See more acute patients See more unfamiliar patients with limited follow up (and wanting to avoid work for others) May feel less accountable for their prescribing (no audit or feedback) May feel less invested in or concerned by antibiotic prescribing in practices where they work as locums Less (access to) training and peer learning May be under more pressure from patients seeking antibiotics May feel under more time pressure (antibiotic prescribing is seen as quicker than not prescribing) Less aware of practices’ AMS initiatives May feel influenced by practices’ high-prescribing culture and feel unsupported when not prescribing antibiotics (want to avoid risks and complaints)
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No pre-existing relationship and expectations from patients (easier to suggest a ‘new’ no-antibiotic approach and less worried about impact on the relationship) Well trained and aware of the evidence May work more flexibly and take longer in consultations if needed to provide good care
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Use typical AMS strategies (for example, guidelines and clinical scores) Select practices that are ‘good’ to work in, and avoid practices perceived as more disorganised and with higher staff turnover Work locally and in regular, longer-term practices Ensure extra time to familiarise with new practices Keep own notes/information/links related to local guidelines, processes, and patients to follow up Agree/request sufficient time for good-quality care Initiate communication with colleagues and take time to develop good relationships Ask for support when needed Rely on IT prompts for first-line antibiotic Ask practices for information about relevant training or meetings and attend them Join local GP groups or locum organisations
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Audit locums’ prescribing Enable locums to issue prescriptions signed with their names, and link locums’ prescribing to their roles Provide feedback to locums, especially on individual antibiotic prescribing; invite locums’ feedback/suggestions for improvements to practices Use appraisal/revalidation to influence antibiotic prescribing (for example, require antibiotic prescribing audit and training) Adopt similar IT systems, guidelines, and processes across regions Improve inductions, including information about practice’s AMS approach and support for prudent antibiotic prescribing Use IT prompts and solutions to promote appropriate prescribing Organise locum peer groups, or include locums in local GP groups Provide free access to and encourage participation in AMS training Need whole-system approach to AMS, including ‘educating patients’
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