The Neighbourhood Health Framework focuses on improving access to diagnostic services by bringing them closer to home as part of the wider ambition to shift care from hospital to community settings. In this context, it commits NHS England to reviewing direct access to diagnostics for general practice and undertaking a review of diagnostic services to map existing community diagnostic centre capacity and planned expansion.

Rapid and point‑of‑care infection diagnostics can play an important role in supporting clinical decision-making, antimicrobial stewardship, and more appropriate antibiotic prescribing. The Government’s approach to improving access to these technologies is informed by the UK 2024–2029 National Action Plan on antimicrobial resistance, which identifies improved diagnostics and diagnostic stewardship as key priorities in reducing unnecessary antimicrobial use. The UK 2024–2029 National Action Plan on antimicrobial resistance is available at the following link:

https://www.gov.uk/government/publications/uk-5-year-action-plan-for-antimicrobial-resistance-2024-to-2029/confronting-antimicrobial-resistance-2024-to-2029

NHS England and local systems will continue to consider opportunities to improve access to appropriate diagnostic technologies, including rapid and point‑of‑care tests, as part of wider efforts to strengthen community diagnostic pathways. Decisions on the adoption and use of these technologies are guided by evidence on clinical effectiveness, cost-effectiveness, and operational feasibility.

On behalf of all the nations of the United Kingdom, NHS England published an invitation to tender for the UK subscription model for antimicrobials on 24 August 2024. The assessment of each product is being undertaken by a panel convened by the National Institute for Health and Care Excellence against the award criteria. Once that process is complete, the results will be communicated to bidders along with an award offer where appropriate.

Following the award offer, it is normal practice for a 10-day standstill period before contracts commence. Further details on timings will be available once the assessment process is complete, however, suppliers involved in the process have already been advised that contract award is likely to be in November, with contracts commencing from quarter one of 2027.

The United Kingdom’s 2024 to 2029 antimicrobial resistance (AMR) national action plan (NAP), published in May 2024, recognises that AMR impacts people differently. People with cystic fibrosis are an increased risk of infection, including resistant infections, and therefore action to tackle the threat of AMR is even more important for this group. In particular, the use of accurate diagnostic testing to guide effective antibiotic use, a priority commitment in the NAP, is critical for people with cystic fibrosis.

The Department, through the National Institute for Health and Care Research (NIHR), has invested over £88 million in AMR programme funding over the last five years. This includes research to develop and evaluate diagnostics and point‑of‑care testing to improve infection detection and optimise antibiotic use. The NIHR also supports the development of health technologies, including diagnostics, through its wider research infrastructure.

The UK will continue to invest in tackling AMR where it is most impactful, helping to ensure that our actions to address AMR reduce the burden for the people who are more affected.

Sewage discharges are regulated by the Environmental Permitting (England and Wales) Regulations 2016. These Regulations allow lower risk discharges to operate under statutory General Binding Rules, but any discharge which cannot comply with those rules can only be made in accordance with an Environmental Permit issued by the Environment Agency. When a permit application is processed, the potential risks to the receiving environment are considered and conditions to protect the environment are applied to any permit that is issued.

If the disposal of toilet waste containing additives compromises the treatment provided by a campsite septic tank then the discharge may cause pollution, and the operator of the septic tank could be subject to enforcement action by the Environment Agency.

It is the responsibility of local commissioners and providers to ensure the adequacy of all services to patients in rural areas, and that includes Outpatient Parenteral Antimicrobial Therapy (OPAT).

In 2022, NHS England surveyed OPAT provision across England, and that report is available to health and social care workers on FutureNHS. As part of the Antimicrobial Resistance National Action Plan 2024-2029, NHS England plans to repeat that survey to assess the impact of the guidance on OPAT provision.

We also note that to support those who are planning to develop OPAT services, including for rural areas, NHS England published guidance on developing OPAT services to integrated care boards and providers in 2025.

The Department for Environment, Food and Rural Affairs monitors antimicrobial resistance (AMR) in zoonotic and commensal bacteria from food samples taken from Third Country Imports to the European Union of fresh meat at Northern Ireland’s Points of Entry. This AMR testing is carried out on beef and/or pork and chicken and/or turkey on alternating years. These inspections are carried out in line with and under European Commission Implementing Decision (EU) 2020/1729 on the monitoring and reporting of AMR in zoonotic and commensal bacteria, which applies in Northern Ireland under the Windsor Framework.

For the rest of the United Kingdom, port health authorities (PHAs) have a statutory obligation to prioritise sampling under official controls which are intended to mitigate known food safety risks. PHAs have their own local sampling plans which will be informed by the UK’s National Monitoring Plan and other intelligence. Currently, it is more practical to sample for AMR screening inland.

