{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T13:31:26Z","timestamp":1792762286633,"version":"4.5.0"},"reference-count":32,"publisher":"Oxford University Press (OUP)","issue":"2","funder":[{"name":"UK Health Security Agency"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,3,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and objectives<\/jats:title>\n                    <jats:p>In England, over 70% of antibiotics are prescribed in primary care. Although antimicrobial stewardship (AMS) is a priority for reaching policy targets and requires a continuous, whole-practice approach, its practical implementation remains unclear. This qualitative study explores how primary care professionals perceive the implementation of existing AMS activities, such as audits, training and patient education, within their practice. The insights will be used to support the development of a practical visual aid (\u2018The Cycle of Antimicrobial Stewardship\u2019) to guide a consistent approach to AMS delivery through the TARGET toolkit and other relevant AMS resources.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>Three focus groups (FGs) involving 17 professionals from general practices across England were conducted, and data were analyzed thematically.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>AMS in primary care is often reactive and linear, typically limited to audit and intervention due to time and resource constraints. Nonetheless, participants supported a more continuous, team-wide approach and viewed the proposed four-step cycle as a practical visual aid to support this. Key enablers to AMS included incentive schemes, Pharmacy First and strategies to manage patient expectations. The evolving role of administrative staff and non-GP prescribers in delivering AMS messaging was highlighted, with a need for tailored training and resources. A real-world example illustrates how a cyclical AMS approach improved urinary tract infection (UTI) management in a busy practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The \u2018Cycle of Antimicrobial Stewardship\u2019 was positively received but requires consistent implementation across teams and external groups, including out-of-hours (OOH) services and community pharmacies. Further work is needed to support a unified approach across the wider primary care system. Strengthening stewardship efforts requires coordinated collaboration that acknowledges the diverse roles of professionals and settings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/jacamr\/dlag062","type":"journal-article","created":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T11:44:29Z","timestamp":1775648669000},"source":"Crossref","is-referenced-by-count":1,"title":["Implementing a cycle of antimicrobial stewardship in primary care: a qualitative study"],"prefix":"10.1093","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-9937-7710","authenticated-orcid":false,"given":"Emily A","family":"Whitehorne","sequence":"first","affiliation":[{"name":"Primary Care and Interventions Unit, Antimicrobial Resistance and Healthcare Associated Infections Division, UK Health Security Agency , Gloucester ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily","family":"Cooper","sequence":"additional","affiliation":[{"name":"Primary Care and Interventions Unit, Antimicrobial Resistance and Healthcare Associated Infections Division, UK Health Security Agency , Gloucester ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine V","family":"Hayes","sequence":"additional","affiliation":[{"name":"Primary Care and Interventions Unit, Antimicrobial Resistance and Healthcare Associated Infections Division, UK Health Security Agency , Gloucester ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda","family":"Strettle","sequence":"additional","affiliation":[{"name":"Village Surgery , NHS, Rotherham ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1223-9356","authenticated-orcid":false,"given":"Donna M","family":"Lecky","sequence":"additional","affiliation":[{"name":"Primary Care and Interventions Unit, Antimicrobial Resistance and Healthcare Associated Infections Division, UK Health Security Agency , Gloucester ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,4,28]]},"reference":[{"key":"2026042803331518300_dlag062-B1","doi-asserted-by":"publisher","first-page":"629","DOI":"10.1016\/S0140-6736(21)02724-0","article-title":"Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis","volume":"399","author":"Murray","year":"2022","journal-title":"Lancet"},{"key":"2026042803331518300_dlag062-B2","doi-asserted-by":"publisher","first-page":"1199","DOI":"10.1016\/S0140-6736(24)01867-1","article-title":"Global