Meeting Antimicrobial Stewardship Targets in General Practice
A significant number of new antibiotic-resistant infections are reported each week. General practices are caught between providing good patient care and prescribing responsibly and the ongoing pressure to meet stewardship targets.
How Urgent is the Problem?
Implementing effective antimicrobial stewardship in general practice has become more urgent as cases of bacteraemia caused by antibiotic resistant bacteria jumped by 9.3% in 2024, climbing from 18,740 cases to 20,484. Deaths linked to resistant infections also rose, from 2,041 to 2,379 in just one year. This represents 338 additional deaths associated with resistant infections.
coli causes most antibiotic-resistant bloodstream infections, accounting for 65% of cases over the past six years.This is particularly relevant to primary care because E. coli commonly causes urinary tract infections. UTIs are one of the most frequent reasons patients visit their GP.
The government’s national action plan sets out what needs to happen. By 2029, the UK wants to cut total antibiotic use in humans by 5% from 2019 levels. The plan also aims for 70% of antibiotic use to come from the Access category across the healthcare system. Meeting these targets starts in general practice, where nearly 80% of all antibiotics were prescribed in 2024.
The Cost of Inappropriate Prescribing
Studies show at least 20% of antibiotics prescribed in primary care are unnecessary. That works out to roughly 20,000 unnecessary prescriptions being issued every day across England. Each one pushes bacteria towards resistance, exposes patients to potential side effects for no benefit and confuses the public about when antibiotics truly help.
People living in the most deprived communities face a 47% higher rate of resistant bacteraemia compared to those in the least deprived areas. This gap has widened dramatically, from a 29% difference in 2019 to 47% in 2024.
Practical Stewardship Strategies That Work
Getting antimicrobial stewardship right requires structured approaches that fit into busy clinical workflows. Good intentions alone will not deliver the changes needed, particularly when teams are already stretched and workloads are at capacity.
The TARGET toolkit was built specifically for primary care. It provides resources for continuing professional development, audit, training and self-assessment. These tools help the whole practice team understand their role in stewardship, not just the prescribers. Reception staff fielding calls about infections, nurses assessing patients and prescribers making treatment decisions all need to work from the same understanding.
Enhanced communication skills make a real difference. Training clinicians to explain why antibiotics are not needed helps patients understand and accept decisions. Delayed prescribing offers another option. A prescription is provided but patients are asked to wait 48 to 72 hours before collecting it. This works well for self-limiting conditions where symptoms might resolve without treatment. It gives patients reassurance that treatment is available if needed while avoiding unnecessary courses.
Point of care testing, particularly C-reactive protein tests, provides extra clinical information to support decisions. A CRP result helps distinguish between viral and bacterial infections. This reduces the temptation to prescribe antibiotics just to be safe when the clinical picture is unclear.
The Role of Clinical Pharmacy
Clinical pharmacists and pharmacy technicians bring specialist knowledge that strengthens stewardship programmes significantly. They can review prescribing patterns,identify areas where prescribing can be optimised and support the wider team with education about appropriate antibiotic selection, dosing and duration.
Clinical Pharmacist-led audit and feedback improve prescribing for common infections like respiratory tract infections and urinary tract infections. The feedback needs to be timely, specific and constructive rather than punitive. Practices that set up regular review cycles with pharmacist input see sustained improvements rather than short-term changes.
Many Primary Care Networks now work with specialist providers to access clinical pharmacist and pharmacy technician expertise without requiring permanent recruitment like Core Prescribing Solutions. This lets PCNs put robust stewardship programmes in place while managing workforce pressures.
Monitoring and Measuring Progress
Practices need access to their own prescribing data to understand where they stand and track whether interventions are working.The NHS Business Services Authority provides prescribing data that practices can use for benchmarking against peers. This data shows total volumes but also the types of antibiotics being prescribed.
Regular audits of antibiotic prescribing for specific conditions help identify patterns. Questions worth asking include whether antibiotics are being prescribed for viral upper respiratory tract infections, whether treatment duration follows guidelines and whether first-line antibiotics are being used before moving to second-line options.
Feedback needs to reach the clinicians doing the prescribing. Anonymous practice-level datais often less effective than information that helps individual prescribers reflect on their own patterns and compare them with colleagues. The goal is not to shame anyone but to create opportunities for learning and improvement.
Overcoming Barriers to Better Stewardship
Time pressure comes up most often when GPs talk about barriers. When consultations are short and appointment books are full, time pressures can influence prescribing decisions. Practice-wide approaches help here. If reception staff can triage appropriately and nurses can provide advice for minor infections, fewer patients need GP appointments for conditions that do not require antibiotics.
Patient expectations matter too. Some patients arrive expecting antibiotics, having already decided that is what they need. Studies suggest perceptions of patient expectations may not always align with actual expectations. Many patients simply want reassurance that nothing serious is wrong and clear advice about managing symptoms. Training in communication techniques helps clinicians navigate these consultations more confidently.
Clinical risk concerns come up as well. What if withholding antibiotics leads to complications? Guidelines and decision support tools help manage this risk by providing clear criteria for when antibiotics are indicated. Safety netting, where patients are told what symptoms to watch for and when to seek further help, provides backup when diagnostic uncertainty exists.
Looking Ahead
Tackling antimicrobial resistance requires effort from everyone. General practices play the biggest role because they prescribe most antibiotics, but theyplay a key role but require wider system support. The wider health system needs to coordinate better. Patients need clearer information about when antibiotics work and when they will not help. Investment in better diagnostic tests and new treatments needs to continue.
When antimicrobial stewardship works well, everyone benefits. Patients get better care because they receive antibiotics when they truly need them and avoid unnecessary side effects when they do not. Public health improves as resistance rates slow down and, most importantly, help preserve antibiotic effectiveness for future care.
