Antibiotics (Primary Care)

Debate between John Glen and Maggie Throup

Monday 23rd November 2015 Commons Chamber

[Maggie Throup]

My hon. Friend is right. That is what we need to make clear. People often do not understand that the causes of those illnesses are quite different.

My local clinical commissioning group, Erewash CCG, is working hard to empower patients to take responsibility for their health, very much along the lines of the antibiotic guardians idea. As part of the initiative, it wants patients to learn to recognise when it is right to visit the GP and when it is right to seek alternative advice, such as that of a pharmacist.

I want to come back to where I began: the little device that performs the C-reactive protein point-of-care test. I can tell that hon. Members are wondering what C-reactive point-of-care testing is. A point-of-care test is a diagnostic test that is quick and easy to perform. It can be used during a patient consultation or completed while the patient waits. It allows for immediate diagnosis and treatment choice. Such point-of-care tests are designed to be used by people who are not laboratory scientists.

A C-reactive protein point-of-care test is a blood test that measures the amount of protein called C-reactive protein in a person’s blood, using just a drop of blood from the finger. Evidence shows that the test can deliver significant benefits when used in the primary care setting. It is used in the primary care setting in several European countries and has been shown to reduce unnecessary antibiotic prescribing by empowering GPs to make informed decisions.

[John Glen (Salisbury) (Con)]

My hon. Friend is making a powerful case for how innovation in the NHS can be the key to securing significant savings and a change in the culture of antibiotic use among the general public. Does she agree that it is about time NHS England moved quickly and decisively to empower people to change their behaviour in respect of managing their own health?

[Maggie Throup]

I completely agree with my hon. Friend. That is exactly why I secured this debate. We need to move quickly because this is a ticking timebomb that we must address sooner rather than later.

Point-of-care testing can reassure patients that they do not need antibiotics and will recover without them. There is evidence that C-reactive protein point-of-care testing could reduce the number of antibiotic prescriptions issued in primary care for acute respiratory tract infections by up to 42%. That represents millions of prescriptions every year. It has been calculated that using C-reactive protein point-of-care tests in primary care has the potential to save £56 million a year in prescription and dispensing costs. At the same time, C-reactive protein point-of-care testing could make a significant contribution to the UK’s antimicrobial resistance strategy.

I am sure that all hon. Members will have visited a GP with a cough and a cold and feeling pretty bad, and thinking that a short course of antibiotics is just what is needed to get rid of the bugs. They expect to leave the GP’s surgery with a prescription for antibiotics and already start to feel better. The problem with that scenario is that there is a high probability that those antibiotics will be useless, because the cold is not a bacterial infection, but a viral or self-limiting infection that antibiotics will not touch. The consequences are far reaching. First, the drugs will have been ingested unnecessarily, and it is likely that antibiotics will have increased antimicrobial resistance in the population. Secondly, a prescription will have been issued unnecessarily, which is a wasted cost to the NHS.

Let us consider an alternative. The hon. Member will still visit their GP with a cough and a cold and feeling pretty bad, but now by using just a drop of blood from their finger, a C-reactive protein point-of-care test can be carried out and will give an almost instant result. If the level of the protein is low to medium, no antibiotics are needed. The hon. Member will leave the GP’s surgery without a prescription, but knowing that they will start to feel better without one. If the level of the protein is high, a prescription for antibiotics can be issued. Such a simple measure is better for the patient, does not add to the ticking timebomb of antimicrobial resistance, saves the need for a prescription, and saves the NHS millions of pounds. I am sure hon. Members will be asking why it is not happening already.

Such a simple test can also be used for more complex cases than coughs and colds. With the life-limiting condition idiopathic pulmonary fibrosis, GPs find it hard to differentiate between the ongoing condition and an underlying infection. An underlying infection, which could be tested by using the C-reactive protein point-of-care test, may require hospitalisation, but the ongoing condition would not. In such instances, it is not just about whether to prescribe antibiotics; it is about whether a hospital bed and all the resources alongside it are needed. Surely a low-cost, point-of-care test is worth its weight in gold given that scenario.

Despite recent reforms, the NHS still works in silos and is inflexible when it comes to funding a test that originally would be carried out in the hospital laboratory. The majority of testing required by primary care is done by block contract through the local hospital, and additional testing is seen as a cost burden on the GP—that was the barrier I hit more than 20 years ago.

Today, C-reactive protein is included as a recommended area of best practice within the National Institute for Health and Care Excellence clinical guidelines for pneumonia, which state that

“clinicians should consider a point-of-care C-reactive protein test for patients presenting with lower respiratory tract infection in primary care”.

That recommendation was made by the NICE guideline development group and based on antibiotic prescription rates, mortality, hospital admission rates, and quality-of-life outcomes. Antibiotic prescription rates were felt by the guideline development group to be the most relevant direct outcome influencing that recommendation.