Quality statement 2: Back-up (delayed) prescribing

Quality statement

Prescribers in primary care can use back‑up (delayed) antimicrobial prescribing when there is clinical uncertainty about whether a condition is self‑limiting or is likely to deteriorate.

Rationale

When there is clinical uncertainty about whether a condition is self‑limiting or is likely to deteriorate, back‑up prescribing (also known as delayed prescribing) offers healthcare professionals an alternative to immediate antimicrobial prescribing. It encourages self-management as a first step, but allows a person to access antimicrobials without another appointment if their condition gets worse.

Quality measures

Structure

Evidence of local arrangements to ensure that prescribers in primary care can use back‑up (delayed) antimicrobial prescribing if there is uncertainty about whether a condition is self‑limiting or is likely to deteriorate.

Data source: Local data collection.

Process

a) Proportion of prescriptions for antimicrobials issued as a back‑up (delayed) prescription.

Numerator – the number in the denominator issued as a back‑up (delayed) prescription.

Denominator – the number of prescriptions for antimicrobials issued.

Data source: Local data collection.

b) Proportion of people issued a back‑up (delayed) prescription for antimicrobials who are advised when to use the prescription.

Numerator – the number in the denominator who are told when to use the prescription.

Denominator – the number of people issued a back‑up (delayed) prescription for antimicrobials.

Data source: Local data collection and TARGET Antibiotics toolkit.

Outcome

a) Back-up (delayed) prescriptions for antimicrobials that are dispensed.

Data source: Local data collection.

b) Antimicrobial prescribing rates in primary care.

Data source: Local data collection.

What the quality statement means for service providers, prescribers and commissioners

Service providers (such as GP practices, health centres, pharmacies) ensure that systems are in place to allow back-up (delayed) antimicrobial prescribing if there is uncertainty about whether a condition is self‑limiting or is likely to deteriorate.

Prescribers in primary care (such as GPs, nurses, pharmacists) can use back‑up (delayed) antimicrobial prescribing if there is uncertainty about whether a condition is self‑limiting or is likely to deteriorate.

Commissioners (clinical commissioning groups, NHS England) allow and monitor the use of back‑up (delayed) antimicrobial prescribing when there is uncertainty about whether a condition is self‑limiting or is likely to deteriorate.

What the quality statement means for patients, people using services and carers

People with conditions that may need antimicrobial treatment, but may get better without treatment, are told that they can have a prescription for an antimicrobial but they should only use it if their condition gets worse. This is known as a back‑up or delayed prescription. They are given clear advice about when they should use the prescription.

Source guidance

Definitions of terms used in this quality statement

Back-up (delayed) prescribing

A back-up (delayed) prescription is a prescription (which can be post‑dated) given to a patient or carer, with the assumption that it will not be dispensed immediately, but in a few days if symptoms worsen.

When using back‑up (delayed) antibiotic prescribing, patients should be offered:

  • reassurance that antibiotics are not needed immediately because they are likely to make little difference to symptoms and may have side effects (for example, diarrhoea, vomiting and rash)

  • advice about using the back‑up (delayed) prescription if symptoms get significantly worse

  • advice about how long they should expect their symptoms to last

  • advice about re-consulting if symptoms get significantly worse despite using the back‑up (delayed) prescription.

A back-up (delayed) prescription with instructions about use can either be given to the patient or left at an agreed location (for example, the local pharmacy) to be collected at a later date.

[Respiratory tract infections (self-limiting): prescribing antibiotics (2008) NICE guideline CG69, recommendation 1.1.6 and expert opinion]

Equality and diversity considerations

Prescribers may need to consider how to advise people who have difficulties in understanding the information given to them because of difficulty in understanding English or cognitive impairment.