burden of bacterial antimicrobial resistance 1990\u20132021: a systematic analysis with forecasts to 2050","volume":"404","author":"Naghavi","year":"2024","journal-title":"Lancet"},{"key":"2026042803331518300_dlag062-B3","doi-asserted-by":"publisher","first-page":"c2096","DOI":"10.1136\/bmj.c2096","article-title":"Effect of antibiotic prescribing in primary care on antimicrobial resistance in individual patients: systematic review and meta-analysis","volume":"340","author":"Costelloe","year":"2010","journal-title":"BMJ"},{"issue":"suppl_2","key":"2026042803331518300_dlag062-B4","doi-asserted-by":"publisher","first-page":"ii36","DOI":"10.1093\/jac\/dkx500","article-title":"Potential for reducing inappropriate antibiotic prescribing in English primary care","volume":"73","author":"Smieszek","year":"2018","journal-title":"J Antimicrob Chemother"},{"key":"2026042803331518300_dlag062-B5","author":"UK Health Security Agency"},{"key":"2026042803331518300_dlag062-B6","author":"National Institute for Health and Care Excellence"},{"key":"2026042803331518300_dlag062-B7","doi-asserted-by":"publisher","first-page":"1","DOI":"10.15585\/mmwr.rr6506a1","article-title":"Core elements of outpatient antibiotic stewardship","volume":"65","author":"Sanchez","year":"2016","journal-title":"MMWR Recomm Rep"},{"key":"2026042803331518300_dlag062-B8","doi-asserted-by":"publisher","first-page":"833","DOI":"10.1017\/ice.2020.94","article-title":"Antimicrobial stewardship in the outpatient setting: a review and proposed framework","volume":"41","author":"Marcelin","year":"2020","journal-title":"Infect Control Hosp Epidemiol"},{"key":"2026042803331518300_dlag062-B9","doi-asserted-by":"publisher","first-page":"859","DOI":"10.3390\/antibiotics9120859","article-title":"Social and contextual influences on antibiotic prescribing and antimicrobial stewardship: a qualitative study with clinical commissioning group and general practice professionals","volume":"9","author":"Borek","year":"2020","journal-title":"Antibiotics"},{"key":"2026042803331518300_dlag062-B10","doi-asserted-by":"publisher","first-page":"30","DOI":"10.3390\/antibiotics12010030","article-title":"Factors influencing the implementation of antimicrobial stewardship in primary care: a narrative review","volume":"12","author":"Suttels","year":"2022","journal-title":"Antibiotics"},{"key":"2026042803331518300_dlag062-B11","doi-asserted-by":"publisher","first-page":"e1002774","DOI":"10.1371\/journal.pmed.1002774","article-title":"A whole-health\u2013economy approach to antimicrobial stewardship: analysis of current models and future direction","volume":"16","author":"McLeod","year":"2019","journal-title":"PLoS Med"},{"key":"2026042803331518300_dlag062-B12","author":"Royal College of General Practitioners"},{"key":"2026042803331518300_dlag062-B13","doi-asserted-by":"publisher","first-page":"1423","DOI":"10.1093\/jac\/dky004","article-title":"Effects of primary care antimicrobial stewardship outreach on antibiotic use by general practice staff: pragmatic randomized controlled trial of the TARGET antibiotics workshop","volume":"73","author":"McNulty","year":"2018","journal-title":"J Antimicrob Chemother"},{"key":"2026042803331518300_dlag062-B14","author":"Royal College of General Practitioners"},{"key":"2026042803331518300_dlag062-B15","doi-asserted-by":"publisher","first-page":"dlac026","DOI":"10.1093\/jacamr\/dlac026","article-title":"The value, challenges and practical considerations of conducting qualitative research on antimicrobial stewardship in primary care","volume":"4","author":"Wanat","year":"2022","journal-title":"JAC Antimicrob Resist"},{"key":"2026042803331518300_dlag062-B16","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1186\/1748-5908-6-42","article-title":"The Behaviour Change Wheel: a new method for characterising and designing behaviour change interventions","volume":"6","author":"Michie","year":"2011","journal-title":"Implement Sci"},{"key":"2026042803331518300_dlag062-B17","doi-asserted-by":"publisher","first-page":"241","DOI":"10.1080\/0142159X.2022.2057287","article-title":"A practical guide to reflexivity in qualitative research: AMEE guide No. 149","volume":"45","author":"Olmos-Vega","year":"2023","journal-title":"Med Teach"},{"key":"2026042803331518300_dlag062-B18","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1191\/1478088706qp063oa","article-title":"Using thematic analysis