Items which should not routinely be prescribed in primary care - insulin pen needles costing ≥£5 per 100 needles

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 higher cost (≥£5 per 100 needles) insulin pen needles per 1000 patients
Why it matters

NHS England guidance states:

Pen needles are available in sizes from 4mm to 12mm and cost from £3.95 to £30.08 for 100 (NHS Drug Tariff). Different needles will fit different pens, but some fit all major insulin delivery pen devices currently available.

Rationalising use ensures that the most cost-effective options are used first line.

The Forum for Injection Technique (FIT) UK considers the 4mm needle to be the safest pen needle for adults and children, regardless of age, gender and body mass index (BMI).

Using shorter length needles helps prevent intramuscular injection of insulin. (IM injection of insulin can result in unpredictable blood glucose levels.) Therefore, the most cost-effective 4mm needle should be chosen.

For patients currently using longer pen needle lengths (8mm, 12mm), changing to a shorter length (6mm or less) is advised, but only after discussion with a healthcare professional to ensure they receive advice on the correct injection technique.

For patients who cannot self-administer, it may be appropriate for the healthcare professional to use a safety needle; however, this would not need to be supplied on prescription.

For guidance on when prescribing may be appropriate in some exceptional circumstances, please see the full NHS England guidance document.
Tags Cost Saving, Efficacy, Diabetes, NHS England - items which should not routinely be prescribed in primary care
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 p LEFT JOIN measures.vw__median_price_per_unit r ON p.month=r.date AND p.bnf_code=r.bnf_code
 WHERE p.bnf_code IN (SELECT bnf_code FROM dmd.vmp WHERE LOWER(nm) LIKE '%insulin needles%' AND bnf_code IS NOT NULL -- find vmp products with vmp name containing insulin needles 
 UNION DISTINCT  SELECT amp.bnf_code FROM dmd.amp AS amp INNER JOIN dmd.vmp ON vmp.id = amp.vmp  WHERE LOWER(vmp.nm) LIKE '%insulin needles%' AND amp.bnf_code IS NOT NULL) -- find amp products with vmp name containing insulin needles 
 AND r.median_price_per_unit >= 0.05 --this selects products with median price of >= 5 pound a box
 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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