Antibiotics (Primary Care)

Kevin Hollinrake Excerpts

Monday 23rd November 2015 Commons Chamber

[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.

[Kevin Hollinrake (Thirsk and Malton) (Con)]

As my hon. Friend pointed out, antimicrobial resistance is a particular problem in emerging economies—in India in 2014, 58,000 babies died because of AMR. Does she think that it would be wise to use international development budgets to tackle that severe and growing problem?

[Maggie Throup]

My hon. Friend makes a good point and I completely agree with him.

When one prominent GP wanted to introduce the point-of-care test, he was refused funding. He is now funding it through other sources as he feels that it provides better patient care than just issuing antibiotic prescription after prescription. Things must change for the sake of the patient, to reduce the number of prescriptions, to contribute to the battle against antimicrobial resistance, and ultimately to save the NHS millions of pounds.

The recently launched review of antimicrobial resistance, chaired by Jim O’Neill, is entitled “Rapid diagnostics: stopping unnecessary use of antibiotics” and states that

“rapid point-of-care diagnostic tests are a central part of the solution to this demand problem, which results currently in enormous unnecessary antibiotic use.”

That is why I am asking the Minister to do whatever she can to break down the silos, create the funding streams for C-reactive protein point-of-care tests in primary care, play her part in implementing our national antimicrobial strategy and save the NHS millions of pounds that could be redirected to disease areas that would really benefit from an injection of funds. This is a win-win-win situation and it must be addressed as quickly as possible.