in psychology","volume":"3","author":"Braun","year":"2006","journal-title":"Qual Res Psychol"},{"key":"2026042803331518300_dlag062-B19","volume-title":"Successful Qualitative Research: A Practical Guide for Beginners","author":"Clarke","year":"2013"},{"key":"2026042803331518300_dlag062-B20","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/26895269.2022.2129597","article-title":"Toward good practice in thematic analysis: avoiding common problems and be(com)ing a knowing researcher","volume":"24","author":"Braun","year":"2023","journal-title":"Int J Transgend Health"},{"key":"2026042803331518300_dlag062-B21","doi-asserted-by":"publisher","first-page":"819","DOI":"10.1080\/14787210.2022.2023010","article-title":"A systems thinking approach for antimicrobial stewardship in primary care","volume":"20","author":"Saha","year":"2022","journal-title":"Expert Rev Anti Infect Ther"},{"key":"2026042803331518300_dlag062-B22","doi-asserted-by":"publisher","first-page":"e159","DOI":"10.3399\/BJGP.2024.0228","article-title":"Impact of the clinically oriented roles of a general practice receptionist: a systematic review with narrative synthesis","volume":"75","author":"Ban","year":"2025","journal-title":"Br J Gen Pract"},{"key":"2026042803331518300_dlag062-B23","doi-asserted-by":"publisher","first-page":"e703","DOI":"10.3399\/BJGP.2024.0677","article-title":"Evolution of the general practice receptionist role and online services: a qualitative study","volume":"75","author":"Stockwell","year":"2025","journal-title":"Br J Gen Pract"},{"key":"2026042803331518300_dlag062-B24","first-page":"10","article-title":"Antibiotic stewardship throughout the primary care visit: opportunities for office staff","volume":"28","author":"Wattles","year":"2021","journal-title":"Fam Pract Manag"},{"key":"2026042803331518300_dlag062-B25","doi-asserted-by":"publisher","first-page":"523","DOI":"10.3399\/bjgp17X693401","article-title":"The future role of receptionists in primary care","volume":"67","author":"Litchfield","year":"2017","journal-title":"Br J Gen Pract"},{"key":"2026042803331518300_dlag062-B26","author":"Health Education England"},{"key":"2026042803331518300_dlag062-B27","doi-asserted-by":"publisher","first-page":"3490","DOI":"10.1093\/jac\/dkx323","article-title":"Trends and patterns in antibiotic prescribing among out-of-hours primary care providers in England, 2010\u201314","volume":"72","author":"Edelstein","year":"2017","journal-title":"J Antimicrob Chemother"},{"key":"2026042803331518300_dlag062-B28","doi-asserted-by":"publisher","first-page":"25","DOI":"10.29045\/14784726.2020.12.4.4.25","article-title":"What out-of-hours antibiotic prescribing practices are contributing to antibiotic resistance: a literature review","volume":"4","author":"Hart","year":"2020","journal-title":"Br Paramed J"},{"key":"2026042803331518300_dlag062-B29","doi-asserted-by":"publisher","first-page":"793","DOI":"10.3390\/antibiotics12040793","article-title":"The national implementation of a community pharmacy antimicrobial stewardship intervention (PAMSI) through the English pharmacy quality scheme 2020 to 2022","volume":"12","author":"Hayes","year":"2023","journal-title":"Antibiotics"},{"key":"2026042803331518300_dlag062-B30","doi-asserted-by":"publisher","first-page":"1828","DOI":"10.1093\/jac\/dkaf135","article-title":"Exploring community pharmacy professionals and general practitioners views on primary care communication and pathways to access antibiotics in England","volume":"80","author":"Lee","year":"2025","journal-title":"J Antimicrob Chemother"},{"key":"2026042803331518300_dlag062-B31","author":"NHS England"},{"key":"2026042803331518300_dlag062-B32","author":"NHS England"}],"container-title":["JAC-Antimicrobial Resistance"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jacamr\/article-pdf\/8\/2\/dlag062\/68173030\/dlag062.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jacamr\/article-pdf\/8\/2\/dlag062\/68173030\/dlag062.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T07:33:31Z","timestamp":1777361611000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jacamr\/article\/doi\/10.1093\/jacamr\/dlag062\/8663789"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,9]]},"references-count":32,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,3,9]]}},"URL":"https:\/\/doi.org\/10.1093\/jacamr\/dlag062","relation":{},"ISSN":["2632-1823"],"issn-type":[{"value":"2632-1823","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,4]]},"published":{"date-parts":[[2026,3,9]]},"article-number":"dlag062"}}