PCN cut antibiotic use by a third with on-site strep A testing

A Devon PCN has repurposed a Covid-19 testing machine to rapidly screen patients onsite for strep A.

According to Townsend, Axminster and Seaton & Colyton (TASC) PCN, the measure has helped reduce antibiotic prescriptions across its three practices by around a third and has significantly cut clinical workload.

It comes in response to a rise in infections caused by the Strep A bacteria, with GPs advised to hold a ‘low threshold’ for prescribing antibiotics to children presenting with symptoms.

The point of care (POC) testing machine – named ID Now and manufactured by Abbott Point of Care – had previously been used to test staff for Covid-19, but has now been retooled to provide strep A testing results within five minutes. Standard testing will see results returned in two to three days.

GPs and practice nurses at the Devon PCN first assess a patient against the Centor criteria, used to identify the likelihood of a bacterial infection causing a sore throat.

Patients who score four or five points are indicated as likely having strep A and are given a prescription for antibiotics.

Patients who score two or three points are invited to do a swab test using the point of care testing machine to 93% specificity and 96% sensitivity, the PCN said.

While patients who score one point are more likely to have a viral infection and will be treated or advised accordingly.

Dr Rob Daniels, PCN clinical director, said that around 66% of those tested with the machine are found to be positive for strep A, cutting about a third of prescriptions for antibiotics that could have otherwise been made.

Dr Daniels said: ‘When patients come in with symptoms of tonsillitis, for example, a lot are worried about group A strep because there are no antibiotics. By testing onsite, there is no need to prescribe antibiotics just in case.’

He added: ‘We are also reducing GP appointments, as the standard care would see us take a throat swab, send it away, wait two to three days for result, and then track the patient down track down along with all their contacts.’

TASC PCN serves a population of 27,000 patients, with around one-in-200 patients presenting with a sore throat over the last two weeks.

The POC testing machine is currently based in just one of the PCN’s practices, with the other two practices delivering swabs for POC testing. Each test costs the PCN £20 before VAT.

Laboratory notifications of invasive group A streptococcus disease are higher than seen over the past five years at 509 compared with 248. The highest rates to date have been reported in Yorkshire and Humberside

The BMA has urged NHS England to bring in urgent additional capacity to NHS 111 call handling services, warning that GP services must not get too overwhelmed to see other sick patients.

But last week, NHS 111 saw a 60% increase in call numbers last week, in part driven by strep A concerns, with 700,000 calls in just one week: the highest number of calls ever recorded outside of the first two weeks of the Covid-19 pandemic.

NICE guidance does not recommend practices routinely adopt rapid tests for strep A for patients presenting with a sore throat, as their effect on improving antimicrobial resistance is likely to be limited. Where appropriate, healthcare professionals are to advise people with a sore throat that the majority of sore throats are caused by viruses.