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The OPEN Project – Out of hours Prescribing: Enhancing communicatioN – a collaborative project funded by the NIHR SPCR commenced three years ago pre-pandemic. Now in the closing weeks, sadly not yet post-pandemic, we are still amid what sometimes feels to be an unrelenting virus. Here we reflect on developing our recently launched ‘Antimicrobial Stewardship Out of Hours’ e-learning for Health (e-LfH) Programme for Health Education England (HEE). 

At the time of seeking funding, Public Health England had reported a small reduction in antibiotic prescribing for common infections in general practice, but the same could not be said for out of hours primary care. Previous work had already documented specific pressures on out of hours patients and prescribers and we set out to expand our knowledge of communication and prescribing in this less studied field of practice. Our project comprised a team of social scientists, clinical academics, and PPI contributors in partnership with two out of hours providers in the South and West of England who between them provide out of hours care for more than 2 million patients.

In terms of our approach we used multiple methods to understand the management of common infections out of hours. Our focus was on collecting recordings of routine patient contacts with our service partners. In addition to this, we collected survey data and 12 months of service level case record entries enabled us to set our study in context.

Our project included the following workstreams:

1. A realist-informed review of the policy guidance and training for out of hours antibiotic prescribing (Alves et al., 2021).

2. An observational study of patient contacts with out of hours clinicians, driven by an ethnomethodology/conversation analytic approach, to look at what people do rather than rely (solely) on what they say about what they do. Over a 12-month period we collected 220 video and audio recordings including clinician advice calls, primary care centre appointments and home visits.

3. Developing training for out of hours prescribers, drawing on knowledge gleaned from the two prior workstreams, illustrated using real examples from the recordings collected in Workstream 2. Following a serendipitous leveraging of additional funds, we proceeded to work with HEE to develop our training for their e-LfH platform.

Our project closed with a virtual key stakeholder event on 30th March to introduce our HEE training sessions and to discuss future priorities with our two service partners. Attendees included senior management and other key staff members from both providers, our HEE programme manager, PPI contributors, our academic collaborators, and researchers. We included a live scribe to provide an illustrated record of our discussions. There was much enthusiasm about the training we have developed as a team and both providers are keen to discuss ways of incorporating these evidence-based outputs into their training offerings for staff.

Image provides a visual summary of the stakeholder event and the and the study itself


The pandemic struck towards the end of data collection for our observational study. The core team continued to work remotely, logging the data, and developing our Antimicrobial Stewardship Out of Hours training programme with HEE e-LfH. The OPEN Project has furnished us with a poignant and long-lasting lesson on teamwork, collegiality and, of course, a genuine feeling of gratitude; we are struck by how supportive and resourceful people can be. 

Finally, sincere thanks to our academic collaborators, service partners, researchers, PPI contributors and all the patients, caregivers and clinicians who supported our research. 

The HEE e-learning programme can be found here: Antimicrobial Stewardship (AMS) Out of Hours - e-Learning for Healthcare (


OPEN Project collaborators and researchers:

Geraldine Leydon-Hudson, Rebecca Barnes, Fiona Stevenson, Lydia Holt, Jennie Hayes, Catherine Woods, Gail Hayward, Michael Moore, Matthew Booker, Beth Stuart, Paul Little, Sue Latter, Kate Heneghan-Sykes, Ross Brand, Clare Louise-Nicholls.


logos of the organisations involved in the OPEN project