Antibiotic prescribing requests for patients with osteomyelitis from podiatry

It has come to the LMC’s attention that practices are still receiving requests from Podiatry to prescribe long-course, broad-spectrum antibiotics (such as clindamycin) for patients with suspected or confirmed osteomyelitis.

The Morgannwg LMC position, consistently reiterated to the Health Board, is that General Practitioners are under no obligation to undertake this prescribing.

The LMC strongly advises practices not to assume this responsibility for the following reasons:

Outside GMS Remit and Competence:

The management of osteomyelitis is considered outside the scope of GMS and a GP’s core competence. Podiatry's own guidelines recommend a multidisciplinary team approach, including Trauma & Orthopaedics, which suggests it is beyond the capability of primary care.

Inappropriate Workload Transfer:

Requiring GPs to prescribe constitutes an inappropriate and unfunded workload shift, often resulting from the Podiatry service's lack of an Independent Prescriber. General Practice should not be expected to subsidise non-GP work.

This is in accordance with the new All Wales General Practice and Health Board Clinical Interface Standards and consistent with the approach MLMC has taken with other such requests. 

Financial and Clinical Risk:

Prescribing long-term, broad-spectrum antibiotics can negatively impact practice prescribing data (4C categorisation) and result in financial penalties for the practice. Furthermore, local guidelines require regular monitoring (e.g., weekly blood tests), which is unsafe and impractical for primary care given typical outpatient blood waiting times.

Action for Practices:

If you receive a request from Podiatry for long-course antibiotic prescribing for osteomyelitis, you should:

1. Decline the request and ideally datix the request, informing the LMC once patient information is removed from correspondence.

2. Inform the Podiatry team that, as this falls outside GMS and requires specialist prescribing and monitoring, they must arrange to manage the prescription and follow-up.

We appreciate the difficult position this places you in, but acceding to these requests perpetuates the problem and diverts precious GMS capacity.

We will continue to raise this matter at the highest level of the Health Board Liaison meetings.

Audiology - MRIs for unilateral hearing loss (update June 2026)

If you receive correspondence following a referral regarding this matter via WCCG or other means, we can confirm that the only safety measure that the LMC has ever asked is that these investigations are not requested or recorded under someone else’s name. 

The LMC is currently working with ENT and audiology to create a safe pathway for patients with unilateral hearing loss who require an MRI. SBUHB audiologists are unable to request MRIs in an ENT's consultant's name as they are a primary care service. The LMC has highlighted that these investigations must not be requested or recorded under someone else’s name unless they have specifically consented to this, due to the associated medico legal and patient safety issues.

In relation to your current patients, and to avoid any further delays, the LMC Exec would suggest that you consider requesting an MRI and then re refer the patient to ENT with result and symptoms of unilateral hearing loss.

For future patient referrals the LMC are suggesting that GPs take the following approach:

Dear Consultant ENT Specialist 

This patient has unilateral hearing loss. This is a specialist area outside the expertise of a GP. I am not the most appropriate professional to assess this further. Please investigate and treat as you feel indicated. I enclose a copy of the audiology assessment and MRI report.

When we have any developments, we will update practices.

MenB (Meningococcal group B) vaccination programme is being managed by SBUHB not GPs

Practices are not involved in the MenB (Meningococcal group B) vaccination programme and this will be run by Health Boards (Swansea Bay UHB).

The MenB (Meningococcal group B) vaccination will be offered to all those aged 17 and 18 who were born between 01/09/2007 and 31/08/2008. The vaccine is also available to those turning 25 after 31/12/2026 who will be attending Higher Education or Residential Further Education for the first time from Autumn 2026. This includes international students and those from the UK Devolved Administrations and Crown Dependencies. The vaccine will not be offered to:

• those who turn 25 on or before 31/12/26, presenting for their first dose

• those under 25 years continuing their studies – not attending further or higher education for the first time, including post graduates

• those in school-level residential settings, for example boarding schools, unless they are eligible due to their age.

Seventeen and 18 year olds who were born between 01/09/2007 and 31/08/2008 will receive an invitation letter from their health board. Letters will be sent after 1 July. For those under 25 and attending Higher or residential further Education for the first time this Autumn, you will not receive an invitation letter but you can contact Swansea Bay University Health Board after 20 July to find out where to get your vaccination.

Swansea Bay University Health Board

Website: Visit the Swansea Bay University Health Board website.

Address: 1 Talbot Gateway, Baglan Energy Park, Baglan, Port Talbot, SA12 7BR

Phone number: 01792 200492

Email: sbu.imms@wales.nhs.uk

Please do not contact your Swansea Bay University Health Board before 20 July 2026 as further information will not yet be ready. If you are under 25 and attending Higher or Residential Further Education for the f irst time this Autumn you will be expected to provide evidence of your offer letter from university or college when you arrive for your appointment.

First doses will be offered in Wales from 20 July until 31 December 2026. Second doses will be offered in Wales until 31 March 2027.

The second dose of the MenB vaccine is recommended at least 4 weeks (28 days) after the first dose to give you the best protection against MenB infection. It takes at least 2 weeks from the second dose of the vaccine for your body to achieve a good level of protection, so delaying the second dose delays protection. Those eligible should aim to get both doses before starting at college or university this Autumn.

Patients will need to have both doses of the vaccine, 4 weeks apart and then wait 2 weeks for the best protection. The MenB vaccine has been thoroughly tested and meets strict safety criteria. It has been routinely used in the infant vaccination programme in the UK since 2015 and has led to 75% reduction in MenB disease in vaccinated groups.