Prescribing Costs in Hospitals and the Community 2018 - 2019

This report allows readers to see how the use of medicines has grown in the three sectors covered, i.e. hospital, primary care and those cases where a prescription is written by a hospital doctor but dispensed by a community pharmacist.

Patients can receive their medicine from the NHS by a variety of routes and the data in this report covers the majority of this prescribing activity. The most common is to receive a prescription from their general practice and have it dispensed by a community pharmacy. However, there are many other ways.

IQVIA collects “issues” from Pharmacy Departments. When analysing primary care prescribing, the number of items is commonly used as a measure of frequency of prescribing and as a proxy for volume. There is no equivalent measure for hospital pharmacy issues, which are described in terms of packs or part packs. Issues will include supply of original packs as ward stock, dispensing for named patients, outpatient clinics and dispensing on discharge. Therefore the data does not include the physical quantity (though this can be deduced by looking at the pack description) and hence no equivalent to the number of Defined Daily Doses.

Not all hospitals contribute data to the HPAI. Some Trusts provided data too late for it to be included in the data used for this report. In such cases, previous data was used to estimate data for those months where data was missing. It excludes military and private hospitals, prisons and schools, but would include private wards within NHS hospitals and Private Hospitals holding an SLA with an NHS site. Outsourced pharmacies servicing chosen hospitals are also sourced and included as a separate site where possible. Homecare and department data are also captured.

IQVIA report coverage as at April 2018 is over 99% for England and approximately 99% for the UK.

The basic measure within the HPAI database is volume, measured in packs. IQVIA then calculates the cost of this volume using the current Drug Tariff (issued by the Department of Health and Social Care) or manufacturers’ price lists. An individual drug may be available in several different pack sizes and pack sizes can vary between medicines. In this report we have used cost since this is a measure which can be added together for different medicines.

The HPAI does not include data on some devices and appliances, for example, products such as nebuliser masks. There is only limited data on dressings. The Prescription Services Division data includes everything which appeared on an “FP10” prescription.

IQVIA releases data on a regular basis. Each IQVIA dataset includes data for 24 months and may include updates to earlier data. The dataset used in this report was last updated with IQVIA data release for June 2019.

Estimated cost: The prices used in the HPAI are the published prices from the Drug Tariff and other standard price lists. This is not a true reflection of the actual expenditure by hospitals as many purchases are made on contract with individual manufacturers or wholesalers at lower prices.

Private usage: The HPAI includes no information taken directly from private hospitals. However, the data used in this report does include usage in private wards within NHS hospitals, or where the NHS hospital supplies a private hospital.

Clinical trial usage: Where the data received can be linked to a valid UK pack, clinical trial usage will be incorporated. This is not always possible as clinical trial packs may not be issued from or recorded within the hospital pharmacy system.

Unlicensed products: Information on unlicensed products is not included within the HPAI.

Drugs issued through aseptic units: Certain types of drug, notably some cytotoxics and intravenous nutrition, are prepared in aseptic conditions. This may be carried out at a separate site by an outside contractor. There is one site in England where IQVIA are not able to collect such data. If the data relate to issues from an aseptic unit, it is sometimes not possible to determine the quantity of drugs used. In such instances an average quantity is substituted.

Medicines supplied via companies providing care at home: A number of specialist medicines are not only provided in hospital or by community pharmacies but are also delivered directly to the patient’s home by various commercial companies. No “homecare” supplies are recorded in ePACT2 data and it is recorded within hospital pharmacy systems to a variable extent. Homecare supplies are generally initiated and commissioned by a hospital but the supply to the patient is made by the company and the hospital is invoiced for this service. However, we do not know what proportion of this is included in the hospital data reported here.

NHS Digital believe that there is no reason to suggest that any analyses have been adversely affected by the data quality issues raised below.

All medicines provided using a prescription and dispensed in the community in the UK need to be submitted to Prescription Services if the dispenser is to be reimbursed and so coverage should be complete. Please note that if a prescription was issued, but not presented for dispensing or was not submitted to NHS Prescription Services by the dispenser, then it is not included in the data. The prescription item is recorded in the month in which NHS Prescription Services received it. In the majority of cases prescriptions will be issued, dispensed and submitted to NHS Prescription Services in the same month. However, prescriptions can be presented for dispensing up to six months after issue, and the dispensing organisation may submit the prescription for payment later still. Prescription data may be attributed to organisations which have since closed. An issuing organisation may have closed before a prescription is dispensed and NHS Prescription Services may also receive prescriptions late from an organisation or a prescription pad from a closed organisation may still be in use by a prescriber previously at that organisation.

