Implementing a cycle of antimicrobial stewardship in primary care: a qualitative study

In England, over 70% of antibiotics are prescribed in primary care. Although antimicrobial stewardship (AMS) is a priority for reaching policy targets and requires a continuous, whole-practice approach, its practical implementation remains unclear. This qualitative study explores how primary care professionals perceive the implementation of existing AMS activities, such as audits, training and patient education, within their practice. The insights will be used to support the development of a practical visual aid ('The Cycle of Antimicrobial Stewardship') to guide a consistent approach to AMS delivery through the TARGET toolkit and other relevant AMS resources.

Three focus groups (FGs) involving 17 professionals from general practices across England were conducted, and data were analyzed thematically.

AMS in primary care is often reactive and linear, typically limited to audit and intervention due to time and resource constraints. Nonetheless, participants supported a more continuous, team-wide approach and viewed the proposed four-step cycle as a practical visual aid to support this. Key enablers to AMS included incentive schemes, Pharmacy First and strategies to manage patient expectations. The evolving role of administrative staff and non-GP prescribers in delivering AMS messaging was highlighted, with a need for tailored training and resources. A real-world example illustrates how a cyclical AMS approach improved urinary tract infection (UTI) management in a busy practice.

The 'Cycle of Antimicrobial Stewardship' was positively received but requires consistent implementation across teams and external groups, including out-of-hours (OOH) services and community pharmacies. Further work is needed to support a unified approach across the wider primary care system. Strengthening stewardship efforts requires coordinated collaboration that acknowledges the diverse roles of professionals and settings.