Pharmacy First could help reduce AMR, suggests report

Community pharmacies could help reduce rates of antimicrobial resistance (AMR) through Pharmacy First, a House of Commons report has suggested.

The Public Accounts Committee (PAC) report – Antimicrobial resistance: addressing the risks – warns that AMR is ‘a major threat to public health globally and domestically, already contributing to an estimated 35,200 deaths each year in the UK’.

‘If AMR continues to grow, it will become increasingly difficult to treat basic infections, which would lead to increases in death and disease, with substantial economic and societal impacts,’ the committee said.

The report added that there is still insufficient use of diagnostic tools to support the use of antimicrobials and that Department of Health and Social Care (DHSC) has made ‘slow progress’ in implementing diagnostic tools that could help reduce AMR.

One of the recommendations made is that the DHSC, NHS England and the UK Health Security Agency (UKHSA) should set out how they intend to make 'demonstrable progress in the use of diagnostic tools, including under the Pharmacy First scheme, over the next two years'.

It said: ‘Diagnostic tools can be used to diagnose what infection a patient has, reducing inappropriate prescribing by enabling clinicians to determine with accuracy whether a patient needs antimicrobial treatment and, if so, which one.’

However, it said the government’s 2019–24 National Action Plan (NAP) target to ‘report on the percentage of antibiotic prescriptions supported by the use of diagnostic tools was not achieved and has not been included in the 2024–29 NAP, and there has been only limited progress in making better use of diagnostic tests’.

The report also highlights that inappropriate prescribing of antibiotics in primary care is estimated to be around 20% of antibiotic prescriptions, ‘which is too high and could drive AMR’.

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It said ‘inappropriate’ includes prescribing antibiotics or other antimicrobials when they are unnecessary (for example, using antibiotics to treat a viral infection), prescribing the wrong one (for example, not the most suitable antibiotic), or using them for longer than necessary.

The committee also found that data sharing is limited within the health and care sector, including between primary care and hospitals, or between hospitals and social care, ‘making it harder for clinicians to make decisions on infection management and prescribing antimicrobials’.

Answering one of the questions raised by the committee in oral evidence, Lord O’Neill of Gatley, author of the government review of AMR in 2014, said: ‘Better data in health would make it easier for clinicians making decisions on infection management and prescribing antimicrobials.

‘The ability to link the results of diagnostic tests to prescription information could result in better antimicrobial stewardship, but a central repository of diagnostics data does not exist.

‘Improved data sharing and collection could also improve information about infections acquired in community settings, such as social care.’

The government has produced three five-year action plans to address the threat of AMR, which ‘represent a focused attempt to address the main drivers of AMR and spent over £560 million on its AMR programme from 2020–21 to 2023–24’, the report noted.

The committee said that if effective, ‘such preventive health spending could have a significant positive effect on government finances in the long-run, and it is important that funding is maintained’.

Commenting on the findings, Dr Diane Ashiru-Oredope, Royal Pharmaceutical Society (RPS) deputy chief scientist, said: ‘Pharmacy teams are well-placed to implement any relevant interventions that are developed.'

'As RPS we are committed to working collaboratively with these organisations to help demonstrate progress particularly where pharmacists are included and integral to the delivery.’

She added: ‘The call for demonstrable progress in the use of diagnostic tools, where appropriate, aligns with the RPS Vision for Pharmacy Professional Practice, which sets out how pharmacy teams can support better patient care and address key challenges facing the nation’s health.

‘The vision also emphasises the importance of delivering consistent, patient-focused services through community pharmacy that enhance access to care.’

Gareth Jones, National Pharmacy Association (NPA) director of corporate affairs, said: ‘Pharmacists take very seriously their roles as antimicrobial stewards and will only initiate treatment after careful consideration of the appropriate options.

‘Wherever they practice in the UK, they follow the protocols laid out by the NHS in each country for the supply of antibiotics. Protocols can differ from country to country.

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‘Expanding the role pharmacies play in preventative measures such as vaccinations could significantly reduce infection, thereby reducing overall demand for antibiotics.’

Company Chemists' Association (CCA) chief executive Malcom Harrison said: ‘AMR is of huge importance to everyone and it is vital all parts of the health service work together to educate the public and uphold best practice. Pharmacy First has offered critical early access to care, preventing possible worsening symptoms and a need for additional antibiotics in the future.’

The report added: ‘NHS England told us that it is more optimistic about the future use of diagnostics. It told us that there would be “an explosion” of point of care diagnostic tests as well as a very bright future for their use once the evidence base is ready. It agreed that it needs to engage more with GPs about prescribing and said it was monitoring use of antibiotics by pharmacists.’

An NHS spokesperson said: ‘NHS England and the Department of Health and Social Care are considering the Public Accounts Committee’s recommendations carefully and continue to work towards the commitments set out in the government’s five-year Antimicrobial Resistance National Action Plan.

‘This includes supporting healthcare professionals with risk stratification tools and diagnostic tests.’

A DHSC spokesperson said: ‘Antimicrobial resistance is a serious global threat – our AMR National Action Plan outlines how we are urgently tackling its spread, both in the UK and overseas.

‘We have made important progress, including reducing antibiotic use in meat and pioneering a world-first subscription model to incentivise the development of new treatments.

‘We are working closely with international partners, including during trade discussions, to mobilise global efforts to limit the spread of AMR.’

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Concerns have previously been raised about AMR, with a recent survey from the National Pharmacy Association (NPA) finding that the majority of community pharmacies are being asked for unnecessary antibiotics 'at least once a day'.

Of the 400 community pharmacies surveyed by the NPA in April, 79% said they refused direct antibiotics requests from patients for minor conditions such as colds at least once a day – either during a Pharmacy First consultation or as an over-the-counter request.

When Pharmacy First was originally launched last year, NHS England, the DHSC and Community Pharmacy England (CPE) committed to 'closely monitoring' antimicrobial supply following the launch of Pharmacy First and an evaluation of the service’s impact on AMR was commissioned by the National Institute for Health and Care Research (NIHR).