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NICE’s new sinusitis guidance could cause us GPs a bit of a headache

11 Nov 2017

During a recent unnervingly quiet day duty, I found time to do an audit. Yes, I know. I could have filled those redundant moments with caffeine and Hobnobs, but I have an ‘audit’ box which has long required ticking in my appraisal/revalidation folder.

So, on a whim, I decided to look at my prescribing rate during emergency surgeries. And I was delighted to discover that I only dish out an FP10, on average, in one in four consultations.

In other words, patients have to be either seriously ill or seriously persuasive to extract a prescription from me. Yet even I, now officially crowned as the stingiest prescriber in the practice, will have problems following the latest NICE guidance on acute sinusitis.

True, many cases of alleged sinusitis are actually just colds where our resolve to refuse antibiotics has, for one reason or another, finally cracked. So there is room for improvement. But NICE’s new guidance is so anti-antibiotics that any hope of implementing it will require a major culture shift from us all.

Just in case you missed it: what patients are entitled to, up to day ten of sinusitis symptoms, is simply advice, that advice being that sinusitis can take a long time to settle, as if they didn’t already know.

And, post day ten, we might consider a high dose nasal corticosteroid and either no antibiotics or a delayed script to use after seven more days of misery, or a severe deterioration in the meantime.

So patients – yes, that is patients with face-ache, luminescent snot and a febrile sense of entitlement – will see us as fobbing them off with a hay-fever spray and a vague promise of the magic pills if they’re dying.

That’s going to take a pretty concerted effort and clear consensus from pharmacists and GPs. And a great deal of stoicism from patients, which is not always something I associate with them, to be honest.

Alternatively, we might decide the paper the guidelines are written on is useful for one thing only – something that a particularly catarrhal patient who has forgotten to bring a hanky will be grateful for, at least.


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