Before Christmas we wrote a nerdy story about Ghost Branded Generics, a problem that costs the NHS £11.6m a year due to prescribers selecting specific manufacturer’s products rather than true generics. This is largely avoidable. Today we launch our Ghost Branded Generics dashboard for every practice and CCG in the country. This can be accessed through every dashboard page (example below) and we think it will be useful to help people change prescriptions from Ghost Branded Generics to true generic prescriptions.
This a very nerdy story about a problem that costs the NHS £11.6m a year. It shows how one small design choice in the software GPs use can have huge ramifications for how we prescribe, and a huge cost impact on the NHS. More than that, it shows how problems like these can only be spotted, and addressed, by mixed teams like ours — doctors, pharmacists, researchers and software engineers — pooling our different skills to build tools and papers.
Each year, we estimate there are up to £5m of Out of Pocket Expenses (OOPE) expenses charged to the NHS, added by dispensing contractors to their invoices. Could some of these expenses be reduced? In 2014/15 NHS Islington CCG wrote to dispensing contractors highlighting such expenses, and from this single intervention achieved a 50% reduction; spread across the country this could amount to a saving of £2.5m.
We’ve done some initial investigations, but don’t have resources to follow up in detail. This post is to note what we’ve found so far. If you are interested in finding out more, and have access to funding, let us know!
In our third full year of existence we produced even more exciting outputs and continued to grow. We welcomed Lydia Berry, back from maternity leave; Dave Evans, Consultant Programmer, who joined the OpenPrescribing technical team; and Brian MacKenna, an Honorary Research Fellow Pharmacist and member of the NHS England Medicines and Diagnostics Policy Unit. We also welcomed Darren Smyth, a UK and European Patent Attorney - our work so far includes our pregabalin papers (here and here), and he has also contributed to our EUCTR work.
Earlier this week, the Media, Freedom & Information Access Clinic at Yale Law School filed a lawsuit against the heads of the Department of Health and Human Services, the NIH, and the FDA over their interpretation and implementation of trial reporting provisions in the FDA Amendments Act of 2007 (FDAAA 2007). The lawsuit was filed on behalf of Charles Seife, a journalist and NYU professor, and Dr. Peter Lurie, President of the Center for Science in the Public Interest.
New “do not prescribe” measures on OpenPrescribing.net
At OpenPrescribing we pride ourselves on developing our tools in response to the needs of our users. Last week NHS England announced a new “Do Not Prescribe” list for consultation.
Within an hour we made graphs showing every GP practice’s prescribing of these items. You can drill down to CCG level, and then practice level.
We hope that this data will be useful for clinicians and CCG pharmacists to identify where there is most room for improvement, or change. Or, to drive discussion about agreement on the guidance.
This week we launched a new feature on OpenPrescribing, an NHS Price Concession calculator. We show the cost impact of price concessions for the whole of England here and the calculator appears on every single practice and CCG dashboard so you can work out the impact locally.
What are price concessions and what are the broader issues?
Price concessions are a short term agreement by the NHS to pay more than the already agreed price for a generic medicine because pharmacists are unable to obtain the generic at its usual price. Regular readers of our blog will remember a series of blogs last year (see archive) where we detailed the issues and this led to the development of our magnificent Drug Tariff and Concession Viewer, which shows the prices over time for each individual drug, automatically updated on a daily basis.
Within an hour we made graphs showing every GP practice’s prescribing of these items. You can drill down to CCG level, and then practice level.
We hope that this data will be useful for clinicians and CCG pharmacists to identify where there is most room for improvement, or change. Or, to drive discussion about agreement on the guidance.
The data that drives OpenPrescribing is described briefly in our FAQ. It is supplied by NHSBSA and NHS Digital, and a few other sources.
Over the years we have come to understand the limitations of this data. We’re sharing them here, so researchers can take them into account when carrying out analyses.
The data relates to primary care prescribing only. Secondary care prescribing is not included. In many cases however, ongoing care is largely managed in primary care, so meaningful analyses are still possible
The data originates from reimbursement claims from dispensing contractors (such as pharmacies), and therefore does not include prescriptions which are issued but never dispensed
As the data is from reimbursement claims, items are recorded for the month in which their costs were claimed by the contractor, which may be several months after they were prescribed (blog)
As the data is captured for reimbursement use, there is no way of knowing the indication of the prescription for patients
The data is for items which were prescribed by practices in England and dispensed in the UK
The data is aggregated to practice level. No data is released for tracking at a patient or GP level
The data only describes what was on the prescription form, not what was actually dispensed. For example, items which were prescribed generically may be dispensed as brands.
