Prescribing data

In April 2016, NHS England launched a national programme to reduce inappropriate antibiotic prescribing. The payments form part of 2 schemes that reward excellence and quality improvement in the NHS: the Commissioning for Quality and Innovation (CQUIN) and the Quality Premium scheme. CCG performance against the antimicrobial resistance quality premium is reported monthly via the NHS England Antibiotic quality premium monitoring dashboard. Data from May 2016 showed the total number of antibiotics prescribed by GPs was down by 7.3% in 1 year (a total of 2,696,143 fewer items) and the use of broad-spectrum antibiotics was reduced by 16% (a reduction of over 600,000 items).

For 2016/17, a new CCG improvement and assessment framework was also launched, which includes antimicrobial resistance indicators.

The Advisory Committee on Antimicrobial Resistance and Healthcare Associated Infection (ARHAI), which provides advice to the government on minimising the risk of healthcare associated infections, has agreed antimicrobial prescribing quality measures for primary and secondary care.

Three medicines optimisation key therapeutic topic (MO KTT) prescribing comparators are available to support this key therapeutic topic[1]. These are:

  • Antibacterial items/STAR-PU: the number of prescription items for antibacterial drugs (BNF 5.1) per Oral antibacterials (BNF 5.1 sub-set) ITEM based Specific Therapeutic Group Age-sex weightings Related Prescribing Unit (STAR-PU).

  • Co-amoxiclav, cephalosporins & quinolones % items: the number of prescription items for co-amoxiclav, cephalosporins and quinolones as a percentage of the total number of prescription items for selected antibacterial drugs (BNF 5.1 sub-set).

  • 3 day courses of antibiotics: ADQ/item: the number of average daily quantities (ADQs) per item for trimethoprim 200 mg tablets, nitrofurantoin 50 mg tablets and capsules, nitrofurantoin 100 mg m/r capsules and pivmecillinam 200 mg tablets.

Antibacterial items/STAR-PU

  • Data for 2015/16 (April 2015 to March 2016) show a 2.32 fold variation in prescribing rates at Clinical Commissioning Group (CCG) level, from 0.62 to 1.44 items/STAR-PU.

  • Between the 3-month period January to March 2014 and the 3-month period January to March 2016 there was a 5.7% decrease in the comparator value for England (total prescribing) from 0.314 to 0.296 items/STAR-PU.

  • Over the same period there was an 8.18% increase in the variation between CCGs, as measured by the inter-decile range, an absolute increase of 0.007 items/STAR-PU. The inter-decile range is the difference between the highest and lowest values after the highest and lowest 10% of values have been removed.

Co-amoxiclav, cephalosporins & quinolones % items

  • Data for 2015/16 (April 2015 to March 2016) show a 3.4 fold variation in prescribing rates at CCG level, from 4.07% to 14.02%.

  • Between the 3-month period January to March 2014 and the 3-month period January to March 2016 there was a 19.9% decrease in the comparator value for England (total prescribing) from 10.6% to 8.5%.

  • Over the same period there was a 32.9% decrease in the variation between CCGs, as measured by the inter-decile range, an absolute decrease of 2.41%. The inter-decile range is the difference between the highest and lowest values after the highest and lowest 10% of values have been removed.

3 day courses of antibiotics: ADQ/item

  • Data for the 3-month period July to September 2016 show a 1.6 fold variation in prescribing rates at CCG level, from 4.87 to 7.65 ADQ/item.

  • Between the 3-month period October to December 2013 and the 3-month period July to September 2016 there was a 6.7% decrease in the comparator value for England (total prescribing) from 6.15 to 5.74 ADQ/item.

  • Over the same period there was a 15.0% increase in the variation between CCGs, as measured by the inter-decile range, an absolute increase of 0.15 ADQ/item. The inter-decile range is the difference between the highest and lowest values after the highest and lowest 10% of values have been removed.

The Medicines optimisation dashboard, which brings together a range of medicines-related metrics from across sectors, includes the first 2 prescribing comparators outlined above. The medicines optimisation dashboard helps NHS organisations to understand how well their local populations are being supported to optimise medicines use and inform local planning. The dashboard allows NHS organisations to highlight variation in local practice and provoke discussion on the appropriateness of local care. It is not intended as a performance measurement tool and there are no targets.



[1] The comparator and associated data presented here are based on the previous Key therapeutic topics publication (February 2016). Data provided by NHS Digital (October 2016; source: Information Services Portal, Business Services Authority). For details of any update to the comparators refer to the NHS Digital website and the Information Services Portal, Business Services Authority.