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NHS England slammed over lack of evidence for Boots sore throat scheme


10 Jan 2017

NHS England has been criticised for using insufficient evidence to call for the Boots sore throat scheme to be implemented by CCGs nationally.

The reasons to set up the scheme around the country are not supported by evidence and based on “heroic” assumptions about the capabilities of GPs, according to the latest Drug and Therapeutics Bulletin (DTB).

The NHS England plans to run the “test and treat” service for sore throats fall under its National Innovation Accelerator (NIA) programme.

Its evaluation was based on the care of just 367 people with sore throats at 35 Boots branches who were assessed for bacterial infections.

Those deemed likely to be infected were offered throat swabs and rapid tests to confirm the cause, with the option of antibiotics if they tested positive for group A streptococcus (strep throat).

Of the 149 people who were considered eligible for the test, 36 tested positive and 56 were referred to their GP for further tests.

Based on these results, NHS England said that if the scheme were rolled out nationally, GP visits would drop from 1.2 million to 400,000 – estimates which DTB called “heroic assumptions”.

The majority of sore throats are viral, however, and there is no proof that the test used can distinguish between carrier status and active infection, especially as up to 40% of those with strep throat have no symptoms.

Furthermore, antibiotics are not recommended for sore throats and painkillers are considered equal for treating the symptoms.

“The small-scale evaluation did not include a comparison of the rate of antibiotic provision with usual care, did not assess outcomes of treatment, did not review complication rates and did not address issues of funding, cost-effectiveness, or scalability,” the article said.

“When it comes to devising a national service for such a common self-limiting condition, let’s base it on evidence,” it said.

NHS response

NHS England said: “Before routinely commissioning any healthcare intervention, NHS England must ensure it is safe, and clinically and cost effective.

“The NHS Innovation Accelerator (NIA) programme identifies and supports innovators with innovations that will improve health outcomes and give patients access to the latest products, services or technology.

“Building on the pilot sore throat test study, and as part of the NIA programme, NHS England has asked UCL Partners to establish an expert panel. This will set out the steps necessary for a sore throat test and service to be supported by a robust evidence base.

“Taking this into account, the Advisory Committee on Antimicrobial Resistance and Healthcare Acquired Infection will consider how a sore throat test and service can be utilised to reduce the risk of antimicrobial resistance. In this way NHS England will ensure this important innovation is effectively deployed in the NHS.”


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