Exploring factors affecting the national implementation and uptake of an antimicrobial stewardship training programme to primary care providers in England

Background Most antibiotics are prescribed in the primary care setting. In response to the global threat of antimicrobial resistance (AMR), the TARGET (Treat Antibiotics Responsibly, Guidance, Education and Tools) antimicrobial stewardship (AMS) training toolkit for primary care clinicians was rolled out in England in 2022. This study aimed to understand preconceived, as well as actual, factors influencing the roll out of training to improve and inform implementation strategies of this and future initiatives. Methods Two workshops were held: one at the launch (22 participants) in 2022 and another 18 months (14 participants) into intervention roll out, in 2024. Qualitative data were collected using the Theoretical Domains Framework to identify barriers and facilitators, and the Expert Recommendations for Implementing Change Framework to identify strategies for supporting change. Results Anticipated barriers, at launch, included lack of secure knowledge and, at a national level, confidence in presenting training content. Anticipated enablers were appointing regional champions and linking training to continuing professional development. Eighteen months later, barriers related to the effort needed to both implement the training and maintaining knowledge of evolving AMR evidence. Promoting the benefits of the training and financial incentives were cited as facilitators. Across both workshops, barriers were a lack of capacity and time. Purposive strategies most employed concentrated on educating stakeholders, providing support and development of stakeholder relationships. Strategies least employed were financial strategies and changing the regional level infrastructure. Conclusions Overall, the implementation of a national training programme requires support, both centrally and regionally, to be successful. Regional variation in priorities and practical issues should be acknowledged when implementing interventions nationwide.