GPs will use AI to reduce antibiotic prescribing under Government five-year plan

GPs will be ‘supported’ with new technologies such as AI to reduce antibiotic prescribing and tackle antimicrobial resistance (AMR), the Government has announced.

A new national plan for combatting AMR has laid out 30 commitments for the next five years, including several relating to GP practices and other healthcare settings. 

The Government stated that ‘reducing unnecessary antimicrobial prescriptions is a core undertaking’ of the five-year plan, with the NHS providing GPs with tools to aid ‘decision support’ and ‘risk stratification’.

The plan also highlighted the need for ‘non-medical prescribers’ to optimise decision-making, since the prescribing of antibiotics is ‘increasingly undertaken’ by ‘health professionals other than doctors’.

By 2029, the Government aims to reduce total antibiotic use in human populations by 5% from the 2019 baseline.

As part of its goal to strengthen antimicrobial stewardship, the NHS will support GPs and other clinicians with new tools which will require the adoption of ‘digital technologies’ such as AI.

‘We will reduce avoidable human exposure to antimicrobials by supporting health and social care teams with decision support, risk stratification tools and judicious use of diagnostic tests, underpinned by improved diagnosis coding, to inform shared decision-making and target antimicrobials to patients most likely to benefit,’ the Government stated in one of its key commitments.

This signals an ‘evolution’ of antimicrobial stewardship and the ‘adoption’ of new methods, including a ‘fresh approach’ based on ‘genuine shared decision-making’ with patients. 

Key tools the NHS will provide to GPs and other clinicians: 

• Clinical decision support tools to ‘guide clinicians in the complex area of treatment choices’ by using ‘large data sets, algorithms and local resistance patterns’ – this is particularly useful where there is incomplete information or in a ‘busy environment;
• Risk stratification tools, which optimise the use of artificial intelligence and help GPs to identify high-risk populations and the ‘threshold for treatment’.

Over the next five years, before these tools are routinely implemented in the NHS, the Government will focus on ‘research, evaluation and validation of AI technology’, as well as gathering further evidence on ‘acceptability to clinicians’.

The plan also emphasised the need to ensure ‘rapid, accurate diagnostic testing’ is available for GPs, as this can ‘reduce unnecessary prescribing and overprescribing’ of antimicrobials. 

On ‘non-medical prescribers’, the Government pointed to the Pharmacy First scheme, which began at the end of January in England and allows community pharmacies to prescribe antibiotics, as well as the plan for all pharmacists to graduate with an independent prescribing qualification from 2026. 

‘Providing tools to support antimicrobial treatment targeted only to patients who need them is critically important for independent non-medical prescribers to optimise diagnostic and therapeutic decision-making, as is continuing to monitor and evaluate the impact of these services on antimicrobial use in the UK,’ the plan stated. 

To help improve surveillance of AMR, the NHS ‘will aim to measure the quality (in addition to quantity) of prescribing’.

The plan said: ‘This will enable clinicians to take a more nuanced approach, rather than solely focusing on the number of prescriptions issued. 

‘The nature of antimicrobial prescribing is changing with increasing numbers of non-medical prescribers, greater utilisation of patient group directions in hospitals and the community, and a shift from face-to-face prescribing to virtual and online prescribing. A better understanding of who (and how) antimicrobials are prescribed to is vital.’

Beyond prescribing, the Government aims to ‘further embed’ infection prevention and control (IPC) training in healthcare settings, and to ensure that IPC measures are ‘designed-in’ at the outset of planning stages for a healthcare facility such as a GP practice.

The plan takes a ‘One Health’ approach which means it covers issues across human health, animals, food and the environment, as well as how these areas intersect.

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It builds on the previous five-year plan from 2019, which helped to reduce human exposure to antimicrobials by more than 8% since 2014, despite the pandemic.

Deputy chair of the BMA’s GP Committee England Dr David Wrigley highlighted the importance of maintaining the same level of antimicrobial stewardship across GP practices and pharmacies.

He said: ‘GPs have made a lot of progress in recent years to reduce antibiotic prescribing, including through use of improved clinical and prescribing software.

‘We’ve long said that if responsibility for some antibiotic prescribing moves to community pharmacy, it is important that this progress is not lost and that pharmacists have access to the training, support, diagnostic tools and systems they need.’

Dr Wrigley also said it is ‘important’ that GPs and pharmacists ‘work together to better maximise the potential of the Pharmacy First scheme’.

East London GP partner Dr Selvaseelan Selvarajah said addressing AMR ‘should be a priority’ for everyone and welcomed the Government’s new action plan.

He suggested that Pharmacy First and other newer models of primary care could risk increasing antibiotic prescribing as patients are seen by clinicians who know them less well.

Dr Selvarajah said: ‘Currently with the push to deliver minor ailments care outside GP practices in settings including pharmacies and same day access hubs, there is a risk of fragmenting patient care away from the GP teams who know their local population well.

‘This could inadvertently further increase antibiotic prescribing as patients are moved between services. Furthermore, messages of when to use antibiotics may be more readily accepted by patients if that message came from clinicians they know well.’

‘Along with a broad and sustained public health campaign about appropriate indications and use of antibiotics, Government needs to ensure clinicians are supported too,’ he added.

Professor Azeem Majeed, professor of primary care and public health at Imperial College London, said AMR is a ‘global health priority’ and that it is ‘good to see the UK continuing to take this challenge seriously’.

He said GPs will ‘already be aware of the need to reduce the prescribing of antibiotics’ as there have been several other initiatives over recent years – as such, the plan is a ‘continuation’ of these policies.

Professor Majeed continued: ‘While the document outlines broad strategies and goals, more detailed information on the implementation processes would enhance its practical usefulness for GPs and other clinical staff who prescribe antibiotics in primary care.

‘Specific examples of how initiatives will be rolled out at the community or local level would provide clarity and facilitate better preparedness among key stakeholders including both health professionals and the public.’

At the end of last year, NHS England told GPs it will monitor the Pharmacy First service for any impact on AMR, following concerns from the profession around antibiotic stewardship.

In 2022, Government figures suggested that healthcare professionals in England had exceeded targets to reduce antibiotic prescribing years ahead of schedule, with total antibiotic use falling by 15% between 2017 and 2021.

The Government’s previous national action plan goal was to reduce prescribing by 15% by 2024 from a 2014 baseline.

Also in 2022, NHS England asked GPs to consider reviewing their prescribing of antibiotics as part of a drive to tackle AMR, which also had the aim of reducing GP workload.

And last year, a Government consultation highlighted that greater use of diagnostic tests to help distinguish between bacterial and viral infections will be key to combatting AMR.