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A ‘subscription model’ for antimicrobials that has made two new drugs available to NHS patients could be expanded as part of the UK’s second five-year plan to tackle antimicrobial resistance (AMR).
The subscription scheme — first announced in 2019 and intended to break the link between the price paid for antimicrobials and the volume sold — offers pharmaceutical manufacturers a fixed yearly fee to provide antimicrobials to the NHS. The first two subscription-style contracts were awarded in July 2022 for cefiderocol (Fetcroja; Shionogi) and ceftazidime + avibactam (Zavicefta; Pfizer).
‘Confronting antimicrobial resistance 2024 to 2029’, published on 8 May 2024 by the UK government and devolved governments, is the second UK-wide plan to tackle AMR and includes proposals to “scale the model to more antimicrobials across the UK”.
The plan commits to “implement purchasing arrangements for new antimicrobials that de-link the price paid for antimicrobials from the volumes sold, monitor and evaluate impact” and “advocate for the wider use of these ‘subscription models’ in other countries”.
NHS England published guidance on commercial arrangements and eligibility criteria for antimicrobial subscription model products alongside the AMR plan, which will apply across the UK, and which it says “will be clinically led and focus on areas recognised by the World Health Organization as areas in need for new antimicrobial treatment options”.
The strategy has been developed to support the ‘UK 20-year vision for antimicrobial resistance‘, which was published in January 2019, and aimed to ensure that AMR would be controlled and contained by 2040.
The latest plan also includes a commitment to support “appropriate prescribing and disposal” of antimicrobials following a widening of prescribing by healthcare professionals other than doctors.
It highlights the introduction of Pharmacy First in England and the fact that all pharmacists will graduate with an independent prescribing qualification from 2026.
“Providing tools to support antimicrobial treatment targeted only to patients who need them is critically important for independent non-medical prescribers to optimise diagnostic and therapeutic decision-making,” the plan states.
It also recommends “role-specific training” in infection prevention and control (IPC) and antimicrobial stewardship (AMS) for pharmacy technicians.
“It is critical to embed infection management capability widely across the NHS and care settings as infections are a common reason for seeking help as an emergency, being admitted to hospital, being admitted to intensive care and dying in hospital,” it says.
“An informed workforce will ensure that resources are appropriately allocated according to risk, with the impact of infections not limited to individual patients but affecting public health at large.
“Role-specific training will be critical to empowering all staff groups, including physician assistants and pharmacy technicians, to implement IPC and AMS principles according to their specific roles and responsibilities.”
Commenting on the latest plan, a spokesperson for the Royal Pharmaceutical Society, said: “Pharmacists have long championed the fight against AMR, contributing significantly to infection prevention and management, public education and addressing health inequalities.
“We are supportive of our profession continuing to play its part in this global issue and have published resources for pharmacists and their teams to be proactive in their practice around antimicrobial stewardship.”
