Identifying the GP practices prescribing “low priority” treatments | University of Oxford

Identifying the GP practices prescribing “low priority” treatments

2 October 2017

A new tool by Oxford University researchers launching today on OpenPrescribing.net identifies which individual GP practices are prescribing a range of ineffective and wasteful treatments that NHS England are spotlighting.

The 19 prescription items considered as “low priority” for NHS funding are the subject of a national consultation on new commissioning guidance, and were selected based on lack of evidence of their clinical effectiveness, concerns for their safety, or cost-effectiveness grounds.

OpenPrescribing.net is the first website of its kind to enable health professionals, patients and the public to easily explore patterns of prescribing nationally, in CCGs and by individual GP practices. It is supported with funding from the NIHR Oxford Biomedical Research Centre and the NIHR School of Primary Care Research

The initiative has been developed by Dr Ben Goldacre and colleagues in the EBM DataLab at Oxford University’s Nuffield Department of Primary Care Health Sciences. It turns publicly-available raw data on every prescribed drug in the NHS into easy-to-read graphs, dashboards and maps, in a way that is clear and accessible to everyone.

Through their new tool, developed in response to the NHS consultation, Dr Goldacre’s team provide specific data and graphs on prescription activity for each of the 19 treatments advised against by NHS England, at each individual GP practice in the country. An accompanying report shows total spend and trends over time.

“We think it’s good for everyone to be able to see what GP practices are prescribing,” said Dr Goldacre. “This helps GPs and the NHS know where they stand, and where there may be room for review. But it’s also valuable for patients, journalists, commissioners of health services and the public. It gives everyone the power to scrutinise prescribing at their own GP practice and explore how they’re responding to changes in clinical evidence - and price - given the finite resources available to the NHS.”

Included in the NHS England list of low-priority items is co-proxamol, which is prescribed as a pain killer. This treatment was withdrawn from general use in 2005 following concerns about its safety and lack of additional benefit when compared with paracetamol. However it continues to be prescribed, and since withdrawal its price has risen significantly, from £1.50 per pack in 2005 to £115 per pack today. Prescriptions for co-proxamol cost the NHS in England more than £7.6 million over the past year.

Also included is homeopathy, a treatment with no evidence base for its effectiveness except as a placebo, according to a 2010 report by the House of Commons Science and Technology Committee. While the report recommends that routine prescription of homeopathy by the NHS “should not continue”, over the past year homeopathy has been prescribed at least once by over 700 GP practices.

“Overall there may be good reasons for individual patients to receive some of these treatments, but in many cases where we have identified outliers there will be room for improvement. Easily accessible data is the key to improving quality. Each of the 19 treatments termed ‘low priority’ by NHS England represent possible waste in our health service, due to either a lack of good-quality evidence for their safety and effectiveness, or because there’s a cheaper alternative,” said Dr Goldacre.

OpenPrescribing.net takes the raw datasets on GP practice prescribing from NHS Digital and processes them into a user-friendly dashboard tool. This data is updated monthly and has been in the public domain under an Open Government License since 2010. The OpenPrescribing website is very widely used, with over 50,000 users and 250,000 analysis pages served over the past year.

NOTES TO EDITORS:

The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

For comment, contact Dr Ben Goldacre, Senior Clinical Research Fellow, University of Oxford ben.goldacre@phc.ox.ac.uk 

Information on the NHS Consultation:

“Items which should not be routinely prescribed in primary care: A Consultation on guidance for CCGs.” Opened 21 July 2017, Closes 21 October 2017.
https://www.engage.england.nhs.uk/consultation/items-routinely-prescribed/

About OpenPrescribing.net:

Data on each of the 19 “low priority” treatments can be found on the link below. By viewing an individual CCG’s page, users can then access prescribing data at individual practices within that CCG: https://openprescribing.net/measure/lpzomnibus

A report detailing time trends and more can be viewed here:

https://ebmdatalab.net/wp-content/uploads/2017/09/NHS-19-variation.pdf 

Figure 1: GPs across the country spend £1.7m on a combination preparation containing paracetamol and tramadol, regarded by NHS England as low value with equally effective alternative options that are cheaper. The expensive combined product is only used in a small number of practices. 

OpenPrescribing.net is one of a range of projects built by the EBM DataLab to help make complex medical and scientific data more accessible and more impactful in the real world. Other projects include trackers for unreported clinical trials, misreported clinical trials, transparency policies and conflicts of interest. The DataLab is an innovative collaboration of clinicians, academics, and software engineers working together. The academic lead is Dr Ben Goldacre from the Centre for Evidence-Based Medicine in the Nuffield Department of Primary Care Health Sciences at the University of Oxford. 

OpenPrescribing is funded by the NIHR Oxford Biomedical Research Centre and the NIHR School of Primary Care Research. Any drug can be explored, while pre-built practice and CCG dashboards show prescribing data on prespecified prescribing measures. The website also shows national prescribing trends for all drugs in the BNF, and chemicals by their name or code, which can also be analysed by CCG or practice. This accessible and open data analysis tool is freely accessible to all users, and had over 250,000 page views in the past year.

Oxford University’s Medical Sciences Division is one of the largest biomedical research centres in Europe, with over 2,500 people involved in research and more than 2,800 students. The University is rated the best in the world for medicine and life sciences, and it is home to the UK’s top-ranked medical school. It has one of the largest clinical trial portfolios in the UK and great expertise in taking discoveries from the lab into the clinic. Partnerships with the local NHS Trusts enable patients to benefit from close links between medical research and healthcare delivery. 

Within the division, the Nuffield Department of Primary Care Health Sciences undertakes internationally acclaimed teaching and research that improves the primary care that GP practices deliver, and is ranked top in the UK. The department’s research covers a broad range of primary care issues including cardiovascular and metabolic disease, health behaviours, infectious disease and child health, patient experience, research methods and evidence-based medicine. www.nihr.ac.uk

The National Institute for Health Research (NIHR): improving the health and wealth of the nation through research. Established by the Department of Health, the NIHR:

  • funds high quality research to improve health
  • trains and supports health researchers
  • provides world-class research facilities
  • works with the life sciences industry and charities to benefit all
  • involves patients and the public at every step

For further information, visit the NIHR website www.nihr.ac.uk