The government has pledged to support pharmacist prescribers with tools to reduce unnecessary antimicrobial prescriptions as part of its five-year plan to tackle antimicrobial resistance (AMR).

Such tools could make use of digital technologies including artificial intelligence (AI), but this would depend on ‘fully integrated digital systems’ with the right data governance permissions, the government said.

And with the ‘changing’ nature of antimicrobial prescribing, including an increased used of  patient group directions (PGDs) and online prescribing, the NHS will aim to measure the quality of prescribing and better understand how antimicrobials are prescribed and to who.

By 2029, the government aims to reduce total antibiotic use in human populations by 5% from the 2019 baseline.

Other measures to tackle antimicrobial resistance suggested by the plan include ‘vital’ access to penicillin allergy de-labelling services, vaccines and infection control to reduce the need for antimicrobials, and a focus on ‘unnecessary prescribing’ of antibiotics among older people.

Clinical decision support tools for pharmacist prescribers

The ‘prescribing and supply of antimicrobials for humans is increasingly undertaken in the UK by health professionals other than doctors’, the government’s plan stated.

It highlighted the availability of antimicrobials through Pharmacy First in England and similar services in Scotland and Wales, as well as changes from 2026 that will see all pharmacists graduating with an independent prescribing qualification, as examples.

‘Providing tools to support antimicrobial treatment targeted only to patients who need them is critically important for independent non-medical prescribers to optimise diagnostic and therapeutic decision-making, as is continuing to monitor and evaluate the impact of these services on antimicrobial use in the UK,’ the plan said.

And the government committed to reducing avoidable human exposure to antimicrobials ‘by supporting health and social care teams with decision support, risk stratification tools and judicious use of diagnostic tests, underpinned by improved diagnosis coding, to inform shared decision-making and target antimicrobials to patients most likely to benefit’.

‘Ensuring rapid, accurate diagnostic testing is available when and where needed is therefore necessary in reducing incidence of AMR,’ the government said.

And it proposed tools for prescribers including:

  • Clinical decision support tools to ‘guide clinicians in the complex area of treatment choices’ by using ‘large data sets, algorithms and local resistance patterns’ – this is particularly useful where there is incomplete information or in a ‘busy environment’, the government said.
  • Risk stratification tools, which optimise the use of AI and help prescribers to identify high-risk populations and the ‘threshold for treatment’.

Over the next five years, before these tools are routinely implemented in the NHS, the government will focus on ‘research, evaluation and validation of AI technology’, as well as gathering further evidence on ‘acceptability to clinicians’, it said.

Quality of prescribing to be measured

To help improve surveillance of AMR, the NHS ‘will aim to measure the quality (in addition to quantity) of prescribing’.

The plan said: ‘This will enable clinicians to take a more nuanced approach, rather than solely focusing on the number of prescriptions issued.

‘The nature of antimicrobial prescribing is changing with increasing numbers of non-medical prescribers, greater utilisation of patient group directions in hospitals and the community, and a shift from face-to-face prescribing to virtual and online prescribing. A better understanding of who (and how) antimicrobials are prescribed to is vital.’

‘Frequent unnecessary prescribing’ of antibiotics in care homes, government suggests

The plan highlighted that ‘frequent prescribing of antibiotics for older patients is widespread’.

It added that ‘there is evidence to suggest that there is frequent unnecessary prescribing in some settings, such as long-term care facilities’.

‘Social care environments such as care homes have at times been overlooked in the arena of AMR programmes, but they are important places where gains can be made to reduce levels of resistant organisms,’ the government said.

And it committed to collecting and reporting AMR data in the context of health inequalities ‘to help inform interventions for marginalised, disadvantaged or vulnerable populations’.

Access to penicillin allergy de-labelling services 'vital' in fight against AMR

Patients who need an alternative to penicillin are at increased risk of AMR or adverse effects, the government said.

And it suggested that access to penicillin allergy de-labelling services were ‘vital’ to ensure patients are not denied penicillin treatments unnecessarily.

The Royal Pharmaceutical Society (RPS) recently warned that millions of people in the UK could be missing out on the most effective antibiotic choice because they mistakenly believe they are allergic to penicillin.

Figures show around 6% of people have a penicillin allergy label on their medical record, equating to four million people in the UK.

But research has shown that around 90% of people do not have an allergy when properly assessed, the RPS said.

And it has a checklist to be used by pharmacists to help diagnose if a patient is allergic to penicillin or not.

A version of this article first appeared on our sister publication Pulse.