Shared learning database

Department of Medicines Management, School of Pharmacy, Keele University
Published date:
July 2012

For the past two years, the Department of Medicines Management, Keele University, has produced this compendium as part of the Prescribing Support Service commissioned by West Midlands NHS organisations.

Produced primarily as a reference for West Midlands medicines management teams, but also of interest to commissioners and prescribers, the publication presents comparative prescribing and healthcare data related to the key medicines management topics identified by the National Prescribing Centre (NPC) as having significant potential for making a contribution to the challenge posed by QIPP (Quality, Innovation, Productivity and Prevention).

The document also contains summaries of important evidence and guidance to support the delivery of QIPP in these areas.

Guidance the shared learning relates to:
Does the example relate to a general implementation of all NICE guidance?
Does the example relate to a specific implementation of a specific piece of NICE guidance?


Aims and objectives

Our aim was to produce a compendium of information to provide West Midlands medicines management teams with a comprehensive overview of local activity relating to the NPC's QIPP topics.

Whereas Keele's focus had largely previously been on the analysis of primary care prescribing data, it was felt that a much broader overview was needed, which included not only comparisons of medicines use, but also other healthcare data, such as information on admissions and local prevalence data, and to provide a preliminary insight into prescribing across the primary and secondary care interface.

We also wanted to produce a document that captured key messages alongside the data, such as recommendations from NICE, discussions on the evidence-base for treatments, new safety signals and to highlight possible future financial impact due to patent expiries or entry of new treatments. The team at Keele (data analysts, pharmacists, medical writers and clinical advisors) worked collaboratively to consider the sources of data that were relevant to the NPC QIPP topics and how it could be best presented.

In the face of emerging NHS organisations, for the second version of the document discussions also took place around grouping of the data. To access the data-sets used in the document, relevant permissions were sought, and the data downloaded onto secure servers at Keele.

Reasons for implementing your project

The QIPP programme, a national Department of Health strategy involving all NHS staff, patients, clinicians and the voluntary sector, aims to improve the quality and delivery of NHS care while reducing costs to make £20bn efficiency savings by 2014/15.

In July-10, the NPC published its first list of QIPP topics relating to medicines use that could offer opportunities for maintaining or improving quality and enhancing value for money. At that time, medicines management teams in the West Midlands were already actively promoting high-quality, cost-effective prescribing in these areas, and had for some time received benchmarked, comparative primary care prescribing data from Keele. Publication of the NPC's 'QIPP list' provided Keele with a clear rationale to continue focussing on these areas of prescribing. We however identified a need to start to provide our stakeholders with a more comprehensive overview of local activity in these areas, which considered not only primary care prescribing data but presented associated healthcare data.

How did you implement the project

Production of the document was split between two data analysts and three medical writers, who worked intermittently on the project over a period of around three months. Medics and secondary care pharmacists were also consulted on specific matters.

Medline, EmBase, the Cochrane library, the NICE website, the NPC Website and the MHRA website were searched for relevant systematic reviews, randomised controlled trials, guidance and safety data. UKMi was consulted for patent expiry dates, to help identify future savings.

Data sources accessed for the project included:
-primary care prescribing data (accessed via ePACT)
-quality and outcomes framework (QOF) prevalence
-hospital episode statistics (HES)
-data on hospital medicines use (provided by IMS Health)
-Clostridium difficile and MRSA reported rates (taken from the HPA website)

Depending on data availability, each data source was analysed at PCT, Hospital Trust, Cluster, SHA and national level. The report was created in Microsoft Access, allowing each PCT to receive their individualised data, where appropriate, benchmarked against other organisations.
(N.B. an anonymised sample report has been provided in this submission)

Key findings

Drawing comparisons with other reports such as the NHS Atlas of Variation, Keele's 'Prescribing information to support QIPP' is intended as a reference to help support medicines management teams to efficiently benchmark their prescribing and outcomes, identify variation and take action as deemed appropriate for the local healthcare economy. Anecdotal feedback suggests the report has been welcomed and more detailed evaluations are planned for future versions.

In relation to prescribing activity, the latest report shows improvements over the past year (at the SHA-level) in the following areas of QIPP related to medicines use:
-low-cost statin prescribing
-prescribing of ACE inhibitors
-cephalosporin/quinolone prescribing rates
-long-acting insulins
-ibuprofen/naproxen prescribing rates
-cost of self-monitoring of blood glucose
-low-cost PPIs
-generic clopidogrel prescribing
-generic alendronate prescribing

In relation to prescribing in primary care, the planned QIPP saving for 2011/12 for the West Midlands was £19,428,000. The final saving declared was £28,117,000.

Key learning points

There is a clear need for NHS organisations to have access to high-quality healthcare data and in recent times there has been a significant effort to widen access to such information. However, accessing and configuring multiple datasets that are necessary to give a broader overview of local activity can be a time-consuming and costly process for individual organisations. There is also the potential for significant duplication of effort. In our view, 'Prescribing information to support QIPP' is an efficient conduit for disseminating information concerning QIPP related to medicines use to a large number of organisations.

In relation to pointers for other organisations, we suggest the following:
1) Select appropriate reporting solutions: in this case Microsoft Access was used to help minimise cost and increase speed of publication for multiple organisations with similar data requirements.
2) Review information design: As more data becomes available, it will become increasing important for analysts to consider ways to configure and present the data to meet the needs of emerging organisations.

Contact details

Professor Stephen Chapman
Professor of Prescribing Studies/ Head of School of Pharmacy
Department of Medicines Management, School of Pharmacy, Keele University

Is the example industry-sponsored in any way?