The Food Standards Agency (FSA) is currently funding two AMR surveys at retail which includes testing foods imported into the United Kingdom. This includes the raw frozen chicken meat survey and the eggshell membrane food supplements survey, which includes supplements imported into the UK.

The Government takes a ‘One-Health’ approach to controlling AMR through the UK’s 2024 to 2029 National Action Plan. The FSA leads on AMR in food and promoting good hygienic practices across the food chain. Surveillance improves our understanding of AMR by measuring, predicting, and understanding how resistant microorganisms spread from animals and agriculture to humans via the food chain. This allows decisions to be based on robust surveillance, scientific research, and datasets. We monitor AMR bacteria found in foods to understand trends over several years and detect emerging new threats to protect the public and future effectiveness of antibiotics both in healthcare and animal welfare.

In 2022 the Veterinary Medicines Directorate (VMD) initiated a collaboration with the Centre for Environment Fisheries and Aquaculture science (Cefas) with the support of the British Trout Association (BTA), to establish AMR surveillance in bacteria responsible for disease in UK farmed trout. Results from this pilot scheme have been reported in the UK Veterinary Antibiotic Resistance and Sales Surveillance Reports (2023 & 2024). Building on this work the development of a national surveillance programme for AMR in healthy aquatic animals – including finfish and shellfish – is currently under consideration.

The Veterinary Medicines Directorate has also established the Private Laboratories Initiative (PLI) to strengthen national AMR surveillance by capturing clinical data from private veterinary diagnostic laboratories, which are not currently included in government surveillance programmes. Addressing this surveillance gap will improve our ability to understand of AMR trends and detect emerging threats. This work includes aquaculture, with work underway led by Cefas. Further details can be found in the UK‑VARSS 2024 report (p.169).

Flea and tick products play an important role in protecting animal and human health; however, the Veterinary Medicines Directorate (VMD) recognises increasing concerns about the environmental impacts of substances such as fipronil and imidacloprid. Monitoring in England has detected these substances in some watercourses at levels that may pose a risk to aquatic invertebrates.

The VMD is leading cross‑government work through the Pharmaceuticals in the Environment Group to support responsible use of these products. Recently published VMD‑funded studies (2024–25) have shown that spot‑on flea and tick products can contribute to environmental levels of imidacloprid and fipronil through wastewater pathways and when dogs swim. These findings strengthen the evidence base, but important gaps remain, including understanding the potential unintended consequences if usage patterns change. This is being considered as part of wider stewardship work to ensure future decisions remain proportionate, evidence based and protective of animal welfare.

The EU has not yet formally approved or published a final legal text, I am however aware of the potential impacts of restrictions on the sale of antimicrobial medicines without prescription on Northern Ireland's health services, particularly demand for GP appointments. The Government has raised this issue and we will, as ever, always advocate for the interests of Northern Ireland.

The Government will publish an explanatory memorandum in due course in accordance with the usual processes.

The 2024 to 2029 United Kingdom antimicrobial resistance (AMR) national action plan (NAP) includes research to improve understanding of AMR spread across humans, animals, agriculture, and the environment, to strengthen future AMR surveillance strategies.

The Environment Agency is conducting research into environmental transmission of AMR including monitoring novel forms of resistance, such as antifungal resistance and bioaerosols. The UK Health Security Agency’s modular ward will generate evidence on how the hospital environment contributes to the spread of AMR infection, with a focus on how risks associated with water and wastewater can be mitigated.

The Health Protection Research Unit on Healthcare Associated Infections and AMR led research on wastewater infrastructure in hospitals on AMR gene dissemination in humans and is exploring the impact of hospital wastewater in terms of perpetuating AMR.

The United Kingdom is looking forward to participating actively in the fifth Ministerial High-Level Conference on antimicrobial resistance (AMR) which will be held in Nigeria in 2026. The Government is considering how best to celebrate the 2028 centenary of the UK's discovery of penicillin. We will internally consider whether this will include bidding to host the sixth Ministerial High-Level Conference on AMR, which will take place in 2028.

The United Kingdom’s 2024 to 2029 antimicrobial resistance (AMR) national action plan (NAP) highlights the importance of accurate diagnostic testing to guide effective antibiotic use.

Outcome six of the NAP commits to cross-sector working to develop diagnostics as a tool to tackle AMR. The Department, through the National Institute for Health and Care Research (NIHR), has invested over £16 million into programme funding for AMR diagnostics research. The Department also funds the NIHR HealthTech Research Centres, which accelerate development of healthcare technologies, including diagnostics.