• Sarah Peters, Samantha Rowbotham, Anna Chisholm, Alison Wearden, Susie Moschogianis, Lis Cordingley, David Baker, Catherine Hyde, and Carolyn Chew-Graham.
• School of Psychological Sciences, University of Manchester, Manchester, UK. sarah.peters@manchester.ac.uk
• Br J Gen Pract. 2011 Sep 1; 61 (590): e579e589e579-89.

BackgroundDespite respiratory tract infections usually being viral and self-limiting, most primary care consultations still result in an antibiotic prescription. The National Institute for Health and Clinical Excellence (NICE) introduced the 'delayed prescribing' (DP) strategy. It remains unknown how useful UK clinicians find this approach.AimTo investigate how DP is used within UK primary care, and the benefits and challenges associated with this strategy.Design And SettingQualitative interview and focus group study in UK scheduled and unscheduled care primary care settings.MethodData were gathered through semi-structured interviews (n = 49) and six focus groups with GPs, trainee GPs, and nurse prescribers (NPs). An iterative analysis approach, using grounded theory principles, was used to generate themes from the dataset.ResultsPrescribers were familiar with DP but used it infrequently. DP was often used to manage diagnostic uncertainty, although NPs, trainee GPs, and GPs working in unscheduled care services preferred patients to reconsult under these circumstances. Prescribers used DP to avoid conflict, although some had found more effective strategies to achieve this. Prescribers were generally uncomfortable giving clinical responsibility to patients, and DP was perceived to communicate a conflicting message to patients about antibiotic efficacy.ConclusionDP was not considered to be a helpful strategy for managing patients with self-limiting respiratory tract infections within primary care and the findings do not support the centrality of DP in NICE guidelines as a primary means of reducing antibiotic prescribing. Future training and guidelines should encourage alternative ways of communicating empathy, addressing patient beliefs, and encouraging self-management.

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