NHS Prescription Services have their own internal quality process to assure the data they provide. They state that due to the complex and manual processes involved there may be random inaccuracies in capturing prescription information which are then reflected in the data. The prescription processing activity is internally audited to at least 99 per cent accuracy (i.e. at least 99 per cent of prescriptions are recorded accurately). Further data quality details are available from NHS Prescription Services.

IQVIA sells their data to a range of customers who would not purchase it if they did not have faith in it. However, it has known limitations. It is based on a sample of Trusts, although that sample covers over 99% of the beds in Trusts in England. There are known problems when a product is used via an aseptic unit (where a drug is prepared for use by dilution). The data received by IQVIA does not always indicate the physical amount of the drug in a bag prepared for infusion and an estimate has to be made using average doses. Data from some aseptic units does not appear in data submitted to IQVIA. Another known deficiency is when medicines are supplied to patients in their homes using a process known as homecare or supplied via outsourced dispensing services. Although the service (including the medicines used) is paid for by the Trust, the details are not always recorded in the pharmacy system and so may not appear in the data provided to IQVIA. This means that the figures are likely to be an underestimate of the medicines used. Note that the costs are not necessarily the true cost paid by the Trusts but rather the equivalent price of these medicines in primary care.

This report is published annually. The timing of this publication is influenced by the agreement between NHS Digital and IQVIA which requires NHS Digital not to publish hospital data until six months after the time period to which it applies.

This report has been released in line with the pre-announced publication date and is therefore deemed to be punctual.

This report is available annually via the NHS Digital website, as a combination of web pages and downloadable reports and data files. The publication may be requested in large print or other formats through the NHS Digital’s contact centre: [email protected] (please include ‘Hospital Prescribing’ in the subject line).

Data included in this report originates from a range of sources. For details of further prescribing data are available,

Comparability over time

Previous versions of this publication are available. 

In previous versions of the publication, sub-national breakdowns at NHS England Region level have been used in order to reflect the current structure. However, moving to new data sources has meant that not all data is available on a consistent regional basis. No regional information is available for this publication.

Comparability with other sources

The Prescription Services data presented here differs from that presented in the NHS Digital publications based on the Prescription Cost Analysis (PCA) system. This is because the PCA database is based on all prescriptions dispensed in England irrespective of where they were written.

This report is used by stakeholders as the only complete source of information about the cost of use of medicines across the NHS in England.

A public consultation was carried out by NHS Digital in the summer of 2019 on its prescribing outputs. It was looking to align outputs with the NHS Business Services Authority data releases and expanding and increasing the usability of prescribing data as new data sources become available. Respondents to the consultation welcomed the move to new data sources for the Prescribing Costs in Hospitals and the Community publication so that the data more accurately reflects the true cost of medicines to the NHS to determine the true scale of spend and growth.

The aim over the coming years is to transition the report to new data sources that are becoming available. The primary care prescribing component is now sourced from the NHS BSA’s new data warehouse which brings a number of data improvements, the main one being that prescribing by dentists will also be included to ensure the whole of primary care prescribing is captured in the costs. The HPAI data set from IQVIA will continue to be used for secondary care reporting of estimated costs however additional contextual information on actual medicine costs from Rx-Info’s Define data will be included for the first time in future publications. A transitional insight report will be published in the Spring of 2020 comparing the two sets of figures on cost and the relevant data sources.

NHS Digital is keen to gain a better understanding of the users of this report and their needs. Please send any comments to [email protected] (please include ’Hospital Prescribing’ in the subject line). Alternatively you can call our contact centre on 0300 303 5678 or write to NHS Digital, 7 and 8 Wellington Place, Leeds, West Yorkshire, LS1 4AP.

The figures used in this publication from the NHS Prescription Services are collected as part of the process of reimbursing dispensers for drugs supplied. The publication therefore uses an existing administrative source. Information about the administrative sources and their use for statistical purposes is included in NHS Digital’s Statement of Administrative Sources.

The hospital data is not collected by the NHS but by a commercial company who cannot require Trusts to provide the data and so any burden is entered into willingly.

This is an Official Statistics publication. The Code of Practice for Official Statistics is adhered to from collecting the data to publishing.

The standard NHS Digital data security and confidentiality policies have been applied in the production of these statistics.

The Freedom of Information Act gives you the right to obtain any further information required.