Improving our understanding and practice of antibiotic prescribing: A study on the use of social norms feedback letters in primary care

Stephanie Steels*, Natalie Gold, Victoria Palin, Tim Chadborn, Tjeerd Pieter van Staa

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)
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In the UK, 81% of all antibiotics are prescribed in primary care. Previous research has shown that a letter from the Chief Medical Officer (CMO) giving social norms feedback to General Practitioners (GPs) whose practices are high prescribers of antibiotics can decrease antibiotic pre-scribing. The aim of this study was to understand the best way for engaging with GPs to deliver feedback on prescribing behaviour that could be replicated at scale; and explore GP information requirements that would be needed to support prescribing behaviour change. Two workshops were devised utilising a participatory approach. Discussion points were noted and agreed with each group of participants. Minutes of the workshops and observation notes were taken. Data were analysed thematically. Four key themes emerged through the data analysis: (1) Our day-to-day reality, (2) GPs are competitive, (3) Face-to-face support, and (4) Empowerment and engagement. Our findings suggest there is potential for using behavioural science in the form of social norms as part of a range of engagement strategies in reducing antibiotic prescribing within primary care. This should include tailored and localised data with peer-to-peer comparisons.

Original languageEnglish
Article number2602
Pages (from-to)1-10
Number of pages10
JournalInternational Journal of Environmental Research and Public Health
Issue number5
Publication statusPublished - 5 Mar 2021

Bibliographical note

Funding Information: This work was supported by Public Health England (PHE). No grant numbers.

Open Access: This article is an open access article distributed under the terms and
conditions of the Creative Commons Attribution (CC BY) license (

Publisher Copyright: © 2021 by the authors. Licensee MDPI, Basel, Switzerland.

Citation: Steels, S.; Gold, N.; Palin, V.; Chadborn, T.; van Staa, T.P. Improving Our Understanding and Practice of Antibiotic Prescribing: A Study on the Use of Social Norms Feedback Letters in Primary Care. Int. J. Environ. Res. Public Health 2021, 18, 2602.



  • Antibiotics
  • Feedback
  • Prescribing behaviour
  • Primary care
  • Social norms


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