Antibiotics and variations – are possibly explained by education and wealth

Several reports on antibiotics are concerning. Sarah Boseley in The Guardian 18th November 2015 reports: Antibiotic defences against serious diseases under threat, experts warn = Scientists in China discover a gene that enables resistance to move between bacteria – which is likely to spread worldwide, they warn

Antibiotics and variations – are possibly explained by education and wealth, and many members of my own family have been helped by them. It is the injudicious use by overwhelmed doctors which is the problem in medicine, but more importantly, the abuse in farming is just as important in the generation of resistance. Antibiotics need to be rationed overtly, so that a limited number are available in primary care, and the newer ones are used more responsibly. Older antibiotics such as chloramphenicol may need to be reconsidered as the gains outweigh their risks..

The Commissioning Review reports 18th November 2015: Atlas shows “unwarranted variation

NHS patients are suffering from “unwarranted variation” in their care, which cannot be linked to levels of illness or patient-preference, a joint report from leading health bodies shows.

The third – and biggest – NHS Atlas of Variation in Healthcare aims to help commissioners, service providers and health professionals by revealing the possible over-use and under-use of different aspects of healthcare.

John Newton, chief knowledge officer at Public Health England (pictured) said: “Variations are not always bad. Some can be explained by local circumstance or patient centered care, but unwarranted variation is very different. While some patients are missing out on the right care, others are being given care they don’t need.”

It showed the percentage of key antibiotics prescribed in primary care for clinical commissioning groups (CCGs) ranges from 6.8 to 16.8%. The Antimicrobial Prescribing Quality Measure (APQM) states usage should be less than 10%, so “there is a clear target for services to aim towards,” the report from Public Health England, NHS England and NHS Right Care states.

Patients with diabetes should receive a range of annual checks. There is a 1.7-fold variation (after exclusions) in the percentage of people with diabetes who got 8 NICE-recommended care processes.

Similarly, there is a 2.7-fold variation in claims by GPs for direct enhanced services for dementia diagnosis and patient support.

Chief medical officer, professor Dame Sally Davies said: “The first step in tackling unfair variation in health services is to identify where the problems are. This Atlas is a key tool in enabling us all to do this.

“Our challenge now is to consider how we can better understand and tackle the underlying causes. This is not a straightforward task, but exploring the data that lies behind these variations will be an important starting point,” she said.

For the full results and analysis click here.

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This entry was posted in A Personal View, Rationing, Stories in the Media on by .

About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

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