NHS England Improvement and Assurance Schemes: ESPAUR Report 2024-25

Abstract Introduction NHS England (NHSE) designs and administers improvement and assurance schemes to incentivise prudent use of antimicrobials across the Integrated Care Systems (ICSs), to optimise patient outcomes, minimise avoidable exposure to antimicrobials and reduce selection pressure for antimicrobial resistance (AMR). Details of these schemes and performance of primary and secondary healthcare organisations are reported below. Primary Care Improvement and Assurance Schemes Within primary care, 17 out of 42 (40%) Integrated Care Boards (ICBs) met the NHS Oversight Framework 2024/25 national target for total primary care prescribing of antibiotics ‘at or less than 0.871 items per STAR-PU’ (population denominator adjusted for age and sex), an improvement from 24% in the previous year (Figure 1). The number of ICBs meeting the national target for primary care proportion broad-spectrum antibiotic prescribing ‘at or less than 10%’ was 41 out of 42 (98%). There was a decrease of 1,221,553 general practice antibiotic prescriptions in the 12 months to 31 March 2025 compared to the previous 12 months. For the National Medicines Optimisation Opportunities 2024/25, there was 12% increase in the proportion of 5 day prescriptions for amoxicillin 500mg capsules between March 2024 and March 2025, to 69% at March 2025, demonstrating improvement beyond the national 60% target.Figure 1.Overview of NHS England improvement and assurance schemes and antibiotic prescribing performance for financial year 2024 to 2025. Permission for use granted by UKHSA ESPAUR team. For the first time national data are available linking the supply of antimicrobials and antibiotic-sparing medicines with a standardised diagnosis for seven common infections in the Pharmacy First service. For the 12 months April 2024 to March 2025 a total of 2,339,908 consultations were delivered in English community pharmacies to 2,252,359 patients. An antimicrobial was supplied in 45% to 85% of consultations (including urinary tract infection). An antibiotic-sparing medicine was supplied in 25% to 36% of consultations for the three relevant infection pathways (see Table 1). For consultations for impetigo, topical antibiotic (fusidic acid 2% cream) was supplied in 53% of consultations and oral antibiotics in 14%. Table 1.Population insights from the Antimicrobial Stewardship – Pharmacy First dashboardPharmacy FirstInfection PathwayNumber of consultationsApril 2024 to March 2025Total = 2,339,908Number of patientsApril 2024 to March 2025Total = 2,252,359Number of unique people consulting per 100,000 population(greatest monthly rate)Percentage of consultations with: (aligned to greatest monthly rate)Advice only providedAntimicrobial suppliedAntimicrobial-sparing medicine suppliedAcute otitis media (for children aged one to 17 years)269,308 (11.5%)259,316(11.5%)250(December)19%45%30%Acute sinusitis (for adults and children aged 12 years and over)278,684 (11.9%)266,445(11.8%)64(March)13%47%36%Acute sore throat (for adults and children aged 5 years and over)806,491 (34.5%)774,092(34.4%)166(March)29%65%Non availableImpetigo (non-bullous impetigo for adults and children aged one year and over)99,223(4.2%)95,653(4.2%)16(March)4%68%25%Infected insect bites (for adults and children aged one year and over)200,023(8.5%)195,299(8.7%)67(August)13%83%Non availableShingles (for adults aged 18 years and over)59,684(2.6%)58,628(2.6%)10(no seasonal variation)10%82%Non availableUncomplicated urinary tract infection (for women aged 16 to 64 years with suspected lower UTI)626,495(26.8%)604,926(26.9%)281(December)7%85%Non availableUTI, Urinary tract infection Secondary Care Improvement and Assurance Schemes For NHS acute hospital trusts providing acute care, the NHS Standard Contract 2024/25 included a requirement for trusts to use reasonable endeavours to reduce prescribing of broad-spectrum antibiotics, however no numerical target for improvement was set. Forty-eight of 132 (36%) trusts achieved a 10% or more reduction in their ‘Watch’ and ‘Reserve’ antibiotic DDD per 1,000 admissions from the 2017 baseline, improved from 30 trusts (23%) in the previous financial year (2023 to 2024). Consumption of antibiotics from the ‘Watch’ and ‘Reserve’ categories across England at end of March 2025 was 2,275 DDD per 1,000 admissions which is similar to the new National Action Plan 2024 to 2029 baseline (2019-20) but reflects a decrease of 1.4% DDD per 1,000 admissions compared to the preceding year 2023-24. The NHS Commissioning for Quality and Innovation (CQUIN) non-mandatory scheme ‘Prompt switching of intravenous (IV) to oral antibiotic’ was extended to paediatric patients for 2024-25. Overall, 33 out of 135 (24%) NHS hospital trusts participated and submitted 9,595 audit cases, of which 541 (6%) were for paediatrics. Sixteen trusts met the 15% or lower threshold by quarter 4. Across England, 18% of cases were receiving IV antibiotics past the point at which they meet switch criteria. For paediatrics, this was 12% (67 out of 541) of cases. Blood Culture Pathway Audit National guidance and standards for blood culture investigations are published within the Standards for Microbiological Investigation. Taking sufficient blood volume and transporting specimens to an incubator promptly are associated with improved sensitivity and allow prompt escalation or de-escalation of treatment according to antibiotic susceptibility. The NHS National Blood Culture Pathway audit received data from 104 providers. Compliance with audit standards was low, with 26% of bottles (range across regions from 16 to 38%) filled to the recommended 8ml blood sample volume and 61% of bottles (range across regions 52 to 74%) placed in the analyser within the recommended 4-hour period. NHS England is working with trusts to support improvement initiatives. Conclusions A general pattern of improvement was evident for primary and secondary healthcare organisations in performance against national improvement and assurance schemes. Data are available for the first time from the Pharmacy First service for managing common infections in community pharmacy and from the first audit of the blood culture pathway and ongoing surveillance is required.