On TARGET for antibiotic prescribing

GPs are leading the way in the effort to tackle growing global antimicrobial resistance with prescriptions for antibiotics falling by 13% in general practice between 2012–2016 – and the College is supporting them in this vital work.

The TARGET Antibiotics toolkit (the acronym stands for Treat Antibiotics Responsibly, Guidance, Education, Tools), developed with the UK Health Security Agency, brings together a huge range of resources for primary care teams. Professor Cliodna McNulty, former head of the Primary Care Unit at Public Health England and RCGP programme lead for TARGET Antibiotics, oversaw the launch of the first toolkit in 2012.

“We’ve gone onwards and upwards since then,” says Professor McNulty. “Public Health England continues to support the TARGET project, and each year we improve the toolkit.”

The TARGET toolkit includes a series of training resources such as clinical scenario slides, webinars, eLearning modules, podcasts and quizzes, covering UTIs, respiratory tract infections and other conditions for which antibiotic prescribing is often considered. Diagnostic flowcharts and patient-facing leaflets, including pictorial materials, can later be used to assist in consultations where communication may be challenging.

“Practices can also take a deep dive into individuals’ prescribing behaviour – which isn’t shown in practice-level data – using the audit tools,” she explains.

All materials are underpinned by behavioural theory and developed using a GP– and patient-centred approach. A randomised controlled trial showed a 4% decrease in overall prescribing in areas where the TARGET toolkit was implemented. “We find that GPs prescribe for up to three reasons,” says Professor McNulty. “Patients perceive that antibiotics make a difference to the length of their illness; GPs want to prevent complications, particularly sepsis; and there is a high level of patient demand.

“The toolkit highlights the minimal difference that antibiotics make to the length of an illness. Resources also describe the complication rate, to reassure GPs that it’s very low. They support GPs with safety netting, as it’s important to reduce sepsis, and also with encouraging patient selfcare and prevention of future illnesses sign off," she said. 