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Issue 1                                                                                                  1st July 2014

Steering group launch

The Cheshire & Merseyside Antimicrobial Resistance (AMR) steering group held a launch event on the 5th June 2014 and the event was attended by professionals from a wide range of backgrounds. The event included presentations from key national speakers and a development session for the newly formed sub-groups.  

Melanie Sirotkin (Public Health England Centre Director) introduced the event by speaking about the national impetus to reduce antimicrobial resistance. Merav Kliner (Acting Consultant in Health Protection, PHE) outlined plans for a 3-year AMR prevention programme involving development and implementation of a Cheshire & Merseyside AMR strategy.

Sue Smith from the PHE Real-time Syndromic Surveillance Team presented findings of a successful pilot surveillance programme of antibiotic prescribing in primary care. This showed it is possible to link GP prescribing data to diagnosis, providing data on numbers of patients receiving antibiotics for certain conditions, e.g. over 60% of patients received antibiotics for a sore throat, with 30% of these not being prescribed according to guidance. There is significant variation of prescribing by practice and surveillance data can help to target practices that require more support to prescribe in accordance with guidance. 

POCT testing
Sherine Thomas (Acting Consultant in Infectious Diseases at Royal Liverpool University Hospital) spoke about near-patient testing (or point of care testing, POCT). POCT is a bedside test and a marker for bacterial infection, such as CRP or pro-calcitonin. It can help to guide professionals as to when to initiate, stop and rationalise antibiotics. Evidence suggests that point of care testing may be effective in reducing antibiotic use.
Head of the Public Health England Primary Care Unit, Prof Cliodna McNulty, talked about a wide range of issues with regards to prescribing in primary care. One aspect that Prof McNulty discussed was delayed prescribing, which can decrease antibiotic use and follow up appointments with only slightly reduced patient satisfaction. However, staff and patients need to be engaged about the value of delayed prescribing. The RCGP website Target antibiotics ( provides tools and training for GPs on how to rationalise antibiotic prescribing.


Delayed prescribing
Rob Barnett, GP & secretary of Local Medical Committee, Liverpool.

The group aims to reduce antibiotic prescribing and consultation rates for illness that can be self-managed. Examples of work include:
  • Develop local agreement of what is a ‘delayed prescription’ and how to implement this
  • Develop primary care IT system to identify if prescriptions are delayed during audit
  • Work with out of hours services to increase delayed prescriptions
  • Work with dental colleagues to develop dental delayed prescribing protocols
Near patient testing/point of care testing (POCT)
Chair (interim)
Evdokia Dardamissis, Consultant in Health Protection, Cheshire & Merseyside Public Health England Centre

The group aims to investigate the cost and effectiveness of POCT in community settings to guide implementation in Cheshire & Merseyside. Examples of work include:
  • Review of evidence of effectiveness and cost-effectiveness
  • Consider operational research project to investigate the effectiveness and cost-effectiveness of implementating POCT in clinical setting(s) in Cheshire and Merseyside
Targeting all prescribers across the health care economy for education and training
Emer Coffey, Consultant in Public Health, Liverpool City Council and Sefton Council

The group aims to raise awareness amongst health professionals and the public of antimicrobial resistance and appropriate prescribing and to optimise prescribing through education and training activities. Examples of work include:      
  • Ensuring that antimicrobial resistance is covered in undergraduate and postgraduate medical training and training for non-medical prescribers 
  • Ensuring appropriate continuing professional development opportunities around antimicrobial resistance and appropriate prescribing for prescribers
  • Exploring opportunities to promote uptake of antibiotic prescribing guidance e.g through audit
  • Reviewing and building on activities to raise awareness of the public around antimicrobial resistance and the need to use antibiotics appropriately.    
Developing a comprehensive antibiotic stewardship programme for primary and community care
Jonathan Folb, Consultant Microbiologist, Royal Liverpool University Hospital

Four priority areas for this subgroup are:
  • Identifying named “stewardship champions” across a range of healthcare settings
  • Developing a closer clinical collaboration between primary community and secondary care, including clinical advisory services
  • Collaborative audit, and feeding back to prescribers about their practice
  • Identifying problem areas of poor practice for targeted intervention
Intelligence on antibiotic prescribing and antimicrobial resistance
Guy Hayhurst, Consultant in Public Health, Cheshire East Borough Council

This group aims to identify data required by other subgroups and present in an easy-to-use format. Examples of work include:
  • Assessing use of antibiotic prescribing
  • Providing information for setting / monitoring policy
  • Supporting audit
  • Benchmarking
  • Local target-setting

We are still looking for professionals to join the sub-groups such as GP's, pharmacists, dentists and vets.

For further information or to join a sub-group, please contact Heather Thomas at Champs (details below).

Phone: 0151 666 5123

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