NHSBSA Medicines Data Information System Specification

This specification:

• introduces the Medicines Data Programme;
• outlines the need to flow data about medicines dispensed or supplied, as held by NHS Business Services Authority (NHSBSA) into NHS Digital and the benefits expected; and
• describes how data will be collected, processed and disseminated

The Medicines Data programme has been commissioned by NHS England as part of the Digital Transformation Portfolio to provide better data about medicines. It is part of NHS Digital’s Product Development Directorate. 

The programme will provide good quality medicines data and is crucial to the delivery of;

• NHS Long Term Plan
• Next Steps on the Five Year Forward View
• Antimicrobial Resistance (AMR) Strategy
• Life Sciences Industrial Strategy
• World Health Organisation’s 2017 3rd global challenge, ‘Medication without Harm’

Through monthly collections the project will establish a set of data about medicines dispensed or supplied, as held by NHSBSA to allow:

1. Analysis and linking of this data to other datasets by NHS Digital to provide richer information and improve intelligence about medicines safety, effectiveness and outcomes. This includes replacing the tactical Medications Safety Dashboard, developed for the Secretary of State, with permanent infrastructure that will allow for maintenance and development. 

2. Data to be made available to a range of organisations for secondary uses such as to inform and support prescribing behaviour, decision making and research. This will include making the data available through the NHS Digital Data Access Request Service (DARS) and enhancing existing and developing new publications. Currently the NHSBSA cannot meet the growing number of requests for data and information.

The project will ensure the availability of a full set of data about medicines dispensed or supplied, as held by NHSBA.   This data will be linked to other datasets to provide richer information and improve intelligence about medicines safety, effectiveness and outcomes.  It will be made available through the NHS Digital Data Access Request Service (DARS) to a range of authorised organisations for secondary uses such as to inform and support prescribing behaviour, decision making and research. 

There is genuine and significant demand for this data from a range of organisations including NHS Digital, NHS England, NHS Improvement, the National Institute for Health and Care Excellence, Clinical Commissioning Groups and Trusts, the Department of Health and Social Care, research bodies, charities and other health organisations.  These organisations are currently represented through a Medicines Data Advisory Group.     

As the data is not currently available it has been difficult for these organisations to identify the benefits they expect to realise by using it.  Quality benefits have been identified and are summarised below.  No monetised benefits have been identified at this stage.  

The existing Medicines Safety Dashboard which links limited dispensing and hospital episode data has identified monetised benefits as a result of de-prescribing of medication and avoided hospital stays.  It is reasonable to assume that the continued development of indicators will result in additional new monetised and qualitative benefits. 

It is also expected that benefits will emerge in the following areas of work:  

• improved intelligence on the uptake of new innovative medicines
• support for pharmacovigilance (the collection, detection, assessment and monitoring) of medicine safety (serious and severe ADRs)
• linkage to future secondary care patient level medicines data to allow measurement of medicine use across patient journeys
• impact of admission on polypharmacy (the concurrent use of multiple medications by a patient) and re-admission
• improved intelligence around use of Sodium Valproate and other teratogenic medicines (which contain an agent that can disturb the development of the embryo or foetus) and maternity
• tracking patients and high-risk medicines post-discharge for example injectable anticoagulants which are used to reduce the ability of the blood to clot

In addition, NHS Digital’s Prescribing and Medicines Team and Life Sciences Team have provided a range of scenarios where they intend to investigate the use of this data including diabetes and long-term conditions.  

NHS Digital will work to ensure emergent benefits are realised and recognised.   

To maximise benefit realisation, the project will promote usage of data through a multi-agency Medicines Data Advisory Group.  Data usage will be monitored through Clear Data Access Requests and the Data Access Request Service.  Benefits experts within the Medicines Data Programme will work with data users to understand and measure the benefits realised.

Expected benefits are summarised below:

Pursuant to sections 254(1) and 254(6) of the Act, NHS Digital is directed to establish and operate information systems for the collection and analysis of data about medicines dispensed or supplied from community settings, as currently held by NHSBSA, according to the NHSBSA Medicines Data Directions 2019. 

