Items which should not routinely be prescribed in primary care - immediate release fentanyl

Below are the database queries which are used to create this measure. These are run against a copy of the BSA prescribing data which we store in Google BigQuery. We're working on making our BigQuery tables publicly available at which point it will be possible to run and modify these queries yourself. But even where code and database queries are not directly useable by others we believe it is always preferable to make them public.

Description Cost of fentanyl immediate release per 1000 patients
Why it matters

NHS England guidance states:

Fentanyl is a strong opioid analgesic. It is available as an immediate-release substance in various dosage forms; tablets, lozenges, films and nasal spray. Immediate-release fentanyl is licensed for the treatment of breakthrough pain in adults with cancer who are already receiving at least 60mg oral morphine daily or equivalent. NICE CG140 Opioids in palliative care states: 'Do not offer fast-acting fentanyl as first-line rescue medication'.

This recommendation does not apply to longer sustained release versions of fentanyl, which come in patch form.

Due to the recommendations from NICE and immediate-release fentanyl only being licensed for use in cancer, the joint clinical working group considered immediate-release fentanyl was suitable for inclusion in this guidance with specific exceptions for people receiving palliative care, reflecting NICE and the terms of the product licence.

The recommendations also reflect findings from the PHE Prescribed Review (September 2019), which outlined the risks of prescribing that can cause dependence or withdrawal and could cause problems for people taking them or coming off them, especially those who have been taking them for a long time.

For guidance on when prescribing may be appropriate in some exceptional circumstances, please see the full NHS England guidance document.
Tags Cost Saving, NHS England - items which should not routinely be prescribed in primary care, Opioids, Pain, Safety
Implies cost savings Yes
Authored by richard.croker
Checked by christopher.wood
Last reviewed 2024-03-05
Next review due 2026-03-05
History View change history on GitHub →

Numerator SQL

SELECT
     CAST(month AS DATE) AS month,
     practice AS practice_id,
     SUM(actual_cost) AS numerator
 FROM hscic.normalised_prescribing
 WHERE bnf_code IN ("0407020A0AAAIAI", "0407020A0AAAJAJ", "0407020A0AAAKAK", "0407020A0AAALAL", "0407020A0AAANAN", "0407020A0AAAPAP", "0407020A0AAAWAW", "0407020A0AAAXAX", "0407020A0AAAYAY", "0407020A0AAAZAZ", "0407020A0AABABA", "0407020A0AABBBB", "0407020A0AABCBC", "0407020A0AABDBD", "0407020A0AABEBE", "0407020A0AABFBF", "0407020A0AABGBG", "0407020A0AABHBH", "0407020A0AABJBJ", "0407020A0AABPBP", "0407020A0AABXBX", "0407020A0AACHCH", "0407020A0BCAAAI", "0407020A0BCABAJ", "0407020A0BCACAK", "0407020A0BCADAL", "0407020A0BCAEAN", "0407020A0BCAFAP", "0407020A0BJAAAW", "0407020A0BJABAX", "0407020A0BJACAY", "0407020A0BJADAZ", "0407020A0BJAEBA", "0407020A0BJAFBB", "0407020A0BKAABC", "0407020A0BKABBD", "0407020A0BKACBE", "0407020A0BKADBF", "0407020A0BKAEBG", "0407020A0BNAGBL", "0407020A0BNAHBJ", "0407020A0BNAIBH", "0407020A0BPAABJ", "0407020A0BPABBP", "0407020A0BWAAAI", "0407020A0BWABAJ", "0407020A0BWACAK", "0407020A0BWADAL", "0407020A0BWAEAN", "0407020A0BWAFAP", "0407020A0BXAAAW", "0407020A0BXABBB", "0407020A0BXAFAX", "0407020A0BYAICD")
 GROUP BY month, practice_id

Denominator SQL

SELECT
     CAST(month AS DATE) AS month,
     practice AS practice_id,
     SUM(total_list_size / 1000.0) AS denominator
 FROM hscic.practice_statistics
 GROUP BY month, practice_id
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