The overprescribing of antibiotics in the NHS is once more in the news following the latest publication bemoaning the increase in such prescriptions over the 3 years from 2010-2013. This has taken place despite repeated appeals to doctors and patients alike, to cut back. To date the only solution being put forward to deal with this intransigent problem is the rather insulting re-education of incompetent GPs and the equally sanctimonious, paternalistic campaigns telling the population at large not to be so silly (I paraphrase of course).
Yet patients, and that is you and me, are supposed to be at the heart of every GP consultation. We GPs are repeatedly urged to put the patient's wishes above everything else. So why has no one ever asked patients' what those wishes actually are?
Well, someone has; just the once. Populus, a market research company, carried out a survey in August 2014 which tried to discover what patients views were regarding antibiotic prescribing for themselves.
They asked a sample population of 1000+ a number of questions which included:
'When you go to your local GP surgery, how often do you expect to get antibiotics to cure your complaint?'
10% responded with 'most of the time'/'all of the time'
Now the interesting thing here is how closely that number tallies with the number of prescriptions issued annually for antibiotics, 35 million and the number of GP consultations each year, 350 million. In other words, and please excuse my primary school knowledge of statistics here, about 10% of all consultations end up in an antibiotic being prescribed or, to put it another way 90% of consultations do not result in such an outcome.
Maybe we should be targeting this 10% in more detail. What are their ideas, concerns and expectations when they visit their GP? Are they frequent attenders? Is there any relation to age? These questions were asked by the Populus survey but I would argue that the sub-groups were too small to get much more than an indicative idea of what was happening.
So how can we get more meaningful, more robust data? Well, why not use a resource already in place, the Patient Participation Groups and their umbrella organisation, The National Association for Patient Participation? The original ethos underpinning these groups, and I quote from their website, is:
• To develop a partnership (of doctors) with patients.
• To discover what a range of patients think about services and to establish their priorities.
• To provide a platform to test and modify ideas and plans.
In other words this is an established group that is ready and waiting for just such a challenge as this. So why don't academics, doctors and patients work together to formulate a targeted questionnaire to put to our misunderstood patients to find out exactly what they really think about antibiotic use. Analysis of the data could then better inform future strategy rather than the rather haphazard manner in which that is currently taking place.
Quite frankly it is insulting to us all, as patients, to think that we have not been consulted as yet on a problem that has been described as being a threat of such magnitude as to ' cast us back into the dark ages....' (David Cameron).