Locums study - The role of locum GPs in antimicrobial stewardship: a mixed-methods study
A considerable and increasing proportion of GPs in England work as locums. Many interventions in general practice are focussed on antibiotic stewardship but these rarely consider the role of locum GPs. Locum GPs might have different experiences of, and approach to, antibiotic prescribing and antimicrobial stewardship than GP partners or salaried GPs who work in the same practice for longer time. The aim of this study is to explore the role of locum GPs in antimicrobial stewardship and optimising antibiotic prescribing in general practice.
why this is important
Unnecessary use of antibiotics contributes to growing antimicrobial resistance. The majority of antibiotics are prescribed in general practice so reducing unnecessary prescriptions of antibiotics by GPs can help preserve antibiotics for when they are really needed. Exploring the experiences of locum GPs can identify how we can better support locum GPs in reducing unnecessary antibiotic prescriptions and providing better care to patients.
In this study we will use statistical methods to analyse data on antibiotic prescribing in general practices to see if there are any differences between prescribing rates of locum GPs and other prescribers.
We will conduct telephone interviews with locum GPs to ask about their views and experiences related to antibiotic prescribing when working in different practices.
The study found that between 2013 and 2015 locum GPs (locums) prescribed antibiotics more often for acute cough, sore throat, acute bronchitis, and asthma and COPD exacerbations, compared to other GPs and nurse prescribers.
Interviews with locums identified perceived challenges to more optimal antibiotic prescribing and engagement with antibiotic stewardship (AMS) by locums. For example, they perceived: difficulties following the correct guidelines and processes which vary across areas and practices; consulting unfamiliar patients and more patients with acute infections; time pressure to consult more patients; patient expectations for locums to prescribe antibiotics; lack of communication with practices and feedback related to antibiotic prescribing; lack of support for no-antibiotic decisions; limited/no communication from commissioners; limited training and peer learning opportunities.
Locums also described factors that may contribute to good-quality prescribing and AMS. For example, they perceived opportunities to: negotiate more time within appointments to ensure sufficient time to discuss no-antibiotic approaches; use a lack of pre-existing relationship with patients to suggest a “new”, no-antibiotic approach; use the experience of working in different practices to suggest potential improvements; and the need for locums to take initiative and be proactive about engaging with professional training and networks.
Results have been published:
Dr Aleksandra Borek, Dr Koen Pouwels, Dr Oliver van Hecke, Dr Sarah Tonkin-Crine, Professor Chris Butler (University of Oxford), and Dr Julie Robotham (Public Health England)
Funder: Royal College of General Practitioners Scientific Foundation Board