Antimicrobial resistance could soon be killing at least 10 million people a year, according to the now former Government chief medical officer Professor Dame Sally Davies. Never one to mince words, she went on to claim that antibiotic resistance could wipe out humanity before climate change does1 and that despite it being an important area, we are underinvesting. We – all of us - need to reduce the use of unnecessary antibiotics.
This might be good news for community pharmacy. The new contractual framework describes opportunities in the patient pathway to make further use of point of care testing around minor illness which could support efforts to tackle antimicrobial resistance2. And you don’t need to wait for an agreed service specification to overcomplicate it.
Research published in 2014 suggested that GP prescribing rates for sore throat were high, and a recent publication in the Journal of the Royal Society of Medicine found inappropriate antibiotic prescribing in 23 per cent of cases. The current NICE guidance recommends the use of antibiotics in patients who present with a collection of symptoms rather than a proven infection.
Point of care tests were recommended by the 2016 O’Neill review Tackling Drug-resistant Infections Globally3, as was promoting their usage to reduce the use of unnecessary antibiotics. The report offers a deadline that all prescriptions for antibiotics should be informed by data or testing technology by 2020.
The NHS has discussed Strep A sore throat services for some time. Following the publication of a community pharmacy feasibility study4, the service was included within the NHS accelerator programme5. NICE produced a Med Tech briefing in 20186 which described the use of these tests in addition to clinical scoring systems, to increase diagnostic confidence of a suspected Streptococcus A infection and guide antibiotic prescribing for people presenting with sore throat. The evidence suggests that point of care tests are more helpful for diagnosing strep A infection than clinical scoring systems alone in people with acute sore throat.
We know that it is feasible to introduce a strep A sore throat test and treat service into community pharmacy. Such a service will support the drive towards community pharmacy management of minor illnesses and reduce the number of people attending general practice
And you don’t need to wait for an agreed service specification to overcomplicate it.
The first NHS funded study has now presented some of its early findings. Patients presenting in the pharmacy are screened using a clinical scoring tool. Patients over the given threshold are then offered a point of care test (the OSOM strep A test). Early evaluation suggests the service is more accessible to patients, reduces GP attendances and the accurate screening for strep A infections is expected to reduce the prescribing of antibiotics. This project won the National Antibiotic Guardian award in the innovation and technology category in June.
In Northern Ireland, a community pharmacy chain has been using c-reactive protein (CRP) testing (desk-based analyser or a semi-quantitative point of care test) along with strep A testing (OSOM strep A test) for patients presenting with typical winter illnesses. These represent inexpensive mechanisms that would allow community pharmacy to decide which patients might benefit from referral to general practice, and which they could handle there and then.
The use of point of care tests in community pharmacy to support the treatment of minor illnesses, relieving pressure on general practice and reducing the use of antibiotics, would seem an important area for the NHS to commission.
By Mark Robinson