TY - JOUR T1 - The ethics of setting national antibiotic policies using financial incentives JF - British Journal of General Practice JO - Br J Gen Pract SP - 419 LP - 420 DO - 10.3399/bjgp17X692465 VL - 67 IS - 662 AU - Grace Li AU - Carwyn Hooper AU - Andrew Papanikitas AU - Susan Hopkins AU - Mike Sharland Y1 - 2017/09/01 UR - http://bjgp.org/content/67/662/419.abstract N2 - Antimicrobial resistance (AMR) is an increasingly urgent global public health issue. Data from Public Health England — from the English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR) — quantifies the scale of antibiotic resistance in key bacterial pathogens.The Department of Health’s 5-year strategy to reduce morbidity and mortality associated with AMR (2013–2018) focused on optimising antibiotic prescribing and improving infection prevention and control.1 In April 2015 NHS England introduced a Quality Premium (QP) focusing on reducing antibiotics. QPs are financial rewards, with a maximal value equivalent to £5 per patient, intended to reward clinical commissioning groups (CCGs) for improvements in the quality of the services that they commission and for associated improvements in health outcomes and reducing inequalities. The AMR QP provided commissioners with financial incentives to reduce antibiotic prescribing; 80% were linked to primary care quality measures (reduction in absolute number of antibiotic prescriptions by 1%, decrease in use of broad spectrum antibiotics by 10%) and 20% linked to improving availability of antibiotic prescribing data from secondary care.2Incentives are a tool that governments use to help support behaviour change, are a recognised domain in behaviour change methodology, and can be considered a form of trade. CCGs are offered an incentive in the form of additional funds for investment if they have reduced antibiotic prescribing. However, the CCG also has to show that it manages public funds responsibly and will only receive a QP if it has managed its funds according to the ‘Managing Public Money’ guidelines and does not require financial support during the financial year (nor deviate substantially from expected surpluses/deficits).2In 2014/2015 only 27% of the total available QP was achieved by CCGs. Although the financial incentive is directed towards CCGs, the behavioural change being targeted is at the level of … ER -