Latest news and views from around the Bennett Institute
Today we’ve released our new Drug Tariff viewer. It was a dataset that we previously didn’t hold, but thought that it would be useful to turn into a graphical viewer for people to use to see how the reimbursement price on drugs changes over time, and also to use as the basis of the effect that price concessions are having on the NHS.
However, obtaining and normalising the data proved to be a bit of a challenge.
The Drug Tariff, published on behalf of the Department of Health and updated monthly, is a strange and mysterious document, written largely in legalese, and understood by pharmacists and almost no-one else. Ask a GP where they find out the cost of the drug, and they’ll say either their computer system or the BNF. For pharmacists, it’s usually the Drug Tariff (or the Tariff). And that’s usually where the most accurate price will be found.
There has been an interesting and concerning story in The Times today regarding shortages on a number of commonly-used medicines and a corresponding increase in the costs.
Here at OpenPrescribing we have been taking a look at these data as well, and trying to estimate to the cost to the NHS this year.
As the Times article suggested, the excess costs are now hitting £50m per month, with £175m extra spent in primary care by September:
One of the most common requests we receive is to be able to use the analyse page without needing to select a denominator, so that you can simply see how much of a drug is being prescribed in each CCG or practice. We’ve now made this feature available. When creating an analysis, simply select “nothing” in the versus dropdown, and you can then see raw monthly data for each practice or CCG.
We have created a new interactive tool for exploring the national Prescribing Cost Analysis (PCA) data, allowing you to investigate prescribing trends over 19 years from 1998 to 2016.
We’ve done a huge amount of hard work to make this tool simple and easy. For example, lots of drug names have changed over time, treatments have moved between Chapters of the BNF, or been assigned new codes. We have “normalised” the data (by hand!) to take account of all this, so we can show each drug according to its current position in the latest BNF dictionary. We have also taken account of changes in national population, and even corrected all prescribing costs to 2016 pounds sterling!
We have created a new interactive tool for exploring the national Prescribing Cost Analysis (PCA) data, allowing you to investigate prescribing trends going back to 1998. The PCA data contains annual data on all drugs dispensed in the community in England. Note this makes it slightly different to the monthly dataset used elsewhere on OpenPrescribing which shows how items were prescribed in England. This means that, for example, in PCA data generic products will not appear until the generic is available to be dispensed, and prescriptions written in Wales will be included provided they were dispensed in England.
We send out monthly newsletters for OpenPrescribing, detailing new features and updates, which you can sign up for here. Our latest issue is below:
NHS England recently launched a consultation on new prescribing guidelines, which lists treatments that should generally no longer be prescribed. We have launched a new tool that allows you to explore the prescribing of these ’low value’ items in any GP Practice or CCG in England.
We were at Oxford University’s Curiosity Carnival, an event featuring researchers from all disciplines enthusiastically explaining their work to members of the public in an enormous variety of forms, all around the city.
We entered the Great Research Bake-Off and took on the challenge of representing some of the key issues around research integrity through the medium of cake.
We displayed an array of fairy cakes, each representing clinical trials. To produce a good cake, or trial, a good methodology is fundamental. And, of course, the results should be published in a paper (the icing on top); the outcome pre-specified (the colour of the case), and the same outcome reported (same colour flag). A plus or minus on top indicated a positive or negative result. However, only a small number of our cakes looked this good!
Today we launch another exciting new feature on OpenPrescribing. NHS England recently shared a list of 19 classes of treatment which they think should not be prescribed by GPs. These treatments were advised against on the grounds that they are ineffective, and therefore wasteful, or at least “low priority”.
We think it’s good for everyone to be able to see what GP practices are prescribing: the GPs themselves, but also patients, journalists, commissioners of health services, the public, medicines optimisation teams, and indeed anyone who is interested in exploring and improving healthcare.
Today we launch another new feature on OpenPrescribing. As you will probably know, we have various standard prescribing measures which show how a practice or CCG is prescribing in comparison with their peers. These are presented as percentages or rates, and often the maths is very simple: what is the proportion of “undesirable drug” divided by “all drugs in that class”. But sometimes there are lots of drugs in the “numerator”, the top half of the equation. For these measures, if a practice is doing badly, we wanted it to be easy for everyone to see exactly which drugs are contributing to that score.