The quantity field is occasionally expressed inconsistently (e.g. sometimes doses, sometimes packs) (notes)
Item figures do not provide any indication of the length of treatment or quantity of medicine prescribed. Patients with a long term condition usually get regular prescriptions. While many prescriptions are for one month (28 or 30 days supply), items will be for varying length of treatment and quantity
BNF codes change over time. We have attempted to account for this (notes)
It can be important to know whether an institution is a standard GP practice, or a different kind of institution (for example, a homeless service, or a drop-in centre). However, in the data provided, there is a small but significant number of obvious errors in coding, such as classification of Care Homes and Violent Patient Services as standard settings, and arbitrary numbers given where the list size is less than 100 or unknown (notes)
Some CCGs have “rebates” agreed with pharmaceutical companies, and therefore the net cost will be less. This is not reflected in the prescribing data, as it is a separate income stream to the organisation
Closures and mergers are not tracked. Therefore it can be difficult to know where patients have gone when a practice is closed, particularly if there is not a single merger. If analysing at a CCG level it is usually safe to assume the majority of patients remain within the same CCG, though this is not always the case
CCGs and practices therein change over time; to project back in time consistently, we show current CCGs and the practices they currently contain (rather than the CCG they were in at the time)
All England Dashboard - A New Feature on OpenPrescribing.net
At OpenPrescribing we pride ourselves on developing our tools in response to the needs of our users. OpenPrescribing is being increasingly used at national organisations and we have had many requests for an All England dashboard. This month we launched the first version of the All England dashboard and blogged about it here.
Phenytoin Supply Disruption Alert
At the Bennett Institute we get many emails about how people are using OpenPrescribing and this month we blogged about how OpenPrescribing can be helpful when medicines are in short supply. Epanutin (phenytoin) 30mg/5ml oral suspension is currently subject to a Supply Disruption Alert and it is very important that patients are identified promptly and their prescriptions are modified if appropriate. To read more about the alert and how OpenPrescribing can be helpful please see the blog here. If you have any other interesting usecases please get in touch at feedback@openprescribing.net
Drug supply issues are an interesting use-case for OpenPrescribing. Here we will talk about a recent example.
What is the problem?
Last week the Department of Health and Social Care issued a “Supply Disruption Alert” for Epanutin (phenytoin) 30mg/5ml oral suspension: Pfizer, the manufacturer, will be out of stock of this product from the week commencing 29th October (today) until early December 2018. This means people currently taking Epanutin (phenytoin) 30mg/5ml oral suspension may need to be prescribed a different product.
This week we have launched a new page on OpenPrescribing.net, the All England dashboard, that allows anyone to see the quality of prescribing at a national level. For the first time we have aggregated all the savings from all our measures in one place. For the month of August these numbers are quite staggering:
£13,190,000 - could potentially have been saved if CCGs used our innovative price-per-unit tool (you can read our methods paper here).
The EU TrialsTracker, which provides the results reporting status of every trial on the EU Clinical Trials Registry, launched last week alongside a paper in the BMJ. We already shared some of the media coverage from the launch of the tracker and comments from Norman Lamb MP, Chair of the House of Commons Science and Technology Committee and Fergus Sweeney, Head of Inspections, Human Medicines Pharmacovigilance and Committees at EMA.
Today we wanted to share a statement, released on Friday, from the Institute for Quality and Efficiency in Health Care (IQWiG) in Germany. For those that are not familiar, IQWiG is the German institute responsible for assessing the quality and efficiency of medical interventions, similar to the role NICE plays in the UK. We were pleased to see a government institute calling explicitly for better results reporting from publicly-funded institutions. IQWiG offers frank experiences from their own work in which withheld data compromised their ability to properly assess the evidence for treatments under review. The director of IQWiG, Jürgen Windeler, specifically calls for a system that checks “whether an applicant has completely reported its previously funded project in the EU Register and, if applicable, refuse further funding.”
Earlier this year we launched our FDAAA TrialsTracker, providing a live look at whether individual sponsors and trialists are meeting their responsibility to report the results of clinical trials on ClinicalTrials.gov. Now we have launched the EU TrialsTracker. This new tracker shows the results status for every trial on the EU Clinical Trials Registry (EUCTR). We are launching the tracker alongside a paper in the BMJ providing a detailed overview of our methods, an analysis of the factors associated with non-reporting and a discussion of the data issues that make assessing compliance difficult on EUCTR.
Our FDAAA TrialsTracker has been updating each working day since February showing which trials on ClinicalTrials.gov have reported, in compliance with the FDA Amendments Act of 2007. Our newly launched EU TrialsTracker and paper in the BMJ show exactly which trials on the EUCTR have reported according to EU guidelines.
This article in Quartz, by Jane C Hu, reports on our BMJ paper assessing compliance with requirement to report results on the EU Clinical Trials Register and the associated EU TrialsTracker.
Last week, a pharmacist from NHS North Cumbria CCG got our attention by mentioning OpenPrescribing on Twitter. He had just received a letter about a product for treating haemorrhoids called Uniroid. It’s a 50/50 mixture of Cinchocaine and Hydrocortisone, and is also available as Proctosedyl (made by Sanofi), and as a generic (i.e. unbranded) product.
The maker of Uniroid wants North Cumbria to start prescribing Uniroid-branded products, on the grounds it will save the CCG about £11,000 per year.
