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Pharmacy First to be ‘closely monitored’ for antimicrobial resistance risk

Contractors have told C+D that they “can’t see a risk” of the new Pharmacy First service increasing antimicrobial resistance (AMR) amid the news that this will be “closely monitored”.

NHS England (NHSE) last week (November 16) announced the long-awaited launch of the new Pharmacy First service from “early next year” and expansion to the pharmacy contraception and blood pressure check services from next month.

The pharmacy negotiator, NHSE and the Department of Health and Social Care (DH) said that they will be “closely monitoring the Pharmacy First service post-launch, particularly in relation to antimicrobial supply to guard against the risk of increasing AMR”.

In a joint letter to contractors, they said that the “National Institute for Health and Care Research (NIHR) will commission an evaluation” to this end.

Community Pharmacy England (CPE) added in a press briefing attended by C+D that a new “implementation group” has been launched to “help monitor and manage delivery” of the service.

It comes as the British Medical Association’s (BMA) top GP has said that GPs have “made much progress in recent years to reduce antibiotic prescribing” and it is “important that this progress is not lost” with the new Pharmacy First service.


Pharmacy singled out?


Chief executive of Pharmacy London Hitesh Patel told C+D last week (November 17) that he “can’t see a risk” of “inappropriate prescribing of antibiotics…as long as pharmacists follow the patient group directions (PGD)”.

He added that pharmacists “don't deviate from PGDs, because the risks are too great”.

Meanwhile, he said that “a lot of times”, pharmacists see “inappropriate prescribing…from doctors”.

Martin Bennett, contractor and managing director of Wicker Pharmacy in Sheffield, told C+D that monitoring “could be useful” because it “will demonstrate that, if anything, pharmacists are likely to be far more cautious than other prescribers with antibiotics”.

He highlighted, however, that information gathered by monitoring pharmacists “is not going to tell [commissioners] too much unless they've got the figures from other prescribers as well”.

He stressed that if pharmacist monitoring found that “10% [of antibiotic prescribing] was not necessary…that might sound terrible”, but that “if you then found out that for GPs and nurses it was 20% [or] 30%, you might think [pharmacy] was a better bet”.


“Medicines experts”


National Pharmacy Association (NPA) director of corporate affairs Gareth Jones stressed that AMR is “a critical issue that community pharmacists take incredibly seriously”.

The NPA is “very confident that the Pharmacy First service will not increase AMR”, he told C+D.

“Pharmacists, as the medicines expert and with a clear understanding of AMR, are ready to initiate antibiotics only when clinically appropriate,” he said.

And director and superintendent pharmacist of the M J Williams Pharmacy Group Ade Williams pointed to NHSE’s latest report on the Pharmacy Quality Scheme’s (PQS) antimicrobial stewardship (AMS) initiatives, which commended pharmacy teams’ efforts.

The report, published in May, said that “community pharmacy can play a vital role in AMS and support the NHS in England to tackle the significant threat of AMR to public health”.

Community pharmacy staff have an “essential clinical role” in AMS activities and “public education to ensure the safe and appropriate use of antibiotics”, it added.


Rise in antibiotic resistant infections


It comes as the UK Health Security Agency (UKHSA) last week (November 15) revealed that there has been a 4% rise in antibiotic resistant infections in 2022 following the lifting of COVID-19 pandemic restrictions in 2021, accompanied by a rise in associated deaths. 

UKHSA’s latest national surveillance data revealed that an estimated 58,224 people in England had an antibiotic resistant infection in 2022, compared to 55,792 people in 2021 - an increase of 4%.  

It also revealed that deaths resulting from severe antibiotic resistant infections increased from 2,110 in 2021 to 2,202 in 2022. 

The latest data showed that antibiotic use in all settings, except dental settings, had increased in 2022 – with total prescribing rising by 8.4% compared with 2021 but remaining below 2019 pre-pandemic levels.


“Disingenuous” concerns 


Earlier this month, NHS chief pharmaceutical officer (CPhO) for England David Webb said that independent prescriber pharmacists will bring a “judicious approach" to prescribing.

He added that pharmacists “might be a sort of prescribing profession that doesn't choose to prescribe that often”.

Meanwhile, Day Lewis executive director Sam Patel last month warned that a rising number of IP pharmacy owners presented “a potential for risk of overprescribing” at the Pharmacy Show in Birmingham.

General Pharmaceutical Council (GPhC) deputy regional director David Clark responded by telling delegates that the regulator may look at overprescribing by IP pharmacy contractors “in the future”.

Also last month, NHSE pharmacy leaders stressed that the commissioner needs to “be able to demonstrate” that community pharmacy can manage antimicrobial stewardship for the upcoming Pharmacy First service.

And earlier this year, the Pharmacy First service came under attack from a group of scientists who claimed that enabling community pharmacists to treat seven minor illnesses could lead to antibiotic resistance.

Pharmacists hit back at the claims, branding them “disingenuous”.

Check the C+D site for the latest coverage on this developing story

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