The project aims to evaluate the implementation of the UK Antimicrobial Resistance (AMR) National Action Plan (NAP) 2019-2024 to contribute to the development and implementation of future AMR policy and adjustment of current implementation plans.


Antimicrobial resistance (AMR) occurs when microorganisms have evolved to no longer respond to the drugs that have previously worked against them. The emergence of resistance in bacteria is a natural phenomenon that has accelerated in response to the use of antibiotics in agriculture and medicine and their release into the environment, including through municipal and industrial wastewater. AMR is a global threat; microorganisms with resistance genes can spread through the movement of people, animals, food, soil, air, and water. In addition, some resistance genes can be directly transferred between microorganisms.

In 2019 the UK Government, its agencies and the Devolved Administrations in Scotland, Wales and Northern Ireland published the UK’s five-year NAP based on a One Health approach. The NAP was published alongside the UK 20-year vision for AMR, in which resistance is effectively contained and controlled. The NAP focusses on three key ways of tackling AMR: 1) reducing the need for, and unintentional exposure to, antimicrobials; 20 optimising use of antimicrobials; and 3) investing in innovation, supply and access of antimicrobials.

The aim of the evaluation is to identify the strengths and weaknesses of the way in which central, regional and local public and private sector agencies have pursued achievement of the NAP commitments, and make recommendations for adjustments to implementation of the NAP and development of future Plans. The project is led by the Policy Innovation and Evaluation Research Unit (PIRU), which is based at the London School of Hygiene and Tropical Medicine (LSHTM).

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The proposed evaluation focuses on specific aspects of the NAP and is comprised of the following five linked elements:

  1. Area and sectoral case studies exploring how the NAP is implemented nationally and locally, including the interplay between the two levels of implementation in animal and human health in the UK, focusing on a number of themes of high salience in the NAP
  1. Exploration of implementation of AMR-related data systems in the UK with a focus on progress towards an integrated surveillance system to support adoption of a One Health approach.
  1. Supporting effective implementation of the use of diagnostic tests in the UK through exploring governance arrangements in the development and use of a group of diagnostic tests.
  1. Supporting stewardship of antibiotics through exploration of self-care from a patient perspective, with a focus on management of common infections.
  1. Supporting the management of AMR in the environment through international comparisons of approaches to management of sewerage treatment works to meet environmental objectives and challenges to mitigating AMR. 

Findings of the implementation evaluation will be reported in the context of reported progress against the targets set out in the NAP.


The evaluation will allow to identify the progress that has been made to address the commitments of the NAP. In addition, information will be collected on the challenges faced when addressing these commitments and recommendations on how these could be addressed. This will provide valuable information to decision makers when making adjustments to the NAP or any future development plans.  


Policy Innovation and Evaluation Research Unit (PIRU) based at the London School of Hygiene and Tropical Medicine (LSHTM).

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