Identifying the GP practices prescribing “low priority” treatments

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 This treatment was withdrawn from general use in 2005 following concerns about its safety and lack of additional benefit when compared with paracetamol.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.