Dear Louis Goddard,

Please find attached a final letter regarding your recent Freedom of
Information request.

We would also value your feedback regarding the way in which your request
was handled. You can provide us with direct feedback on our website at the
following web link:

[1]Information Governance Survey

Any feedback you provide will be strictly anonymous and much appreciated.

Summary of Response

A copy of the information is attached.

Time Period

Prescribing data from April 2015 to March 2018 with data presented by
financial year totals.

NHSBSA Prescription Services process prescriptions for Pharmacy
Contractors, Appliance Contractors, Dispensing Doctors and Personal
Administration with information then used to make payments to pharmacists
and appliance contractors in England for prescriptions dispensed in
primary care settings (other arrangements are in place for making payments
to Dispensing Doctors and Personal Administration). This involves
processing over 1 billion prescription items and payments totalling over
£9 billion each year. The information gathered from this process is then
used to provide information on costs and trends in prescribing in England
and Wales to over 25,000 registered NHS and Department of Health users.

Drug Details

Data limited to prescribing of drugs as defined based on the following
section from version 68 of the British National Formulary (BNF):

- Antidepressants:- BNF section 04.03 (antidepressant drugs)

Patient Identification

Data is only included for prescribing where the patient's NHS number and
age was able to be captured during the prescription process activities. 
Patient information is not always possible to be captured during
processing and based on the criteria used for this analysis; patient
information was only available for 96.38% of prescription items.

The patient count figures are based on a distinct count of NHS number as
captured from the prescription image. 

Please note, the figures for the number of identifiable patients should
not be combined to produce total figures as this could result in double
counting.  For example, a single patient could receive drugs in all three
reported financial years and therefore combining the figures would count
this patient three times.

The patient age is based on the age captured from the prescription form or
if this is not possible it may be calculated based on the patients date of
birth and the month for which the prescription was submitted.  Results
have been presented to group the data into age bandings (0-10, 11-17,
18-24, 25-39, 40-59, 60 plus) based on the age of the patient at the time
of prescribing/dispensing. 

Please note, separate age bands should not be combined as it is possible
that a single patient may appear in multiple age bands during a single
time period.  For example, a patient receiving antidepressant drugs
throughout a year may be aged 24 at the beginning of the year and 25 at
the end of the year and therefore would appear in both age bands.

Prescribing Data

Based on dispensed prescription items that were processed by the NHS BSA,
not including items not dispensed, disallowed and returned back.

Excluding items prescribed but not presented for dispensing or not
submitted to NHS Prescription Services by the
dispenser.                               

Data reported for items prescribed and dispensed in England.

Data has been reported down to prescribing practice along with the
associated CCGs and Regions.  Additional entries have been included to
cover prescribing from outside of the CCG environment.  These figures have
been grouped under the category "Non-CCG prescriber" and allow the broken
down figures to be consolidated to the national totals.

Data Quality Concerns

The NHSBSA process around 92 million prescription items per month. A
random sample of 50,000 prescription items is checked monthly to estimate
the accuracy of processing. As of March 2018 the 12 monthly rolling
accuracy was at 99.63%.  However, when figures are reported at a more
granular level there is a potential that accuracy rates could be lower
than this rate.

It is unexpected to see much prescribing of anti-depressants to very young
children or babies so additional checks on this area of prescribing have
been performed.  A sample of the child data was compared to the images of
the paper prescription forms from which the data was generated. These
checks revealed issues in the reliability of data in patients aged 6 years
and under and severe issues in those aged 2 years and under. The main
issue is that a commonly prescribed item, Amoxicillin 125mg/5ml oral
suspension, has been captured as Paroxetine (an antidepressant).  Initial
investigations suggest that this could be caused by manual input errors as
the system code used for these two drugs is very similar.

To account for these known quality issues it is strongly recommended to
only report on antidepressant prescribing to patients aged 7 and over.

Reported Figures

The following fields have been included in the datasets:

+ Financial Year: the financial year corresponding to the month for which
the prescription was submitted to the NHSBSA by the dispenser for
reimbursement.

+ Country: analyses focus on prescribing/dispensing from within England
only.

+ Region: the region relating to the prescribing organisation.  Where
prescribing originated outside of the CCG/Practice environment the region
has been recorded as "Non-CCG prescribing".

+ CCG: the CCG relating to the prescribing organisation.  Where
prescribing originated outside of the CCG/Practice environment the region
has been recorded as "Non-CCG prescribing".

+ Practice name: the name of the practice prescribing the medication. 
Where prescribing originated outside of the CCG/Practice environment the
region has been recorded as "Non-CCG prescribing".

+ Practice code: the unique code of the practice prescribing the
medication.  Where prescribing originated outside of the CCG/Practice
environment the region has been recorded as "Non-CCG prescribing".

+ Age Band: the banding for the age of the patient at the time of
prescribing/dispensing.  Patients may appear in multiple age bands during
a single financial year.

+ Drug Group: data has been restricted to prescribing from identified
medicines reported as "Antidepressants".

+ No. of identifiable patients: a count of the distinct number of NHS
numbers, as captured from the prescription images that meet the reported
criteria.  Please note, care should be taken when reporting these figures
as combining these results could result in the double-counting of
patients.  The NHS number cannot be captured for every prescription form
and based on the criteria used for this analysis was only available for
96.38% of prescription items.

+ No. of items prescribed to identifiable patients: a count of the no. of
prescription items that meet the reported criteria.  Please note, as
figures are reported based on age bandings it is not possible to associate
items where the patient's age could not be identified from the
prescription data.

Please note that this information will be published on our Freedom of
Information disclosure log at:

[2]https://apps.nhsbsa.nhs.uk/FOI/foiReques...

Your personal details will be removed from the published response.

Regards,

Chris Dunn

Information Governance Assistant

Corporate Governance
Tel: 0191 203 5352

Internal tel: 500 5352

Fax: 0191 264 5281

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