Local implementation of national guidance on management of common infections in primary care in England

Introduction: Evidence-based infection guidance outlines how healthcare professionals should meet their antimicrobial stewardship (AMS) responsibilities. In 2017, the National Institute for Health and Care Excellence (NICE) commenced development of new infection management guidance for primary and secondary care. Aim: To determine how antimicrobial guidance was produced and implemented by medicines management teams (MMTs) in the English primary care setting in 2017, prior to the launch of joint Public Health England (PHE) and NICE guidance on the management of common infections. Methodology: Qualitative interviews and questionnaires of MMTs representing clinical commissioning groups (CCGs) in England were conducted to explore their local AMS activity in 2015–2017. Results: A total of 11 MMT AMS leads were interviewed, representing a range of the 209 CCGs, based on antimicrobial prescribing data. The majority of AMS leads interviewed reported that their local guidance was adapted from the PHE summary tables. Of the 209 CCGs in England at the time, 187 (89%) responded to the questionnaire, with various respondents choosing to leave some answer fields blank, resulting in varied total numbers for each question. MMTs representing 146/181 (81%) CCGs reported having an antimicrobial committee or process that develops local primary care antimicrobial guidelines. Overall, 149/180 (83%) CCGs reported localising the 2017 PHE managing common infections guidance, while 41/180 (23%) CCGs signposted directly to the PHE guidance. Questions about use of NICE guidance, clinical knowledge summaries (CKS) and Scottish Intercollegiate Guidelines Network (SIGN) guidance were not directly asked, but in free-text comments, four MMTs reported using CKS to develop local guidance; three reported using relevant parts of NICE guidance; and none used SIGN guidance. MMTs representing 120/128 (94%) CCGs indicated that the 2017 PHE managing common infections guidance was ‘useful’ or ‘very useful’, while 146/172 (85%) CCGs did not know how many primary care practitioners used local antimicrobial guidance. MMTs reported that they were not always informed when national guidance is updated and changes are not always obvious. Conclusion: In 2017, the majority of MMTs developed and reviewed local antimicrobial guidelines for primary care using the PHE managing common infections guidance, owing to comprehensive inclusion in the same document. MMTs should be informed when national guidance is updated, and changes should be highlighted, so that the MMTs can review local guidance in a timely manner. The impact of local antimicrobial guidance needs evaluation; a fifth of CCGs do not have an antimicrobial committee or equivalent process that develops and reviews local antimicrobial guidelines for primary care and may find such a committee useful.