At OpenPrescribing, we provide tools for analysing prescribing behaviour in primary care in the NHS in England. If you work with prescribing data, you may have noticed that practices which are “dormant” apparently continue to prescribe. This short article explains why, for the curious.
Our prescribing data comes from the NHS Business Services Authority (NHSBSA), who are responsible for processing dispensing information supplied by pharmacies. Each line of the data includes a practice code which uniquely identifies the GP Practice that issued the prescription. To understand more about each practice (including its contact details, location, and CCG membership), we cross-reference this code with GP Practice data published by NHS Digital. That data contains a column, status, which sometimes contains the value D, for dormant.
Today we are launching something very exciting: a new tool that identifies over £100m in new prescribing cost savings for the NHS. The average practice can save £50,166 a year by using our tool. These are vastly bigger savings than any other current advice such as “always prescribe generically”. You can use the tool right now, online, for free, at our OpenPrescribing.net service: just look for the “experimental measures” link on any CCG or GP practice page. You can also read our preprint paper describing the extent of the NHS savings, and more detail on the technical background, here; and also our detailed FAQ on various technical matters here.
Recently, we’ve been experimenting with integrating the Dictionary of medicines and devices (dm+d) into our prescribing data. dm+d is the standard dictionary for the medicines and devices used across the NHS, and it contains codes and descriptions for these medicines.
There are several benefits to using dm+d; the most useful side-effect is to allow us to show user-friendly names for drugs. The canonical names for drugs in the NHS prescribing data are sometimes very hard to read. They are taken from the NHS’ own version of the British National Formulary, which uses heavily truncated names, full of abbreviations, so they can fit within an arbitrary 15-character limit.
We’ve recently added the option to download your results from the Analyse searches you complete on OpenPrescribing.
There are now three ways to download data from the site. We do also offer free custom extracts, so if there is anything you are struggling to get from the website yourself send us an e-mail.Update: Due to resource limitations we are no longer able to offer free custom extracts.
If you download and use any data from OpenPrescribing please link back to us or cite us.
OpenPrescribing takes open datasets from NHS Digital and NHS Business Services Authority, and makes it easy for people to explore the prescribing dataset. We also use this dataset in our research, and offer bespoke data extracts from the prescribing dataset for researchers, clinicians and NHS staff (get in touch!). In this series of blog posts we’ll explain key concepts and share our knowledge of the prescribing dataset. In the first blog, we take a look at BNF codes.
Today NHS England announced it is reviewing the prescribing of medicines which it deems to be “ineffective, unnecessary [and] inappropriate for prescription on the NHS”.
We make no comment here on whether it is a good or a bad idea for the NHS to stop prescribing these items. We are keen that everyone in the NHS should use data better, to help understand who is prescribing what, and below we show how you can use OpenPrescribing to investigate the prescribing of these items in your area.
We launched our e-mail alerts on OpenPrescribing to help people keep track of prescribing trends at their GP Practice or CCG. Our alerts send you a monthly e-mail highlighting any new signals in our prescribing measures (including the new measures we launched this month!). This will help you keep track of changes in prescribing, as our alerts can help you find changes that might otherwise be difficult to spot by eye.
You can sign up to receive alerts for any GP Practice or CCG in England by going to the dashboards and entering your e-mail address. We will then send you monthly updates tailored for the practice or CCG you are interested in.
We’ve been spending some time at OpenPrescribing designing a set of new measures to identify interesting variations in prescribing behaviour across the country.
We’ve talked to people from CCGs, and have looked (via Freedom of Information requests) at a number of CCG schemes for improving prescribing, and have come up with a number of areas that we think are important.
Some, like the opioids measure, are important for both cost and clinical reasons. Others, such as the glaucoma measure, show where there is prescribing by brand, which we don’t think is necessary. We also have measures, like generic diltiazem, which show where we think there is prescribing which doesn’t meet national guidance on how they should be prescribed.
