Following the Public Accounts Committee 30th Report – Antimicrobial resistance: addressing the risks, we connected with Natasha Ratnaraja, Consultant in Infection and Chair of the Medical Microbiology and Virology Specialty Advisory Committee at the UK's Royal College of Pathologists (RCPath). Here, Ratnaraja discusses the biggest takeaways from the report and how laboratory professionals should approach antimicrobial resistance (AMR) moving forward.
What are the biggest takeaways from the Public Accounts Committee 30th AMR report?
Although AMR is frequently discussed, there are still major challenges in scaling up access to diagnostics. We saw similar issues during the pandemic – getting diagnostics out quickly and globally remains difficult.
A strong workforce is critical to making progress in this area. While it's important to track how much money is being spent on AMR, we also need to focus on the professionals involved with antimicrobial stewardship.
We've examined the prescription model, which does help reduce AMR – though not as effectively as demand management. Still, it plays an important role in guiding prescribers to make appropriate, evidence-based decisions about antibiotic use.
Finally, it's encouraging that the UK government is recognizing AMR as a serious health risk. That recognition is something the RCPath values and supports.
What do you see as the most urgent barriers to optimal diagnostic deployment in AMR management?
There’s a lot of bureaucracy in the UK around developing new antimicrobials and diagnostics, which creates barriers. One key issue is the slow process of getting CE marking for diagnostic equipment. We also need to reduce funding obstacles to support innovation and access.
Health inequalities – especially those linked to geography – are another major concern. Larger laboratories often have better funding and more resources, while smaller labs may be left behind. This imbalance affects patient access to timely diagnostics.
To address this, we need to focus on point-of-care testing (POCT) and bringing diagnostics directly to patients and communities. However, these efforts must be overseen by NHS laboratories or through the pathology network to ensure that testing is validated and reliable. Without proper oversight, there’s a risk of unregulated or low-quality tests entering the market.
A strong, skilled workforce is essential for antimicrobial stewardship. We need people working on the front lines, in labs, and in clinical settings to support good prescribing practices and effective diagnostics.
Research is also crucial. During the COVID-19 pandemic, we saw that when funding was made available and bureaucratic hurdles were lowered, high-quality research could happen quickly. The same approach is needed now for AMR.
AMR is a public health emergency, and it must be addressed urgently. The O’Neill report warned that 10 million people could die annually due to AMR by 2050. That represents a significant and preventable loss of life.
In what ways can investment in diagnostic tools help reduce inappropriate antimicrobial prescribing in frontline settings?
Most healthcare settings already use POCT in some form, but it's largely focused in secondary care. There are opportunities to expand this into primary care and community pharmacies. However, any expansion must be overseen by the NHS to ensure patient safety.
We’ve seen in the past – for example, with sterilization equipment – that without proper monitoring, these efforts can actually put patients at risk rather than protect them. Oversight is critical to making POCT safe and effective.
As the UK government looks to establish more large community health centers, POCT should be part of that plan. But to do this properly, investment in the workforce is essential.
This work can’t be done without trained staff in place. They don’t all need to be infection specialists, but they must have proper training, understand infection control, and be equipped to provide oversight. Leadership skills are also key to making these services effective and safe.
The report stresses the need for investment in the consultant medical microbiology and virology workforce. Where are the most critical gaps currently, and how are these affecting AMR-related care?
There’s a well-known workforce shortage across the NHS, particularly in infection specialties such as medical microbiology, virology, and infectious diseases. These specialists don’t work in isolation – they collaborate closely with colleagues in both community and secondary care. So it’s essential to have enough trained professionals in place.
According to the last workforce survey, there was a 20.3 percent vacancy rate for consultant medical microbiologists. That figure reflects shortages even before any planned service expansions – and we already know the current workforce isn’t sufficient to meet existing demands.
For example, conducting an antimicrobial stewardship ward round in just one acute medical unit can take three hours. It’s effectively a full-time role, especially when other wards are included.
To meet these demands, we need to grow the workforce not just in microbiology and virology, but also in antimicrobial pharmacy, specialist nursing (especially in outpatient antimicrobial therapy units), and infectious diseases. Acute medicine colleagues also play an important role.
As a representative of the RCPath, I would highlight that medical microbiologists and virologists – who played a central role during the COVID-19 pandemic – are essential to effective antimicrobial stewardship.
What practical steps are needed to improve interoperability between pathology systems and electronic health records?
This is an issue we’ve raised with the UK Health Security Agency (UKHSA). There needs to be greater transparency and better integration across healthcare systems. At the moment, electronic prescribing and patient record systems vary significantly in quality and connectivity.
