Understanding the role of Integrated Care Boards in primary care Antimicrobial Stewardship

Problem

UK Antimicrobial Stewardship (AMS) strategies have been in place since 2016. Primary care antibiotic prescribing has fallen by around 40%, but rates vary considerably between areas, with higher prescribing in more deprived and northern locations. Integrated Care Boards (ICBs) play a key role in developing and promoting AMS strategies in primary care. Our study investigates the development and implementation of AMS policies in ICBs.

Approach

This qualitative study recruited a purposive sample of 12 ICBs across England with relatively high antibiotic prescribing rates. Semi-structured interviews are being conducted at each ICB with ICB and local Trust AMS leads, local primary care guideline leads, AMR senior responsible officers, and microbiologists. Interviews follow a topic guide that was developed with support of the PPI group and will be analysed thematically.

Findings

ICBs implement a range of antimicrobial stewardship activities, which vary in scope and effort. Some regularly review and update the local primary care antibiotic prescribing guidelines, while others simply implement the national guideline. The ICB AMS teams used various activities to promote awareness and adherence to guidelines and other AMS initiatives among GP practice teams. These can include bulletins, educational sessions, changes to lab reports, audits and local incentive schemes. Multi-disciplinary groups including pharmacists, infection prevention control team and microbiologists are key to increasing the acceptance of new messages during educational sessions. Local incentive schemes have been effective in promoting a switch to prescribing practices in new guidelines.

ICB AMS activities have been disrupted by Covid and by the merging of multiple CCGs into single ICBs and the subsequent restructuring of ICBs. There has been a shift to online delivery of educational sessions since Covid, which was difficult initially but has allowed larger numbers of participants in single sessions. ICBs (formed from as many as eight CCGs) reported difficulties in aligning multiple guidelines into one that was appropriate for the larger and more diverse geography. The implementation of AMS strategies was influenced by the structure of the team and whether sufficient staff with the right expertise had been retained and this varied between ICBs. Some ICBs have a strong internal structure for AMS work, such as an AMR board with different groups underneath specifically responsible for certain tasks, but others have just a couple of staff members responsible for their entire AMS programme, leading to inevitable delays and limiting the ability to influence local primary care prescribers.

Consequences

ICBs play a key role in implementing antimicrobial stewardship strategies that will help achieve the objective of the AMR National Action Plan to control AMR in England by 2040. However, they need to be properly resourced to provide the needed support and incentives to bring about change.