Seven Day Prescribing for Long Term Conditions

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 Total quantity where a prescription is for seven tablets or capsules of common LTC medicines as a proportion of all tablets or capsules for common LTC medicines
Why it matters There is no current consensus on durations of prescriptions across the NHS and prescribers are advised that they should write a prescription for a duration that is clinically appropriate. The British Medical Association reports growing requests to prescribe seven day quantities of medicines to fund supply of medicine compliance aids (MCAs), adding to GP workload. The Royal Pharmaceutical Society has issued guidance stating that while some may think of MCAs as a panacea, there is limited evidence base to support their use, and safety incidents have been reported to the National Reporting and Learning System.

We propose this measure of seven day prescriptions for long-term conditions as a surrogate measure for MCAs. Caveats include; a seven day prescription may be clinically relevant even for long-term conditions in certain circumstances, some pharmacies will supply a MCA without a seven day prescription after making an individual assessment, and some local areas may fund provision of MCAs via a separate payment. Locally you may wish to review prescriptions of seven day duration for clinical appropriateness. Additionally the NHS Long Term Plan has set out targets for the NHS to reduce the negative impact it has on the environment. Many MCAs will be single use plastics or cardboards so if they are being supplied inappropriately there will be an opportunity to reduce waste in this area.

The medicines we have used for the measure are generally used once daily for long term conditions: atorvastatin, simvastatin, levothyroxine, amlodipine and ramipril.

Please note that this is an experimental measure. We would be grateful for any feedback at [email protected].

You can read more detail on the measure definition notebook and on our blog.
Tags Standard, Safety, Greener NHS
Implies cost savings No
Authored by brian.mackenna
Checked by richard.croker
Last reviewed 2019-10-09
Next review due 2020-10-09
Associated notebook https://github.com/ebmdatalab/jupyter-notebooks/blob/master/new_measures/Seven%20Day%20Prescribing%20for%20Long%20Term%20Conditions/Seven%20Day%20Prescribing%20for%20Long%20Term%20Conditions.ipynb
History View change history on GitHub →

Numerator SQL

SELECT
     CAST(month AS DATE) AS month,
     practice AS practice_id,
     SUM(total_quantity) AS numerator
 FROM hscic.raw_prescribing_normalised
 WHERE quantity_per_item=7 AND ( bnf_code LIKE '0205051R0%' OR  ##ramipril 
 bnf_code LIKE '0212000B0%' OR ##atorvastatin 
 bnf_code LIKE '0212000Y0%' OR ##simvastatin 
 bnf_code LIKE '0602010V0%' OR ##levothyroxine 
 bnf_code LIKE '0206020A0%') ##amlodipine 
 AND ( bnf_name LIKE '%tablet%' OR bnf_name LIKE '% tab %' OR bnf_name LIKE '% tab' OR bnf_name LIKE '% tabs %' OR bnf_name LIKE '% tabs' OR bnf_name LIKE '%capsule%' OR bnf_name LIKE '% caps %' OR bnf_name LIKE '% caps' OR bnf_name LIKE '%caplet%' OR bnf_name LIKE '%Chewtab%' )
 GROUP BY month, practice_id

Denominator SQL

SELECT
     CAST(month AS DATE) AS month,
     practice AS practice_id,
     SUM(total_quantity) AS denominator
 FROM hscic.raw_prescribing_normalised
 WHERE ( bnf_code LIKE '0205051R0%' OR  ##ramipril 
 bnf_code LIKE '0212000B0%' OR ##atorvastatin 
 bnf_code LIKE '0212000Y0%' OR ##simvastatin 
 bnf_code LIKE '0602010V0%' OR ##levothyroxine 
 bnf_code LIKE '0206020A0%') ##amlodipine 
 AND ( bnf_name LIKE '%tablet%' OR bnf_name LIKE '% tab %' OR bnf_name LIKE '% tab' OR bnf_name LIKE '% tabs %' OR bnf_name LIKE '% tabs' OR bnf_name LIKE '%capsule%' OR bnf_name LIKE '% caps %' OR bnf_name LIKE '% caps' OR bnf_name LIKE '%caplet%' OR bnf_name LIKE '%Chewtab%' )
 GROUP BY month, practice_id