The comparators in this dashboard have been developed in response to the National Overprescribing Review (NOR). They relate to the quality of the prescribing system in addressing or avoiding overprescribing.
Specifically, the comparators relate to the aspect of the prescribing process that manages repeat prescriptions. The total quantity of individual prescription products dispensed to patients over time will be the sum of multiple prescriptions for those products. Repeat prescriptions make up around three-quarters of all prescription items.
In the context of overprescribing, the repeats process plays an important role in checking how appropriate the prescribed product is for the patient, as well as the appropriateness of total amount prescribed and dispensed (supply) to the patient over time.
It is desirable that the total amount dispensed to patients over time balances wasted quantities of the product with the administrative burden for prescribers and staff, as well as maintaining the convenience of access to and safe supply of prescribed products for patients.
With the right level of management of the process and patient involvement, wasted quantities could be minimised and risky levels of certain products avoided.
Approach to metric selection
The comparators show quantity dispensed per patient above a threshold quantity. The default threshold is chosen to be what would be clinically appropriate for most patients, accepting that, for some patients, larger quantities may be appropriate.
Prescribers typically do not see the amount that has been dispensed over a given period as they typically authorise prescriptions on a prescription-by-prescription basis. The comparators contribute two pieces of information to prescribers:
- What has been dispensed to the patient, not just what has been prescribed.
- The cumulative quantity dispensed over a 12-month rolling period.
Medicine categories were selected where the medicines included followed a regular dosing schedule with limited variance across all clinical indications. Medicine groups were also influenced by patient safety risks or known areas of oversupply.
Drug lists
The medicine categories are not exhaustive. Only medicines for which a maximum prescribing pattern could be identified were included, and only medicine categories where a high proportion of prescribing was made up of the identifiable pattern medicines are included in the dashboard.
The complete list of medicines included is available in the following spreadsheet:
The drug list also includes the weighting given to each drug. This is the expected dose, so a drug with a weighting of 1 is expected to be taken once daily, a weighting of 2 is taken twice daily and so on.
For Oral Nutritional Supplements and Paediatric Oral Nutritional Supplements, this is based on millilitres per drink, and the threshold is set at the number of drinks, regardless of the volume per drink.
What the comparators show
The comparators show where a patient has received more than the expected quantity (threshold) of a medication in the 12-month rolling period to the month in question. Patients are assigned to a single practice throughout the dashboard. This is their most recent registered practice, regardless of where the prescribing has taken place.
There are filters available to indicate patients who are 75 or older in the month in question. A patient may move from the under 75 to the 75+ group over time.
There are also filters to sort patients by polypharmacy. This is where a patient has received 10 or more distinct chemical substances from BNF chapters 1-10 (excluding chapter 5) in the most recent calendar month of the 12-month rolling period. A patient may move in and out of polypharmacy on different months across the dashboard.
At ICB level, there are different views to show either the number of patients who are considered oversupplied in the previous 12 months, or the quantity of prescribing which is considered oversupplied in the previous 12 months.
There are views available for SICBL and Practice to understand oversupply at these levels.
Purpose
The purpose of the dashboard is to highlight areas of potential patient risk, where patients may be being given more product than is typically recommended within a year. This also highlights areas of potential waste where quantities supplied are unnecessary and not being taken by the patient.
Thresholds have been set to allow some excess quantity due to claim frictions, and should be adaptable to longer prescribing patterns such as 2 or 3-month prescribing patterns. While a quantity more than threshold should be investigated, there may be reasons where these are clinically appropriate.
The dashboard can also be used to evaluate the impact and effectiveness of efforts made to address the oversupply of medications.
How to use these comparators
We see these comparators being used by GP practices as well as local ICBs, alongside relevant and appropriate education and training support that is in place.
Clinical pharmacists working with GP practices will play an important role in supporting GP practices to identify and address specific patients who are deemed at risk of harm from oversupply of medication and who require a review of prescribing as a priority.
Accessing the dashboard
If you’re registered for ePACT2, you can access the oversupply dashboard via ePACT2.
Contact us
Our contact email address for all enquiries is DataServicesSupport@nhsbsa.nhs.uk
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