Prescribing measures, indicators and comparators
The HSCIC and NHS BSA are working to introduce new patient weightings to support national and local monitoring of prescribing.
These have not been fully implemented, but this work will be completed shortly. (See below, under 'Patient denominators (updated March 2014)'.
Traditionally, prescribing has been measured using the number of items prescribed and the cost of these drugs. This is used to compare drug utilisation between NHS organisations and practices, and to look at historic trends. Data on the patient list size for each practice is also available and allows three ratios of prescribing to be commonly used:
- items per patient
- cost per patient
- cost per item
Additional measures of volume (rather than the number of items) and patient denominators (weighted to take account of the differing needs of patients) have been developed. These are used in reports and information systems produced by NHS Prescription Services.
These measures can be used to develop indicators and comparators that help organisations to monitor prescribing and compare themselves with other organisations.
How do I use the prescribing measures?
This booklet outlines which measures are available, and how these measures can be used to produce prescribing performance indicators. These indicators are important for the continued performance and financial management of the drugs bill.
An online learning tool, based on the booklet and recorded in March 2012, is available via the National Prescribing Centre (NPC) legacy website.
Note that the NPC is now a part of the National Institute for Health and Clinical Excellence (NICE), known as the Medicines and Prescribing Centre.
Prescribing indicators and comparators show how organisations including Clinical Commissioning Groups (from 2013/14), Primary Care Trusts (up to 2012/13) and GP practices compare with other organisations and national averages. Indicators and comparators, including QIPP prescribing comparators, are available on the Information Services Portal, hosted by the NHS Business Services Authority.
The guidance is currently being updated and will be available shortly.
Who can access the data?
Only Clinical Commissioning Groups, Hospital Trusts, Local Area Teams and other NHS or public sector organisations that have a valid reason to access the data can register for the Information Services Portal. A limited view of the prescribing data is available to other users, including the public, via a guest log in.
How do I access the data?
Go to the Information Services Portal (external)
A set of prescribing comparators, available since March 2011, support the Key Therapeutic Topics - Medicines management options for local implementation produced by the Medicines and Prescribing Centre, NICE. Both the Key Therapeutic Topics and the comparators originally supported the Department of Health's Quality Innovation Productivity and Prevention (QIPP) medicines and procurement medicines work stream. They now support NHS England's Medicines Optimisation Measurement work stream and have been renamed Medicines Optimisation Key Therapeutic Topic (KTT) Comparators.
August 2015 : Descriptions and Specifications for 2015-16 Comparators
The current (2015-16) Medicines Optimisation Key Therapeutic Topics Comparators are detailed in the following document [485kb].
Changes were made in May 2015 to the comparators following feedback received in February and March 2015 on proposals for retaining, revising or retiring the 17 2014-15 QIPP prescribing comparators and introducing new comparators (see below)
Feedback on proposals for retaining, amending or retiring the 2014-2015 QIPP comparators and introducing new comparators
Following the publication of the update to the Key Therapeutic Topics - Medicines management options for local implementation (15th January 2015), feedback was invited on proposals for retaining, revising or retiring the 17 current (2014/15) QIPP prescribing comparators and introducing new comparators. The proposals were outlined in the following QIPP Prescribing Comparators document [307kb]. NB: Invitation for feedback period is now closed.
The feedback received is detailed in this 'Feedback on proposals' [3Mb] document.
August 2014: Feedback on the proposals for retaining, amending or retiring the 2013-14 QIPP prescribing comparators are detailed in the following document [709kb].
December 2013: Descriptions and specifications for the 2013-14 (and 2014-15) QIPP comparators are detailed in the followingdocument [490kb]
Average Daily Quantity (ADQ)
This a measure of prescribing volume based on prescribing behaviour in England. It represents the assumed average maintenance dose per day for a drug used for its main indication in adults. The ADQ is not a recommended dose but an analytical unit to compare prescribing activity.
Patient denominators are intended to allow more meaningful comparisons of data over time and across organisations, by taking into account the numbers and specific characteristics of patients in an area or therapeutic treatment group.
ASTRO-PU and STAR-PU weightings have been updated to reflect current prescribing practice, based on prescribing patterns in primary care in England in 2013. These were made available and introduced into national prescribing data sets in February 2014.
Note: for some high volume medicines, the patents have expired and cheaper generic alternative formulations are available. This leads to lower cost based weightings in 2013 than in 2009.
ASTRO-PU stands for Age, Sex and Temporary Resident Originated Prescribing Units. This weighting is designed to weight individual practice or organisation populations for age and sex to allow for better comparison of prescribing patterns. These figures are based on the cost or volume of prescribing across all therapeutic areas, and these weightings should be used only when considering all prescribing. The number of temporary residents attending practices is no longer captured or included in funding allocations.
The cost based weightings are standardised (based on a male child under 4 years being 1) as they are used in national resource allocation formulae. The item based weightings are not standardised, as this more clearly shows relative use across different demographic groups.
There are differences in the age and sex profiles of patients who are prescribed drugs in specific therapeutic groups. For example: drugs for dementia are generally prescribed for older people. STAR-PUs (Specific Therapeutic Group Age-sex weightings Related Prescribing Units) allow more accurate and meaningful comparisons within a specific therapeutic group by taking into account the types of people who will be receiving that treatment. These have been developed using the same methodology as used for ASTRO-PUs but are based on costs within therapeutic groups rather than all prescribing. The STAR-PU weightings for anti-bacterials are item based, as this is more appropriate for such prescribing. These weightings should be used only for the specific therapeutic area. Note: ADQ based weightings have been introduced for hypnotics and antidepressants.
For further information about recent changes to patient weightings please see the following Prescribing Units 2013 Briefing [179kb].