Local response

Cornwall Antimicrobial Resistance Group (CARG)

In Cornwall the response to the national strategy is co-ordinated by the Cornwall Antimicrobial Resistance Group (CARG). The UK Five Year Antimicrobial Strategy states:

“Success will require a wide range of public and private sector bodies to take co-ordinated action to deliver an integrated programme, which will safeguard human and animal health.”

“…providing clinical leadership and improved collaborative working …”

Starting membership of CARG:

  • NHS England – Medical Director DCIOS (Chair)
  • Royal Cornwall Hospital (acute NHS trust) – Chief Pharmacist (Deputy Chair), Antimicrobial Pharmacist, Microbiologists, DIPC Nurse Consultant
  • NHS Kernow – GP Clinical Lead, Pharmaceutical Advisor, DIPC Nurse Consultant
  • Peninsula Community Health (includes Community Hospitals & Nurses) – Medical Lead
  • Public Health England – Consultant
  • Academic - European Centre for Environment and Human Health
  • Community Pharmacist – LPC Chief Officer
  • Veterinary sector - small animal veterinary surgeon 

Purpose of CARG:

  • Responsible for ensuring implementation of UK five year AMR strategy
  • Specifically supporting delivery of three main strategic aims
  • Reports to Health and Wellbeing Board via Health Protection Committee
  • Also reports into various committees within each stakeholder organisation eg Medicines Optimisation Programme Board 

CARG workstreams:

  • Education and Engagement with the Public
  • Education and Engagement with Healthcare Workers & Vets
  • Comprehensive Stewardship Programme for All Sectors 

Primary Care

For the last two years GP practices in Cornwall have been implementing the TARGET Antibiotics toolkit.

  • Treat
  • Antibiotics
  • Responsibly
  • Guidance
  • Education
  • Tools

The TARGET Antibiotics Toolkit aims to help influence prescribers’ and patients’ personal attitudes, social norms and perceived barriers to optimal antibiotic prescribing. It includes a range of resources that can each be used to support prescribers’ and patients’ responsible antibiotic use, helping to fulfill CPD and revalidation requirements. 

In 2014/15, GP practices completed a self-assessment checklist and implemented strategies to help to reduce the inappropriate prescribing of antibiotics, e.g. delayed prescribing, patient leaflets. Doctors may consider issuing a ‘delayed or back-up prescription’ so that the patient can obtain antibiotics after a certain period of time if their symptoms continue. 

When antibiotics are not prescribed patients can be given information on how long their symptoms may last, how to treat them and what to do if they do not ease. For the last two years NHS Kernow has provided all GP practices with printed A5 pads of the patient leaflets to use during consultations. 

Quarterly antibiotic prescribing data is sent out to GP practices, including data for individual prescribers, so that they can monitor their total antibiotic items and numbers of broad spectrum antibiotics that should be kept to a minimum because of antimicrobial resistance (cephalosporins, quinolones & co-amoxiclav). 

The current ‘Management of infection guidelines for primary and community services’ can be found here.