Opioid prescribing comparators have been developed as part of the work started in response to the Public Health England (PHE) prescribed medicines review.
This dashboard is still a work in progress so we’re working to add more content to help NHS organisations understand the use of medicines associated with dependency and withdrawal in their area.
The report was published by PHE in September 2019. Analysis showed that 11.5 million adults in England (26% of the adult population) in 2017/18 received and had dispensed one or more prescriptions for the following:
- Opioid pain medicine
- ‘Z’ drugs
5.6 million people (13% of the population) received and had dispensed a prescription for an opioid pain medicine.
An implementation programme was started to address this issue. As part of this, NHS England and the Medication Safety Improvement Programme invited Wessex Academic Health Science Network (AHSN) and the NHSBSA to develop a set of opioid prescribing comparators to support local work to reduce harm from opioid prescribing for non-cancer patients.
Using the development process first used for the NHSBSA Polypharmacy prescribing comparators, Wessex AHSN and NHSBSA have worked together with clinicians to develop the NHSBSA opioid prescribing comparators.
This dashboard also includes comparators based on those recommended by the prescribed medicines review that describe the number of patients receiving each of the five dependency and withdrawal forming medicine classes for a short period and over a 12 month period.
The NHSBSA prescribing comparators have been developed to help GP practices, PCNs, ICBs and others to:
- understand the scale of their local opioid issues
- understand which areas of opioid prescribing are most problematic locally
- identify patients who are deemed to be at the greatest risk from harm to be prioritised for a structured medication review
- measure the impact of any interventions aimed at reducing harm from opioids
- understand the local scale of use of dependency and withdrawal forming medicines in the short and long term.
This dashboard is still under development. We will be adding more content in the future. We are particularly trying to make use of more timely data from the EPS system which is new for this dashboard which we hope will be useful. As always, feedback can be sent to firstname.lastname@example.org
If you are registered, you can access the opioid comparators on ePACT2.
What the comparators show
These comparators are the first national prescribing data to split prescribing data by gender. They are also the first to make live electronic prescribing system (EPS) data available to help identify patients who have been on opioids for 3 but not yet 6 months to help prevent acute use of opioids turning into chronic use for non-cancer pain.
It is important to highlight that the data is extracted from prescription data. It does not contain diagnosis. Therefore, when using the data to prioritise patient, practices will need to screen outpatients using opioids for cancer pain as this is an entirely clinically appropriate usage of opioids.
The purpose of the NHSBSA Opioid Prescribing comparators is to highlight variation and to support PCNs and GP practices in addressing their opioid work in line with medicines optimisation priorities.
They can also be used to evaluate the impact and effectiveness of efforts made to already address opioid prescribing.
Different views of prescription data
This dashboard presents data from two different stages of the prescription reimbursement process so that different types of analyses can be performed.
Opioid Prescribing Comparators (Snapshot)
Shows Electronic Prescribing System (EPS) data as soon as possible after dispensers have submitted a reimbursement claim for a prescription item to NHSBSA.
Opioid Prescribing Comparators (Trend)
Shows validated prescription reimbursement information reported after being processed by NHSBSA Prescription Services for reimbursement. This includes paper prescriptions and historical data to show trends over time. This is based on the data normally available via ePACT2.
Features of the snapshot view
This data is made available to reduce the lag between prescription claims and availability of data. This is intended to enable more timely activity at clinical level. Historical trends are not available in these views.
We aim to refresh this data every 2 weeks, it always represents a 28 day period that is described in a box at the top of each comparator page in the dashboard.
- The EPS comparators are based on EPS messages only. This represents around 92% of the prescription items within the scope of these comparators.
- EPS data may be refreshed frequently, and no historical data is provided. So, figures in reports may be updated from day to day.
- The data includes acute and repeat items.
- The prescribing data used in these comparators does not include hospital prescribing. Therefore, medicines supplied through home care or by the hospital pharmacy, such as oncology treatments or any specialised medicines, are not included.
- Using unprocessed data makes this view more exposed to glitches in technology which can sometimes prevent us from meeting our objective of updating every 2 weeks.
Features of the trend view
These views are currently under development and there are a few other technical limitations that are described within the pages themselves.
The trend view currently includes some comparators focussed on opioids (OP), and some comparators covering other types of dependency and withdrawal forming medicines as recommended by the prescribed medicines review (PMR):
- OP01 – patients receiving opioid pain medicines
- OP02 – patients receiving opioid pain medicines by duration
Opioids and other medicine classes:
- PMR01 – Patients receiving dependency and withdrawal forming medicines by selected medicine group
- PMR02 – Patients receiving selected dependency and withdrawal forming medicines for 12 months
These PMR specified comparators also offer the choice of a broader definition of opioids that includes compound analgesics and therefore a view of a larger population of opioid users.
We’re working on adding more of the Snapshot comparators to the trend view.
The processed prescription data (trend) views include all processed prescriptions submitted to NHSBSA for reimbursement on paper or via EPS. These views include historical data covering the latest 12 months. This is intended to show changes over time.
These views are updated along with the ePACT2 data, the target dates are shown on the prescriptions data release calendar.
How to use these comparators
We envisage the comparators being used by GP practices, and PCNs in collaboration with local ICBs. This will be with the relevant and appropriate education and training support in place.
NHS Right Care outlines how it sees information as the stimulus for debate and change. They advocate an approach of taking a population perspective to trigger the search for unwarranted variation and assess the value of the healthcare provided both to population and individuals. This is the approach by these opioid prescribing comparators.
Clearly, in addressing outlying practice and unwarranted variation, clinical pharmacists working in GP practices will play an important role in supporting practices to identify and address patients who are deemed at risk of harm from opioid prescribing for chronic, non-cancer pain and who require through medication reviews as a priority.
Dashboard specification documents
See appendix 2 for more detail on the sources used for the OME values.