Practice level prescribing - glossary of terms

The NHS Business Services Authority (BSA) prescribing and dispensing information systems use the therapeutic classifications defined in the British National Formulary (BNF) as extended by the BSA. The same drug may appear in different areas of the BNF as it can be prescribed to treat more than one condition. For example, aspirin is licensed for use as an antiplatelet and as an analgesic.

NHS Prescription Services have created pseudo BNF chapters for items not included in BNF chapters 1 to 15. The majority of such items are dressings and appliances, which have been classified into 4 pseudo BNF chapters (20 to 23). Chapters 18 and 19 include preparations used in diagnosis, and 'other preparations'. There is no chapter 16 or 17. NHS Prescription Services have produced a booklet on BNF classifications and the pseudo classifications used.

The BNF is updated in March and September each year. NHS Prescription Services update their BNF classifications annually. While the therapeutic classification of drugs occasionally changes, all practice level publications reflect the classification in use at the time of publication.

The primary purpose of the BNF is to provide information for clinicians. The format of the BNF was changed with Edition 70 (September 2015 to March 2016) making it more user friendly. However, the BSA, who process dispensed prescription forms, collect dispensed prescribing data and produce the ePACT data, continue to use the old BNF classification system to code medicines, which has become widely used in the UK as a classification to allow comparisons between drug groups. For example, it is used to report cost and trend in medicines use and supports several NHS Digital official publications. The data is used in many NHS IT systems. 

This is the BNF code for the drug:

• characters 1 and 2 show the BNF chapter
• 3 and 4 show the BNF section
• 5 and 6 show the BNF paragraph
• 7 shows the BNF sub-paragraph
• 8 and 9 show the chemical substance
• 10 and 11 show the product
• 12 and13 show the strength and formulation
• 14 and 15 show the equivalent

The 'equivalent' is defined as follows:

1. if the presentation is a generic, the 14th and 15th characters will be the same as the 12th and 13th character
2. where the product is a brand, the 14th and 15th digit will match that of the generic equivalent, unless the brand does not have a generic equivalent in which case A0 will be used

The drug is shown by individual preparation name, which may be proprietary or generic, followed by form and strength.

The names used are often presented in an abbreviated form due to the limited number of characters available in the BSA Drug and Appliance database. Note that this field is limited to 40 characters in this file, so some names may have been cut short, compared with descriptions used elsewhere, for example the Prescription Cost Analysis figures published by NHS Digital.

For data covering August 2010 to March 2013, this is code of the Strategic Health Authority (SHA) in which the practice resides. Following changes to the structure of the NHS, from April 2013 this field relates to the Area Team.

Please note that prescription data may be attributed to organisations which have since closed. Prescriptions can be presented for dispensing up to 6 months after issue, so an issuing organisation may have closed before a prescription is dispensed. Prescription Services of the NHS Business Services Authority may also receive scripts late from an organisation or a prescription pad from a closed organisation may still be in use by a prescriber previously at that organisation. Therefore, it is possible that SHA codes will appear in data from April 2013 onwards.

For data covering August 2010 to March 2013, this is code of the Primary Care Trust (PCT) in which the practice resides. Note that for a small number of PCTs, Prescription Services do not use the same codes for care trusts as Organisation Data Services (ODS). The codes this affects are shown below.

Following changes to the structure of the NHS, from April 2013 this field relates to the Clinical Commissioning Group (CCG).

As with the SHA field, please note that prescription data may be attributed to organisations which have since closed. Prescriptions can be presented for dispensing up to 6 months after issue, so an issuing organisation may have closed before a prescription is dispensed. Prescription Services of the NHS Business Services Authority may also receive scripts late from an organisation or a prescription pad from a closed organisation may still be in use by a prescriber previously at that organisation. Therefore, it is possible that PCT codes will appear in data from April 2013 onwards.

It should also be noted that following the NHS reforms in April 2013, PCTs were replaced with 211 CCGs. In addition, over 150 other 'cost centres', including trusts, councils and private company providers now exist. These 'cost centres' (the HSCIC refers to these as Non-CCG cost centres) are not linked to CCGs but are funded directly by Area Teams. Non-CCG cost centre prescribing is included in the Practice Presentation Level prescribing data.

Whilst PCTs used to be responsible for all prescribing activity in their area, their replacements, CCGs, are not. Prescribing activity not recorded against a CCG will be recorded against the responsible non-CCG cost centre body. The non-CCG cost centre bodies are listed alongside the CCGs and are linked to the responsible Area Team above.

