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Several interventions have been tested in research trials and shown to be effective at reducing antibiotic prescribing for patients who will not benefit from antibiotics. These interventions are not widely used in England at present. This study aims to understand how we can encourage greater use of these interventions in general practice in England.

why this is important

Taking antibiotics when they are unlikely to help increases antibiotic resistance and increases the chances of patients having future infections that are resistant to antibiotics. Most antibiotics are prescribed in general practices and it is important to support prescribers so that only antibiotics which can benefit patients are prescribed.


The STEP-UP study has 4 workstreams each of which use different methods:

  1. Quality Premium – We want to understand how a financial incentive scheme, called the Quality Premium, has worked in influencing antibiotic prescribing rates. This workstream involves interviews with Clinical Commissioning Group (CCG) and general practice staff, and a national survey to all CCGs across England.
  2. Delayed Prescribing – We want to understand the influences on use of delayed prescribing. This workstream includes a realist review to understand how, for whom and in what context delayed prescriptions are used.
  3. Implementation Study – We want to see how general practices implement three interventions when they are given support materials to encourage their use. The interventions are: communication skills, point-of-care CRP tests, and delayed/back-up prescribing. This workstream involves focus groups with general practice prescribers, workshops with professionals and members of the public and the development of support materials. We will test support materials in a study with 8 general practices in England to see whether they reduce antibiotic prescribing.
  4. Health Economics – We want to assess GP and patient preferences to use an immediate, a delayed or no antibiotic prescription in different scenarios. This involves using Discrete Choice Experiments (questionnaires).

research team

The STEP-UP study is a collaboration between researchers at the University of Oxford, Imperial College London and Public Health England.

Principal Investigator: Prof. Sarah Walker, University of Oxford.

University of Oxford team: Prof. Chris Butler, Dr Sarah Tonkin-Crine, Dr Aleksandra Borek (NDPCHS), Dr Sarah Wordsworth, Dr Laurence Roope, Dr Liz Morrell, Dr Koen Pouwels (Health Economics Research Centre, NDPH)

Imperial College London team: Prof. Alison Holmes, Dr Ceire Costelloe, Dr Philip Anyanwu, Dr Monsey McLeod, Dr Anne Campbell, Dr Benedict Hayhoe, Prof. Azeem Majeed.

Public Health England: Dr Julie Robotham, Dr Susan Hopkins.

University of Southampton: Prof. Michael Moore.


Funder: Economic and Social Research Council (ESRC)