Collection 

The data being collected is obtained from NHS Prescription Services (part of the NHSBSA).  It is an extract of information captured during prescription processing to calculate reimbursement payments to community dispensers.  It is taken from paper FP10 prescription forms and Electronic Prescription Service messages.     

The data relates to medicines, which includes but is not limited to patient information, from the NHSBSA of all prescriptions issued by prescribers and dispensed or supplied in the community. This includes prescriptions for medicines that are dispensed or supplied by community pharmacists, appliance contractors and dispensing doctors and prescriptions submitted by prescribing doctors in England for medicines personally administered in England.  Included are prescriptions written in England and dispensed outside England, prescriptions written in Wales, Scotland, Northern Ireland and the Isle of Man but dispensed in England. Prescribers include GPs, hospital doctors, NHS dentists and non-medical prescribers e.g. nurse, pharmacists. 

The collection will include data processed by NHSBSA since April 2015.  Patient level information will be included, as shown in the list of fields to be collected below.  Historic data held by NHSBSA since April 2015 will be included in the collection:

The following data is not collected by NHSBSA

• items dispensed or supplied within secondary care
• items on an issued prescription that has not been presented for dispensing
• items on a prescription that has been presented for dispensing but not submitted to NHS Prescription Services by the dispenser

Data will be collected monthly using MESH for secure data transfer, as illustrated in this diagram.  The data about medicines dispensed or supplied will become an Information Asset in NHS Digital (IAR0000747) and will be retained by NHS Digital in line with data retention policies. 

The data will be made available within NHS Digital and also to ALBs, NHS providers and commissioners and the life sciences community, for analysis to build intelligence on the safety and effectiveness of medicines and the impact of medicine use on patient outcomes and experiences, including improvements to an existing medication safety dashboard. Analysis will support research and innovation and measure uptake as well as enhancing opportunities to link to other data sets to improve patient care.  

The medicines data can also be linked to other patient level data sets already held in NHS Digital to provide a better understanding of the likely outcomes of medicine use regarding benefits, effectiveness and risk.

Linked data will be used to:

• maintain and develop the current Medications Safety Dashboard
• enhance existing and develop new publications
• respond to requests for data and information

Other patient level data sets available for linkage with the medicines data include but are not limited to:

Hospital Episode Statistics (linking prescribing data to hospital admissions), providing the opportunity to measure the impact of prescribing on hospital 

• admissions (benefits and risks) including the further development of the existing Medications Safety Dashboard.  
• Maternity services dataset to provide a better understanding of the use and safety of medicines in pregnancy
• Mental health and psychological therapies data sets to provide an understanding of how medicines are used for patients with mental health conditions.  
• GP dataset (if/when available) to provide further information about why and when medicines are prescribed (indication/condition), monitoring of medicine use, length of treatment and outcomes   
• corporate reference data to validate data and derive additional information not provided by NHSBSA

There are also opportunities to link this data to other data sets held by external bodies including Public Health England, Genomics England and other researchers.

Dissemination

Requests for data about medicines dispensed or supplied will be managed through NHS Digital’s Clear Data Access Tools and Data Access Request Service. 

Publication

Data about medicines dispensed or supplied can be used to:

• analyse data in a more meaningful way;
• enhance publications, including Prescription Cost Analysis (PCA);
• develop additional statistical outputs, for example, diabetes-related statistical outputs created by linking prescribing data to clinical audits data.

Information will be published in line with NHS Digital’s duty to publish under section 260(1) of the Health and Social Care Act 2012, unless it falls within section 260(2) of the Act. For the avoidance of doubt the following data is specifically excluded from publication:

• unique prescriber code
• Patient NHS Number

Changes to the NHS Business Services Authority Medicines Data Directions 2019or Specification will be managed by agreement with the following stakeholders and groups:

• the Department for Health and Social Care
• NHS Digital’s Executive Management Team     
• NHSBSA
• Medicines Data Advisory Group
• Data Co-ordination Board (for information if required)