For example, prescribing activity from a PCT will not be completely comparable with the activity of the replacement CCG(s) as some of the former PCT prescribing activity will now be recorded under a new, non-CCG body. At the Area Team level, all prescribing activity in an area will be recorded as either a CCG or non-CCG body.

This is code for the practice. It can potentially be used to linked to other data that uses the practice code as is defined by the NHS Digital Organisation Data Service (ODS). The format is Axxxxx where "A" is a letter and "xxxxx" is a 5 digit number.

Accompanying the release of the prescribing data is a file giving the name and address of each practice indexed by this code. The practice name and first line of the address are often the same. Where a practice does not supply a practice name the first line of the address is used. This file is arranged so the final column is usually the postcode even if this requires other parts of the address to be repeated or left blank to achieve this.

This gives the number of items for this presentation that were dispensed in the specified month. A prescription item refers to a single supply of a medicine, dressing or appliance prescribed on a prescription form. If a prescription form includes three medicines it is counted as three prescription items.

Item figures do not provide any indication of the length of treatment or quantity of medicine prescribed (the quantity is given in the 'Quantity' field, described below).

Patients with a long term condition usually get regular prescriptions. Whilst many prescriptions are for one month, 28 or 30 days supply, others will be for various lengths of treatment and quantity.

This is the basic cost of a drug as used in primary care. This is the cost at list price excluding VAT, i.e. the price listed in the national Drug Tariff or in standard price lists and is not necessarily the price the NHS paid. It does not take into account of any contract prices or discounts, dispensing costs, fees or prescription charge income, so the amount the NHS paid will be different.

NIC is used in Prescription Services reports and other analyses, as it standardises cost throughout prescribing nationally, and allows comparisons of data from different sources. The figures are in pounds and pence.

From July 2012 onwards, the formula used to calculate 'Actual Cost' has been changed to include the new reimbursement payments which will be charged back to practices from dispensed prescriptions.

The current formula is:

• the NIC less discount
• plus payment for consumables (previously known as Container Allowance)
• plus payment for Containers
• plus Out of Pocket expenses

Prior to July 2012, this Actual Cost was defined as the NIC less the average discount percentage received by pharmacists calculated from the previous month, plus container allowance. This is the estimated cost to the NHS, which is lower than NIC.

Community pharmacists are reimbursed for medicines they have dispensed on the basis of the NIC less a deduction related to the discount that they are assumed to have received from their suppliers (for details see the Drug Tariff Part V - Deduction Scale). A container allowance is then added (see Drug Tariff Part IV). The figures are in pounds and pence.

Note: electronic Drug Tariff can be found at:

https://www.nhsbsa.nhs.uk/pharmacies-gp-practices-and-appliance-contractors/drug-tariff

The quantity of a drug dispensed is measured in units depending on the formulation of the product, which is given in the drug name. Quantities should not be added together across preparations because of different strengths and formulations.

1. where the formulation is tablet, capsule, ampoule, vial etc the quantity will be the number of tablets, capsules, ampoules, vials etc
2. where the formulation is a liquid the quantity will be the number of millilitres
3. where the formulation is a solid form (such as cream, gel, ointment) the quantity will be the number of grammes

The date is given as the year and month to which the file refers. For example, June 2012 would be 201206. This date relates to the month in which the prescriptions were dispensed.

This is the International Non-proprietary Name (INN) and is the standard registered name for the active constituent of that medicine, for example omeprazole. For compounds the name may be more complex, such as co-magaldrox magnesium/aluminium hydrox). In some cases the name is a collective one for a range of medicines, such as alginic acid compound preparations.

For prescriptions in BNF chapters 19 to 23, there is no "chemical" name, as these are dressings and appliances. Therefore, these items are reported under the BNF section name, for example, night drainage bags.

All prescription statistics in this data are based on information systems at NHS Prescription Services, part of the NHS BSA. The figures used are collected as an essential part of the process of reimbursing dispensers (mainly pharmacists and dispensing doctors) for medicines supplied. All prescriptions which are dispensed in England need to be submitted to NHS BSA if the dispenser is to be reimbursed and so coverage should be complete.

NHS Prescription Services quality assures the data they provide. They state that due to the complex and manual processes involved there may be inaccuracies in capturing prescription information which are then reflected in the data. Currently the prescription processing activity is internally audited to 97.5% accuracy (meaning at least 97.5% of prescriptions are recorded accurately). While the BSA can adjust payments to dispensers if an error is identified they are unable to correct the prescribing data.

This is prescribing which cannot be allocated to a specific practice, and is not included in this data.