NHS England taken to task for sore throat 'test and treat plans' in pharmacies

January 9, 2017

Plans to run a 'test and treat' service for sore throat in community pharmacies in England are based on flimsy evidence and "heroic assumptions" about the potential impact on family doctor (GP) appointments, concludes an editorial in this month's issue of the Drug and Therapeutics Bulletin.

The NHS England plans fall under its National Innovation Accelerator (NIA) programme, which aims to promote "mature innovations with an evidence base, ready to scale in the NHS, and where there is no easy or obvious mechanism for adoption."

But dtb questions just how far these criteria apply, given that the scheme was evaluated in just 367 people from 35 community pharmacies owned by one commercial chain.

The pilot involved people aged 12 and older with a sore throat, which was assessed using criteria designed to winkle out the likelihood of bacterial infection (group A streptococcus) as the cause.

Those deemed most likely to have a were then offered a throat swab and a rapid test to confirm the cause, with the option of antibiotics if they tested positive.

The evaluation drew on 367 people, of whom 149 were considered eligible for the test: 36 tested positive for group A streptococcus infection. Pharmacists referred 56 people to their GP for further tests.

Based on these figures, NHS England suggests that if the scheme were rolled out nationally, visits to the for sore throat would plummet from 1.2 million to just 400,000—estimates which dtb dubs "heroic assumptions"—and would add up to a hefty £34 million in savings for the NHS every year.

But says dtb: "The small-scale evaluation did not include a comparison of the rate of antibiotic provision with usual care, did not assess outcomes of treatment, did not review complication rates and did not address issues of funding, cost-effectiveness, or scalability."

It continues. "It did not provide evidence that a test and treat service in community pharmacies would achieve a reduction in GP consultations, a reduction in antibiotic prescribing, an improvement in outcomes for patients or a financial saving."

And there are other drawbacks to the scheme, the costs of which were borne by patients in the pilot, states dtb.

Most sore throats are viral, and there's no evidence that bacterial sore throats last longer or that the test used can distinguish between carrier status and active infection. Up to 40% of those 'infected' with group A streptococcus have no symptoms.

Furthermore, antibiotics are not recommended for sore throat and there's no evidence to suggest that they are any better than simple painkillers for tackling the severity of symptoms.

And as only 6% of patients with a make an appointment to see their GP, "it is not clear what would happen if the other 94% were to access this service," says dtb.

It concludes: "When it comes to devising a national service for such a common self-limiting condition, let's base it on evidence."

Explore further: New test for patients with sore throats cuts antibiotic use by nearly a third

More information: Editorial: Sore throat test and treat - a £34 million question? Drug and Therapeutics Bulletin, DOI: 10.1136/dtb.2017.1.0446

Related Stories

New test for patients with sore throats cuts antibiotic use by nearly a third

November 8, 2013
A new 'clinical score' test for patients with sore throats could reduce the amount of antibiotics prescribed and result in patients feeling better more quickly, research in the British Medical Journal shows.

New strep throat guidelines tackle antibiotic resistance

September 10, 2012
(HealthDay)—Doctors need to accurately diagnose and treat strep throat in order to avoid inappropriate use of antibiotics that can lead to drug-resistant bacteria, according to updated guidelines from the Infectious Diseases ...

Seven tips to combat viral upper respiratory illness

December 28, 2016
The next time you go to see your health care provider for an upper respiratory illness - a cough or cold - don't assume you'll get a prescription for an antibiotic.

Suspect strep throat? Re-check negative rapid test results with lab culture

May 28, 2014
Clinical guidelines conflict on testing teens and adults whose symptoms point to a possible strep throat. A chief contention is whether negative tests results from a rapid analysis of a throat swab, done in a doctor's office, ...

Forgotten bacterium is the cause of many severe sore throats in young adults

February 17, 2015
New research from the University of Alabama at Birmingham suggests that Fusobacterium necrophorum more often causes severe sore throats in young adults than streptococcus—the cause of the much better known strep throat. ...

Sore throat: Is it strep or something else?

November 18, 2013
It's a common complaint, "Mom, my throat hurts." The quandary for many parents is why does it hurt? Is it a virus or something more? For some infections, like strep throat, that question can be difficult to determine without ...

Recommended for you

Google searches can be used to track dengue in underdeveloped countries

July 20, 2017
An analytical tool that combines Google search data with government-provided clinical data can quickly and accurately track dengue fever in less-developed countries, according to new research published in PLOS Computational ...

MRSA emerged years before methicillin was even discovered

July 19, 2017
Methicillin resistant Staphylococcus aureus (MRSA) emerged long before the introduction of the antibiotic methicillin into clinical practice, according to a study published in the open access journal Genome Biology. It was ...

New test distinguishes Zika from similar viral infections

July 18, 2017
A new test is the best-to-date in differentiating Zika virus infections from infections caused by similar viruses. The antibody-based assay, developed by researchers at UC Berkeley and Humabs BioMed, a private biotechnology ...

'Superbugs' study reveals complex picture of E. coli bloodstream infections

July 18, 2017
The first large-scale genetic study of Escherichia coli (E. coli) cultured from patients with bloodstream infections in England showed that drug resistant 'superbugs' are not always out-competing other strains. Research by ...

Ebola virus can persist in monkeys that survived disease, even after symptoms disappear

July 17, 2017
Ebola virus infection can be detected in rhesus monkeys that survive the disease and no longer show symptoms, according to research published by Army scientists in today's online edition of the journal Nature Microbiology. ...

Mountain gorillas have herpes virus similar to that found in humans

July 13, 2017
Scientists from the University of California, Davis, have detected a herpes virus in wild mountain gorillas that is very similar to the Epstein-Barr virus in humans, according to a study published today in the journal Scientific ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.