Patterns of GP and nurse independent prescriber prescriptions for antibiotics dispensed in the community in England: a retrospective analysis

Background: Physician-nurse task shifting, a process of delegation whereby tasks are moved to other specialized healthcare workers, is used in primary care in many countries to improve access, efficiency and quality of care. One such task is the prescription of medicines. Objectives: To identify nurse independent prescriber (NIP) and GP numbers in England, the proportions and types of NIP and GP antibiotic prescriptions dispensed in the community, and the impact of COVID-19 on the volume, rate and types of antibiotic prescriptions dispensed. Methods: Descriptive population-based retrospective cohort study using routinely collected data on prescriptions for antibiotics dispensed in the community in England between January 2014 and October 2021. Results: Between 2014 and 2021, numbers (headcount) of NIPs whose prescriptions were dispensed in the community rose by 146% to 34 997. GP numbers (headcount) rose by 10% to 44 681. Of the 25.373 million antibiotic prescriptions dispensed between 2014 and 2021, NIPs were responsible for 8.6%. The rate of dispensed antibiotic prescriptions per prescriber per calendar year decreased (by 50% for NIPs and by 21% for GPs) between 2014 and 2020. This decreasing trend continued following the onset of the COVID-19 pandemic across both groups. Narrow-spectrum antibiotics (penicillins, macrolides, tetracyclines) were the most frequently dispensed across both NIPs and GPs. Conclusions: NIPs are an increasing contributory influence on total antibiotic prescribing and should be included in antimicrobial stewardship efforts. Interventions for this group need to be tailored to the population and context in which they work.