Improving COPD Rescue Pack Governance and Antimicrobial Stewardship Through a Pharmacy Technician-Led Primary Care Pathway

Liverpool First PCN

Project summary

An antimicrobial prescribing audit across our Primary Care Network (PCN) highlighted COPD rescue pack prescribing as a significant risk for inappropriate antibiotic use and variations in practice. Rescue pack antibiotics were often requested through repeat prescribing systems without structured clinical review, leading to gaps in prescribing governance and missed opportunities for COPD management, while also increasing pressure on GP appointments.

The audit further revealed inconsistent adherence to the recommended 5-day courses of antibiotics for COPD exacerbations and variations in prednisolone prescribing. Some patients regularly received both antibiotics and prednisolone together, while others received antibiotics alone despite worsening breathlessness. Education around rescue pack usage was inconsistent, leaving some patients unaware of when they might need antibiotics only, prednisolone only, or both treatments based on their symptoms.

To enhance antimicrobial stewardship and standardise rescue pack management, a Pharmacy Technician-led COPD rescue pack pathway was piloted across two GP practices, serving populations of approximately 6,000 and 2,000 patients from 1st to 31st March 2026. All rescue pack requests underwent clinical triage through Pharmacy Technician appointments using a standardised EMIS template and escalation criteria. Patients received structured assessments, education on rescue pack use, self-management advice, and safety-netting information. Those presenting with red flag symptoms or acute deterioration were appropriately escalated for urgent GP or ANP assessments.

During the four-week pilot, 25 rescue pack requests were reviewed, with 19 packs issued following clinical assessment and 4 requests declined, effectively eliminating inappropriate repeat-rescue-pack prescribing during this period. The intervention enhanced antimicrobial stewardship by ensuring antibiotic selection and duration were consistent with NICE and regional guidance, promoting 5-day courses for COPD exacerbations and 14-day courses for bronchiectasis as clinically indicated. Two patients were escalated to GPs for urgent assessment while eight clients were optimised with triple therapy inhalers by a pharmacy technician under the supervision of pharmacist.

With each request previously expected to require a 10-minute GP appointment, this pathway potentially freed up approximately 230 minutes of GP appointment capacity during the pilot. Additionally, the initiative supported better value prescribing by reducing inappropriate antibiotic issuance, standardising antibiotic durations, and optimising the use of the existing ARRS workforce. This pathway is now integrated into routine workflows and is poised for rollout across all 10 practices within the PCN.