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Antibiotic Prescribing Audits in PCNs: A Practical Guide
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- How can a PCN run an antibiotic prescribing audit?
- What should a PCN antibiotic prescribing audit measure?
- Where can PCNs find prescribing data?
- How should PCNs use audit and feedback?
- When should a PCN re-audit antibiotic prescribing?
The UKHSA ESPAUR report recorded 20,484 antibiotic-resistant bacteraemia episodes in England in 2024, a 13.1% increase since 2019. An antibiotic prescribing audit helps PCNs identify unwarranted variation.
Key Takeaways
- Use two evidence types: Prescribing data identifies variation; case-note review assesses whether individual prescribing was appropriate.
- Compare fairly: STAR-PU can support comparison, but local population need and delivery context still matter.
- Close the loop: Feedback should lead to one focused change, safety monitoring and a planned re-audit.
How can a PCN run an antibiotic prescribing audit?
A PCN can organise antibiotic audit primary care work as a focused, clinically owned cycle. Use the broader general clinical audit cycle as its framework.
- Agree a GP or clinical-director sponsor, Clinical Pharmacist lead and one priority question.
- Review PCN antibiotic prescribing data to identify variation worth investigating.
- Set criteria from current local antimicrobial guidance and relevant national standards.
- Review a proportionate case-note sample, then deliver confidential, constructive feedback.
- Implement one change, monitor balancing measures and re-audit using comparable data.
What should a PCN antibiotic prescribing audit measure?
A PCN antibiotic prescribing audit should combine aggregate prescribing measures with a targeted record review. NICE antimicrobial-stewardship guidance recommends monitoring prescribing, giving feedback to prescribers and embedding audit in quality-improvement programmes.
| Aggregate data can identify | Case-note review can assess |
| Total antibiotic items per STAR-PU, trends and variation between practices. | Indication, guideline concordance, agent, dose, duration, documentation and safety-netting. |
| A broad-spectrum antibiotic audit, including the 4Cs: co-amoxiclav, cephalosporins, ciprofloxacin and clindamycin. | Whether there was a documented clinical reason for prescribing outside the relevant guidance. |
Use current guidance. High volume does not automatically mean inappropriate prescribing. Population need and delivery context should inform antibiotic audit primary care activity.
Where can PCNs find prescribing data?
Use current NHSBSA dashboards and comparators, OpenPrescribing and local systems. ePACT2 antibiotic prescribing data adds a view of local variation. The 2026/27 NHS England Network Contract DES guidance identifies ePACT2, OpenPrescribing and NHSBSA comparators as supporting tools.
Investigate one focused priority: a defined syndrome, 4C use, course length or repeat antibiotics. This supports antibiotic stewardship in NHS GP practices while retaining a PCN-level operational focus.
How should PCNs use audit and feedback?
An antibiotic prescribing audit and feedback cycle should make safer prescribing easier, not simply tell clinicians to prescribe less. A 2025 systematic review and meta-analysis included 56 randomised trials of audit-and-feedback interventions for primary-care antibiotic prescribing. This supports a focused local improvement plan for reducing inappropriate antibiotic prescribing.
NICE’s quality standard on data collection and feedback expects stewardship teams to monitor data and give feedback at prescriber, team, organisation and commissioner level. Practical responses may include a local-guideline prompt, shorter default course length, repeat-antibiotic review or confidential peer discussion.
Expert insight from Adeem Azhar, qualified Clinical Pharmacist and CEO
Antibiotic stewardship isn’t just a clinical priority it’s a practical, everyday discipline that every GP practice can embed through audit, team education, and direct pharmacist support. These steps protect patient safety now and preserve antibiotic effectiveness for the future.
Adeem Azhar, MPharm, IPres
Co-Founder and Chief Executive Officer – Core Prescribing Solutions
Qualified Clinical Pharmacist
A Clinical Pharmacist can coordinate this antimicrobial stewardship audit with a GP sponsor, Pharmacy Technician and practice representatives. Where additional capacity is needed, consider Clinical Pharmacist support.
When should a PCN re-audit antibiotic prescribing?
Re-audit after the agreed intervention has had time to embed and comparable data are available. Monitor balancing measures such as infection-related reconsultations, urgent-care escalation and clinically significant complications.
The work should focus on reducing inappropriate antibiotic prescribing while protecting timely access to necessary treatment. It should not drive prescribing down indiscriminately. The RCGP and UKHSA TARGET antibiotic auditresources provide templates for common topics. Adapt each template to local guidance and a defined sample. A TARGET antibiotic audit can focus learning on the chosen issue.
Frequently Asked Questions
Looking for support with a PCN antibiotic prescribing audit?
Core Prescribing Solutions can help turn prescribing data into a focused, clinically governed improvement programme. Explore medicines optimisation support to discuss what your network needs.
