Optimising Paediatric Antibiotic Prescribing in Primary Care: The LLR Approach

Leicester, Leicestershire and Rutland ICB

Project summary

Paediatric antibiotic prescribing in the 0-9yrs cohort in Leicester, Leicestershire and Rutland (LLR) had remained above the national target of ≤27% (as stipulated by the National Oversight Framework) for over three years, further destabilised by the October 2022 Group A Strep outbreak. At its peak in May 2023, the LLR average reached 36.9% (national 34.1%), with the highest-prescribing practice at 69.2%. Despite gradual improvement in line with the national trend, by August 2025 rates had fallen to 27.4% (national 28.8%), but persistent variation, parental pressure, re-consultation behaviour and inconsistent delayed prescribing practice remained - representing a clear patient safety concern and ongoing contribution to antimicrobial resistance.

In August 2025, LLR ICB launched a systemwide paediatric AMS campaign to better address this national target. A multidisciplinary Task & Finish Group, chaired by the ICB Senior Medicines Optimisation Pharmacist, brought together primary care, urgent care, community pharmacy, paediatrics, public health, communications and academia. Meeting bimonthly, the group reviewed prescribing trends, identified variation and co-ordinated cross-sector action. Interventions included a co-designed Practice Resource Pack with clinical scenarios, consultation scripts and a parent factsheet, a patient and prescriber online webkit, a new delayed prescribing guideline for clinicians, monthly updates on the ICB infections webpage, three webinars and two GP training sessions, TARGET Train-the-Trainer rollout, structured engagement meetings scheduled with each of the 18 outlier practices, reviewing prescriber-level feedback, reviewal of applicable PGD's, and updated applicable LLR antimicrobial guidelines. A Pharmacy First triage algorithm was also provided to GP reception teams.

Just three months after launch, LLR achieved this ≤27% target for the first time in over three years showing sustained improvement throughout the winter months (Dec 26.5%, Jan 26.2%). Pharmacy First data confirmed no compensatory rise in community pharmacy antibiotic supply - evidence of genuine, systemwide behaviour change rather than displacement. Practices also reported reduced parental pressure, improved clinical confidence and more consistent AMS practice across the system.

Whilst no direct cashable savings data is available for re-consultation rates or hospitalisations, the sustained reduction in unnecessary antibiotic prescribing across LLR is expected to generate downstream savings through reduced adverse drug reactions, fewer AMR-related complications and decreased parental re-consultation - all of which carry significant NHS cost implications.