About one in four prescriptions issued for antibiotics in England each year – about 10m in all – are likely to be unnecessary as patients deliberately look for “soft-touch” doctors who give in to their demands for the medicines, a leading health official has said. Mark Baker, director of clinical practice at the National Institute for Health and Care Excellence (Nice), has warned that the growing crisis of antimicrobial resistance, in which profligate use of drugs has allowed bacteria to develop resistance, threatened healthcare and the “whole basis of medicine”. He also said infections would have to be treated by surgery if drugs no longer worked.

Baker is director of clinical practice at the National Institute for Health and Care Excellence (Nice), whichNice on Tuesday published guidance on the issue for doctors, dentists, podiatrists, pharmacists and other professionals. Expectations of getting antibiotics were now “entrenched”, said Baker. “There are people who are addicted to the idea of having antibiotics. If they know there is a soft-touch doctor then they go to them.” If they did not succeed with one doctor, they would try another or even search the internet to source the medicines, he said.

Unless the latest guidance was translated into action, he said there would have to be a rethink in practice “because we have spent 60 years assuming that most infections will be cured by antibiotic drugs”. If these no longer worked, said Baker, “then we will have to rediscover and relearn how to treat infections surgically and I don’t think anyone wants to be in that position”.

The guidance calls for prescribers to discuss with patients the likely nature of their condition, the benefits and harms of immediate prescribing, and options such as “watchful waiting” or delayed prescribing, when prescriptions are issued only after microbial samples taken from patients have been tested. It demands more rigorous local policing of prescribing practice, with expert teams monitoring and comparing data from different hospitals, GP practices and other prescribers. Instances of very high, increasing or low volumes of prescribing should be examined.

Baker said an open and transparent culture should allow health professionals to question colleagues’ prescribing practices when they were not in line with local or national guidelines and no reasons were given for those decisions. There was a lot of very good practice, said Baker, but examples of bad practice might, as a last option, be referred to professional regulators such as the General Medical Council (GMC).

Tim Ballard, vice-chair of the Royal College of GPs, said the guidance “to provide the right antibiotic at the right dose at the right time” was sensible. “But we can come under enormous pressure from patients to prescribe antibiotics, even when we know they are not the right course of action. People must realise that this is dangerous for each and everyone of us, not just ‘other people’.” He said it might be counterproductive and unhelpful to involve disciplinary procedures when GPs already faced “very difficult and stressful conversations” with patients.

The college would be looking to regulators to support GPs who refused to prescribe unnecessary antibiotics and then faced complaints from patients. Separate guidance for patients, possibly backed up by NHS public education campaigns, is expected next year. The Department of Health said: “Tackling the overuse of antibiotics is a global issue that affects everyone – government, patients, doctors, dentists and vets treating animals – not just GPs.

“In order to make sure we have effective antibiotics for generations to come, we are raising global awareness of the dangers of resistance to antibiotics and providing tools for GPs to support prescribing decisions.”

Niall Dickson, chief executive of the GMC, said doctors should only prescribe if they were satisfied that this would serve the patient’s needs.
“Where they consider that the treatment would not benefit the patient, they do not have to provide it.”

However, the GMC saw the Nice guidelines as “being more about changing the norms of practice generally than pursuing individual doctors”. The dangers of antibiotic resistance first became a major issue in the UK in the late 1990s when they were raised by Sir Liam Donaldson, the then chief medical officer. His successor, Dame Sally Davies, took up the cudgels in 2013, with David Cameron calling for global action the following year.

Experts fear the crisis is deepening, with no new class of antibiotics or other major scientific development in 30 years. A total of 41.6m prescriptions were issued in England in 2013-14, costing the NHS £192m. Previous Nice guidance on the use of antibiotics to treat respiratory tract infections, issued in 2007, was aimed at cutting prescribing by 22%. After an initial dip, it began to increase again.

A survey last year suggested more than a quarter of doctors prescribed antibiotics even when they were not sure they were medically necessary, and nine in 10 felt under pressure from patients to prescribe them. Other figures suggest nearly all patients who ask for antibiotics get them.

...Doctors feel pressurised to prescribe antibiotics by patients....

What we probably need is a placebo/sugar pill with a feasible sounding 'drug name' that can be prescribed to the 'worried slightly unwell'. It'd probably have as much effect as an anti-biotic anyway...

Where has this attitude come from, that a qualified professional should be bullied, because I, as a layperson, know more than them with their years of training?

Whilst it would be nice, it's medically unethical in this day and age. And with the power of the internet, patients would easily find out if it were a placebo.

While I don't disagree with jon's point above the problem is that when, not if, it became clear that doctors were dishing out placebos there would be serious damage to the reputation and trust in the medical profession as a whole.

I was pretty dumbstruck when I read that. Especially the bullying bit.

Where has this attitude come from, that a qualified professional should be bullied, because I, as a layperson, know more than them with their years of training?

Ahh but you have forgotten - with Google every oik is suddenly an expert and that sore throat is, once they have Googled the symptoms, some strange tropic disease even though the furthest they have travelled is to Blackpool !

I appreciate fooling/lying to the patient is always ethically murky but the fact is you're lying to them just as much giving them an antibiotic that won't cure their problem just to shut them up.

While I don't disagree with jon's point above the problem is that when, not if, it became clear that doctors were dishing out placebos there would be serious damage to the reputation and trust in the medical profession as a whole.

So it's not just doctor's reputations that's at stake here.We need to stop being being prescribed drugs we have, essentially, a limited supply of before they stop working.