Telephone appointments with GPs are leading to a worrying rise in antibiotic prescriptions that could put lives at risk, experts warn.
Medications that fight bacteria are crucial to clearing infections and preventing life-threatening complications. However, difficult-to-treat cases are increasing as the bacteria that cause them become increasingly resistant to drugs.
Over the last decade, the NHS has made a concerted effort to reduce the number of antibiotic prescriptions to patients, in order to curb the spread of superbugs.
However, the figure is rising again, with almost 37 million prescriptions issued last year, compared to 36 million in 2022 and 31 million in 2020, official figures show.
The number of antibiotic prescriptions is increasing again: almost 37 million were written last year, compared to 36 million in 2022 and 31 million in 2020.
Now experts say fewer face-to-face GP appointments across the NHS could be a major factor behind the rise, as research suggests patients seen remotely are significantly more likely to be prescribed antibiotics.
They also warn that the amount of antibiotics being distributed could be significantly higher than the data suggests because many people turn to private GPs for care, and their prescriptions are not included in the government figures.
“The rise in antibiotic prescriptions is a worrying trend and something needs to be done to stop it,” says Dr Ryan Hamilton, associate professor of antimicrobials at De Montfort University, Leicester.
“Remote GP appointments are not the only cause of the increase, but there is good evidence that they contribute.”
The World Health Organization warns that by 2050, superbug infections could cause 10 million deaths worldwide each year.
In England, 58,000 people get an antibiotic-resistant infection every year.
Almost 8,000 people in the UK die annually from these types of infections. In 2013, in response to the looming crisis, the then chief medical officer, Dame Sally Davies, cracked down on the number of NHS antibiotic prescriptions.
Its focus was mainly on GPs and it took the extreme step in 2015 of sending warning letters to thousands of GPs who were considered to be “overprescribing” antibiotics.
Dame Sally also accused GPs of bowing to pressure from “anxious” patients and prescribing antibiotics for mild conditions such as coughs and colds, even though the drugs were not effective against them.
Their efforts were successful: the number of NHS antibiotic prescriptions fell from 43 million in 2012 to a low of 31 million during the Covid pandemic in 2020.
However, since then the number has increased. Experts say there are several possible reasons.
It has been suggested, for example, that as infections become more difficult to treat, more antibiotics are needed to treat them, since a single treatment will not be effective.
However, a growing number of experts believe that this increase in antibiotic prescriptions is directly related to the reduction in in-person appointments that has occurred since the pandemic.
Since 2019, the annual number of remote GP appointments has increased by approximately 40 per cent, with the majority taking place by telephone.
Last year, research by NHS England and charity The Health Foundation found that virtual appointments were more likely to result in a prescription for antibiotics.
An example of bacterial transduction, the mechanism that can lead to antimicrobial resistance
The research, published in the journal eClinical Medicine, found that patients presenting with cold and flu symptoms were 25 percent more likely to receive antibiotics if they were seen remotely compared to those treated in person.
Experts say remote appointments lead to a higher rate of antibiotic use because GPs are more “unsure” about the diagnosis.
“When GPs see patients remotely, there is more guesswork because they can’t do a physical examination,” says Watford GP Dr Nisa Aslam.
‘If a doctor were seeing a patient with respiratory symptoms in person, they might monitor their oxygen levels to make sure their condition is not worsening or listen to their lungs using a stethoscope to look for signs of a bacterial infection.
But you can’t do this over the phone. That’s why doctors are more likely to offer antibiotics “just in case.”
One patient who knows the danger of drug-resistant infections is Vanessa Carter, 45, from Devon, who contracted the superbug MRSA in hospital after being injured in a car accident in 2004.
“It was a ten-year battle to eliminate MRSA,” says the mother-of-one, who now works with the charity Antibiotic Research UK as a patient advocate.
“That’s why it’s so important that we do everything we can to limit the number of antibiotics we take, otherwise more patients will suffer like me.”
