OpenPrescribing Newsletter May 2019

Varied implementation of UTI prescribing guidelines One of our recent papers, published in the Journal of Antimicrobial Chemotherapy, highlighted variability in the speed at which different CCGs switched from prescribing trimethoprim to nitrofurantoin (as recommended by PHE for uncomplicated UTI). It appears that the practices which changed the most were in CCGs that had taken some action to promote the new guidelines, such as a change in formulary. What are the implications?

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How can we improve the management of necessary changes in clinical practice?

Just before Christmas we had a paper published in the Journal of Antimicrobial Chemotherapy. It looked at how GP practices responded to changes to the guidance for antibiotics for urinary tract infections (UTIs). It’s an interesting story in itself, but we think that it prompts some wider questions about how GPs are helped to keep up-to-date on guidance on prescribing. What is the issue? For many years the mainstay of antibiotic treatment of uncomplicated UTIs in women has been trimethoprim.

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All England Alerts : A New Feature on OpenPrescribing

This week we have launched a new email alerting service that covers all of NHS England. Many users of OpenPrescribing already receive our monthly newsletter and our innovative email alert service for practice and CCG prescribing measures and for price concessions. We have now developed this service covering all of England based on user feedback. To sign up, just go to the All England page and enter your email address in the box beside the measures categories (see screenshot below).

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UK Trials and Brexit

We recently noticed a very dramatic drop in the number of UK clinical trials post-Brexit on the EU Clinical Trials Register (which would be a catastrophe for British science) and wrote to MHRA to get their view. It turns out that the drop is largely due to bad data management: this is worrying, but not the same thing as a drop in the number of UK clinical trials. The Short Story We’ve been conducting research on trends in clinical trials globally with one very striking recent finding: examining clinical trials on medicinal products, using the EU Clinical Trials Register (EUCTR), the number of trials with a competent authority decision from the UK has fallen dramatically.

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Communicating variation in prescribing - Why We Use Deciles

On OpenPrescribing.net we provide data for individual practices and CCGs (and now STPs and regions!) making it easier for everyone to explore NHS prescribing patterns in England - supporting safer, more efficient prescribing. However, providing data for an individual location in isolation is rarely useful. We need to provide context, so that some sort of judgement can be made about whether the prescribing in question is especially high or low, and how extreme it is, in comparison with others.

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Openness and Transparency: why is openness and transparency important for good data analysis and how does OpenPrescribing embody it?

At the Bennett Institute we value openness and transparency as we believe open discussion of ideas and methods are the key ingredients for high quality data analysis. We think it is unhelpful that so much NHS data analysis is outsourced, or done behind closed doors. This blog sets out the steps we take with OpenPrescribing.net to ensure all our analysis and methodology is freely available for inspection, review, and importantly re-use, by anyone.

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NHS price concessions cost charities and local authorities an additional £5.6 million last year

In the last year we estimate that price concessions have cost an additional £165 million in unplanned expenditure for Clinical Commissioning Groups (CCGs), and our OpenPrescribing.net price concession calculator was featured in a major BBC news story and in the Pharmaceutical Journal this week. However, interestingly, NHS price concessions do not just affect the NHS: they also represent unplanned expenditure for charities, local councils, and others. Here, we report our estimate of the impact on non-CCG organisations as an additional £5.

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NHS Regional and STP Dashboards — A new Feature on OpenPrescribing

Today we launched NHS regional and STP dashboards on <OpenPrescribing.net>, which allow anyone to see NHS prescribing patterns across areas larger than CCGs. You can find these new dashboards under “Area and Practice Dashboards”. What is an NHS STP or Region? The NHS across England is now organised into Sustainability and Transformation Partnerships (STPs) and NHS England regions. There are 44 STPs made up of NHS organisations such as CCGs and hospital trusts, and local councils, who developed shared proposals to improve health and social care, whilst ensuring services are joined up across all of the organisations they incorporate.

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FDAAA TrialsTracker: Milestones and Methodology Updates

It’s been a busy start to the year for the FDAAA TrialsTracker! As the FDAAA TrialsTracker celebrates its 1 year anniversary, we now show over 1000 trials currently overdue to report under the FDA Amendments Act of 2007 (some background on our tracker and the FDAAA 2007 here). Additionally, we estimate that the FDA could have collected over $2 billion in fines if they were enforcing these requirements. To date, we have no evidence they have issued even a single dollar in fines.

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