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.