The Big Fight Campaign

Professor Phillip Routledge

Rhys Howell

Debra Woolley

Janice Price

Christine Woods


Abertawe Bro Morgannwg University Health Board


Project Scope

The Big Fight campaign aims to improve patient outcomes and minimise the potential risks for increasing antibiotic resistance and C. difficile infection (CDi) through the development and implementation of a multidisciplinary programme through which the principles of prudent healthcare can be applied to improve antimicrobial stewardship in primary care.


Key stakeholders include:

  • Patients, carers and the public;

  • Local authorities; and

  • Healthcare professionals.

Starting conditions

ABMU Health Board has, for a number of years had the highest antibiotic prescribing in Wales and one of the highest across England and Wales combined. Prescribing data also shows wide variation in the prescribing of antibacterials.


The Medicines Management team had implemented a variety of antimicrobial stewardship improvement interventions over several years with limited success which culminated in the successful case for a funded Big Fight Campaign with a dedicated team of staff which commenced in early 2016. The team includes an antimicrobial pharmacist, infection control nurse and data analyst.



Analysis / Problem Solving Methods / Approach

The Big Fight team were able to access a variety of support through the Bevan Commission Exemplar programme. This support enabled the team to take a ‘fresh look’ at implementation of improved antimicrobial stewardship in the community and develop a programme of work.


Goals and Target

  • A reduction in overall antimicrobial prescribing in primary care across ABMU Health Board.

  • A reduction in variation of overall antimicrobial prescribing in primary care across ABMU Health Board.

  • That more key stakeholders across ABMU Health Board (including care home staff, GP practice staff and community pharmacy staff as a minimum) understand the importance of and feel well informed and supported regarding antimicrobial stewardship and have a good working knowledge of prevention and optimal management of CDi, re-infection and relapse.

  • A reduction in inappropriate GP appointments for self limiting viral infections across ABMU Health Board.

  • A reduction in overall CDi cases in non-inpatients across ABMU Health Board.


Future State

Recent prescribing data shows that Abertawe Bro Morgannwg University (ABMU) Health Board is reducing overall prescribing of antibacterials at a greater rate than the rest of Wales.


Antimicrobial prescribing is significantly affected by seasonal variation and so whilst initial results are promising it will be difficult to validate any improvement until after winter 2016/17 where antimicrobial prescribing traditionally reaches its highest levels.


Interventions / Actions

The Big Fight Team have progressed a number of priority actions to improve antimicrobial stewardship in the community. Two such examples are reported in separate pages (‘GP Practices’ and ‘Enhanced Antimicrobial Stewardship in Care Homes’).


Others include:

  • Engagement with key stakeholders;

  • Utilisation of the ABMU Health Board ‘GP Practice Prescribing Management Scheme’ to:

  1. Introduce non-clinical local Big Fight Campaign Managers in GP practices;

  2. Facilitate GP practice-based antimicrobial stewardship improvement plans, clinical audit and patient engagement activities;

  • Production of a toolkit to support cluster based pharmacists and technicians to support antimicrobial stewardship activities;

  • Provision of resources to support patient education and co-production;

  • Analysis and dissemination of GP level prescribing data linked to the Welsh National Prescribing Indicators;

  • Inclusion of Antimicrobial Stewardship in GP Cluster Plans across ABMU.


Benefit / Impact / Outcome

The Big Fight team undertook a stakeholder engagement event in November 2016 – ‘The Big Event’ was multidisciplinary with over 100 attendees (including from GP practices, care homes and patient representatives), which generated a wealth of ideas around engagement.


Fit with Prudent Health

  • Messages will be co-produced with members of the public to educate and raise awareness of the dangers of inappropriate antibiotic use and associated antibiotic resistance. This will help to manage patient expectation/demand for antibiotics during GP consultations.

  • Education/support for members of the public about self care of self limiting infections will better enable them to choose well when seeking support i.e. community pharmacist advice. It is anticipated that this will also help to reduce inappropriate GP consultations.

  • Improved cost effectiveness of antimicrobial prescribing.

  • A reduction in harm.

  • Enhanced antimicrobial stewardship knowledge of GPs and other stakeholders in the community


Part of Cohort Bevan Exemplar Projects 2015-16

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