Opioid prescribing comparators have been developed as part of the work started in response to the Public Health England (PHE) prescribed medicines review.
This release is the first set of data we’re making available. It will help NHS organisations understand and manage the extend of use of dependency-formatting medicines 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.
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
This first release is still under development. We will be adding more views and comparators. 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 ePACT2support@nhsbsa.nhs.uk
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.
Opioid Prescribing Comparators Dashboard overview (YouTube Video)
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 the context of their medicines optimisation prioritise.
They can also be used to evaluate the impact and effectiveness of efforts made to already address opioid prescribing.
This dashboard currently uses data from the Electronic Prescribing System (EPS). This data has not been processed by NHSBSA prescription services, so may be subject to change either due to resubmission by a dispenser or validation of the data performed as part of the prescription processing.
We intend to add additional views based on processed prescription data, with more historical data in due course.
- The EPS comparators are based on EPS messages only. This represents around 91% of the total number of prescription items.
- 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.
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 from 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.