Response to a news article on the RCGP website

I have read with great interest both the news article published on the RCGP website, ‘Thousands of GP appointments “lost” due to children with conjunctivitis being turned away from nursery, says RCGP’,¹ and the leaflet produced by the RCGP to educate childcare professionals, parents, and teachers about managing conjunctivitis in young children.² General practice is under unprecedented workload pressure,³ and every attempt to rationalise appointments so that resources can be utilised appropriately ought to be commended.

The purpose of the aforementioned leaflet is to reassure parents et al that young children with conjunctivitis do not require assessment by a GP, nor exclusion from school. I wonder, however, that in emphasising this message, if the RCGP has oversimplified the advice regarding the use of antibiotics. The leaflet states that children ‘DON’T need to … use antibiotics’. A literal interpretation of this particular language by parents et al may lead to children with severe conjunctivitis not receiving treatment and risking serious complications. This advice is not in keeping with a National Institute for Health and Care Excellence (NICE) Clinical Knowledge Summary (CKS),⁴ which, having based its recommendations on a recent Cochrane Database Systematic Review,⁵ concludes that topical antibiotic treatment should be administered in severe cases.

The NICE CKS accepts that there is no agreed definition of severe conjunctivitis, and that it is reasonable to use clinical experience to determine the severity of a case. Perhaps a revised version of the leaflet, one that applies specialist ophthalmology input to highlight the difference between severe and non-severe conjunctivitis, would be more effective in triaging those children in need of antibiotics towards a GP, while simultaneously meeting the RCGP’s objective of rationalising appointments.

• © British Journal of General Practice 2017