Penicillin allergy de-labelling in primary care; correcting primary care records using a prescribing incentive scheme...

Penicillin allergy records are common and associated with several patient and health system harms. Using the local primary care prescribing and medicines optimization scheme (PMOS) for 2025/26 GP practices working across NHS Cornwall and Isles of Scilly integrated care board (ICB) in SW England, serving a population of 600 000, were financially incentivized to remove incorrect low-risk penicillin allergy (penA) records.

Pharmacists from the ICB Medicines Optimisation Team, in partnership with an Antimicrobial Pharmacist at the local hospital developed the penicillin allergy de-label incentive scheme. GP records were searched for patients with a penA record and had subsequently received a prescription for any penicillin antibiotic. GP practice staff trained in penicillin allergy de-labelling (PADL) telephoned these patients to take a penA focused history, risk assess the history, confirm tolerance to the subsequent penicillin antibiotic and consent the patient to PADL. Successful completion of the PMOS scheme generated an incentive payment to practices.

In Cornwall, 50 of 55 (91%) practices engaged with the PMOS and returned data by 31 March 2026 on 3263 identified patients. Of these, 1627 (49.9%) were successfully contacted, of which 981 (60.3%) were eligible for PADL and 882 (54.2%) consented to PADL. The incentive scheme was delivered by practice-based pharmacy technicians, pharmacists and general practitioners.

The study reports on the de-label of a large number of low-risk patients with penA across a primary care health community in the UK. This was possible due to education and training for a prescribing lead in each GP surgery coupled with financial incentive.