in antibiotic prescribing are likely to be due to a number of factors. Additionally the release of the reports coincided with the annual increase in antibiotics seen during the winter months.
However, the GP practices in Ashford CCG met all but one of the 2017-18 QP & IAF targets, and the GP practices in Canterbury and Coastal CCG met all of the targets (some were achieved with a considerable margin).
(please see full project pack for outcomes table)
The overview files have also received excellent feedback from practices:
