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Evaluating the ‘Quality Premium’ and identifying unintended consequences associated with reduced community use of antibiotics in post-COVID era

Department of Infectious Disease

, , Dr Nina Zhu , Ms Donna Lecky Monday, May 31, 2021 Competition Funded PhD Project (European/UK Students Only)
London United Kingdom Epidemiology Health Informatics

About the Project


This is an exciting opportunity to be one of a four student cohort, working at the NIHR Health Protection Research Unit in Healthcare Associated Infection (HCAI) and Antimicrobial Resistance (AMR) at Imperial College London.

The Unit is a collaboration between Imperial College London and its partners, Public Health England, Imperial College Health Partners, Warwick University, and Cambridge Veterinary School.  

The ethos of the Unit is one which embraces interdisciplinarity and multi-professional research to tackle AMR and HCAI, producing a vibrant and diverse research environment in which world-class facilities and access to international experts make the exploration of exciting and innovative research projects across the breadth of AMR possible. 

The Unit’s Director, Professor Alison Holmes and our Theme Leads represent international expertise from the Faculty of Medicine, the Faculty of Engineering, the Dyson School of Design, the School of Public Health and the Centre for Molecular Bacteriology and Infection.

Depending on the choice of topic, there are also opportunities to collaborate with two other HPRUs at Imperial; the HPRU in Respiratory Infection and the HPRU in Modelling Methodologies and Health Economics. Whichever project you choose, you will be working closely with our experienced research staff who include bench scientists, medics, epidemiologists, pharmacists and systems dynamics modellers. You will also be supported by the Unit’s dedicated administrative team who can assist students in adopting patient and public engagement in their projects and in applying for post-doctoral fellowships at the end of their studies.


This is a 3 year PhD project, offering a stipend of £18,000 per annum. Fees are available at the home rate only.

Evidence has demonstrated the impact of national Antimicrobial Stewardship initiatives (e.g. the Quality Premium) on reducing antibiotic prescribing in primary care; emerging evidence has shown further reduction of prescribing since COVID-19; formal evaluation of the impact of the Quality Premium on reducing health and economic burden of antimicrobial Resistance and potential unintended consequences is limited. The project will link individual level pre/post Quality Premium/COVID hospital records and primary care prescribing data perform paired analysis to quantify the impact of the Quality Premium on Antimicrobial resistance; assessing the impact of changing prescribing practice in England, identifying unintended consequences associated with national antimicrobial stewardship initiatives and informing policy re-design within the changed landscape of infection management in primary care since COVID-19.

The project will build on the Unit’s work on the potential unintended consequences of reduced prescribing, to deliver the following objectives: 

  • Comparison of the effectiveness of antimicrobial stewardship initiatives including the Quality Premium implemented in UK over time.
  • Assessment of effectiveness of the Quality Premium payments in England compared with other UK countries.
  • Establishment of routine use of tools for assessing impact and determining the optimal policy mix on a range of outcomes including health, resource efficiency and health systems performance.
  • Standardised GP diagnostic algorithms for Urinary Tract Infections and Respiratory Tract Infections.

Eligibility Criteria

To apply you must have a minimum of an upper second class honours degree or equivalent, meet the College’s English language requirement and meet the criteria to be eligible for home fees.

To apply for this position please, use the enquiry form below to send a cover letter explaining why you are a suitable candidate for this PhD studentship, together with your CV and the names of two referees.

Funding Notes

The intended start date is prior to the 31 July 2021. As such Home fee classification and studentship awards will be determined according the existing fee regulations. However, EEA/Swiss nationals should be aware that if for any reason they do not commence studies by the 31st July, they will be subject to re-assessment against the new (amended) fee regulations and depending on their circumstance, they may loose an entitlement to Home fee status or the studentship. Under such circumstances, affected students would need to withdraw, or self-fund their studies at the overseas fee rates


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