One key problem is that primary and secondary care systems often don’t communicate with each other. For example, in secondary care, I may not be able to see what antibiotics a patient was prescribed in primary care, or what lab or microbiology results they had – and vice versa. This lack of information can negatively affect prescribing decisions because clinicians don’t always know what treatments have already been tried. While patients may provide some of this information, it’s not always reliable.
Geography adds another layer of complexity. In central Birmingham, where I previously worked, multiple hospitals serve the same patient population. Patients often move between trusts, but those trusts don’t always share data. Accessing results from another hospital can be difficult – especially out of hours – and that can delay or complicate care.
In smaller health systems, things can be more manageable, but we still face challenges with incompatible IT systems. What’s needed is full transparency around test results and prescribing decisions, accessible to all relevant providers.
Primary and secondary care are part of the same health economy. We need to work more closely together to ensure everyone involved in patient care has a clear understanding of their medical history and treatments, regardless of where they were previously seen.
This is particularly important in tertiary care hospitals, where patients are often referred from other hospitals. Without access to their previous results, it’s very difficult to make safe and informed decisions. Connectivity is essential.
How does poor access to diagnostic test results hinder antimicrobial prescribing, and what role can pathologists play in resolving this?
It’s a challenge because, while pathologists can support improvements, we aren’t typically responsible for decisions about electronic patient record systems – unless we're in executive roles. However, we can advise, and the RCPath is actively working to push for better system connectivity.
At the national level, there is growing recognition of this need, especially in discussions about the 10-year health plans. These plans mention both patient-facing apps and the importance of interoperable electronic patient records. For pathology to be fully integrated, diagnostics must be part of that conversation.
There are still many barriers to achieving standardization – such as differences in test coding, terminology, and system interoperability. Investment is needed in these basic infrastructure areas to make progress possible.
Our role at RCPath is to raise awareness and advocate for these changes. The 10-year plan takes some steps in the right direction, but I would have liked to see more focus on diagnostics and infection, given their relevance to patient care in both primary and secondary settings.
Given the current pressures on the NHS and lab infrastructure, what immediate improvements could help reduce infection risk and support better diagnostics?
It’s always difficult because the current climate is challenging for everyone – not just for infectious disease specialists or the NHS as a whole. There is already some work underway to address this, and I understand that UKHSA is looking into it.
One area of focus is health inequalities in prescribing. We know from various austerity reports that infectious diseases are more common in areas affected by economic hardship. As the wider economic situation changes, it may be useful to map these patterns to identify which areas need more support.
This could help guide where to prioritize diagnostics and ensure there are people in place to support antimicrobial stewardship in those regions. That would be my immediate goal – making sure that areas with fewer resources still have access to diagnostics and prescribing support.
There is a clear variation across the UK in how health services are delivered, and addressing that unevenness is essential.
How is RCPath taking a more visible leadership role in national AMR strategies going forward?
Looking ahead, we’re doing what we can to support the infection specialties. We have a parliamentary session planned for November, and we're actively working toward that. Over the past few years, the RCPath has been collaborating closely with the British Infection Association. Together, we've produced several documents to support the workforce, and we’re currently working on a larger resource.
The key to progress is collaboration. We're engaging with major infection societies, like UKHSA, to develop guidance that supports the current workforce – because we have to work with the people we already have. While expanding the workforce is still a goal, it's not something that will happen overnight.
We’re also building stronger links with industry, which is important for research. These partnerships can be very beneficial in moving things forward. There’s always more to learn, and we will continue to evolve, but despite the challenges, it's an important and active time for us.
One major shift is the joint training now offered for medical microbiologists and infectious disease physicians. As someone who completed joint training, I’ve seen how it increases visibility on the wards, which helps build trust with clinical teams. That trust directly supports better patient care and antimicrobial stewardship, as clinicians are more likely to engage with specialists they know and see regularly.
AMR and the role of microbiology and virology were highlighted in a previous RCPath strategy. That recognition has helped us focus resources and seize opportunities to raise awareness – whether responding to government inquiries like the Public Accounts Committee or submitting evidence to national initiatives.
For example, we made sure microbiology was included in the RCPath’s response to the new cancer plan for England. Patients undergoing chemotherapy often have weakened immune systems, and infection management is a key part of their care. That perspective may not always be considered in broader cancer pathway planning, so it’s important we speak up.
We continue to respond to national consultations and guidance to ensure the voices of microbiology and virology are represented. Our role also includes setting standards – through developing clinical guidelines and best practice documents – which helps ensure high-quality care and provides a benchmark for the profession.
Ultimately, we’re working to support our members, raise awareness of the specialty, and ensure the value of infection specialists in diagnostics and patient care is clearly understood.
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