Antimicrobial resistance: new role for UK pharmacies

Out-Law News | 25 Jan 2019 | 3:02 pm | 2 min. read

Pharmacists will be asked to intervene to avoid over-prescription of antibiotics under new plans that have been outlined by the UK government to combat antimicrobial resistance (AMR).

Health contracts expert Louise Fullwood of Pinsent Masons, the law firm behind Out-Law.com, said there is value in utilising the resources at high street pharmacies in the delivery of primary care to ease the burdens on doctors, and welcomed the plans to involve pharmacists in the battle against AMR.

AMR is recognised by scientists as a growing problem – many bacterial diseases are evolving in a way which makes them resistant to existing medicines. If unchecked, this development will pose a health risk to the global population.

The UK government on Thursday set out a new 20-year vision for how it proposes to contain and control AMR, in addition to a more detailed five-year plan setting out more immediate actions. Strengthening "antibiotic stewardship" is one of the government's stated ambitions.

As part of its efforts to achieve this, the government said it plans to "enhance the role of pharmacists in primary care to review the dose and duration of antimicrobial prescriptions (especially long-term or repeat ones) and work with prescribers to review those that are inappropriate through evidence-based, system-wide interventions".

A "patient-level prescribing and resistance data source" to facilitate "timely access at point of care to support clinical decision making" is also to be developed, and the government said it will also raise public awareness to "encourage self-care and reduce expectations of antibiotics".

Fullwood said: "This is a great example of using the skills and expertise of pharmacists to help tackle the real problem of AMR. A survey, reported in the British Medical Journal in 2014, identified that more than half of GPs felt pressurised by patients to prescribe antibiotics, and 44% admitted having done so to get the patient to leave the clinic. Pharmacists are under less time pressure and are well positioned to be able to give time to patients to fully explain why antibiotics may not be suitable, or even dangerous."

"The development of involving pharmacies should be welcomed as part of the progress to a more integrated and connected healthcare system, which we are observing and working with a range of clients on developing various aspects of," she said.

Plans to change the way pharmaceutical companies are reimbursed when supplying medicines to the NHS will also be explored, in a move that may be seen as an attempt to incentivise the development of new antibiotics, according to the government's plans.

"To support global initiatives increasing access and stewardship, the UK will … develop and test new models for national purchasing arrangements that de-link the price paid for antimicrobials from the volumes sold, using a NICE led healthcare technology assessment to support robust stewardship," the action plan said.

The government said that, without action, AMR could be responsible for 10 million deaths around the world each year by 2050.

"The rise and spread of antimicrobial resistance is creating a new generation of ‘superbugs’ that cannot be treated with existing medicines," the government said. "Already, the organisms that cause many common diseases such as tuberculosis, HIV/AIDS, malaria, sexually transmitted diseases, urinary tract infections, chest infections, bloodstream infections and food poisoning, can resist a wide range of antimicrobials. Some cases of tuberculosis and gonorrhoea are already resistant to antibiotics of last resort."

"For most antimicrobials, there are few replacement or alternative products in the development pipeline. Research and development of the vaccines, diagnostics, tools and tests needed to prevent infections is similarly lacking. The impacts of unchecked antimicrobial resistance are wide-ranging and extremely costly, not only in financial terms, but also in terms of global health, food security, environmental wellbeing, and socio-economic development," it said.