FOI-01164

Thank you for your request for information about the following:

I would like to request some data regarding the use of rescue packs for COPD, please can you provide data on the following 
Number of patients receiving Prednisolone 5mg tablets, and receiving medication to treat COPD (inhaler device plus antimuscarinic), where the quantity prescribed per item was less than or equal to 60 tablets.
Within the same 30 day monthly reporting period the same patient has also received a prescription for: Amoxicillin, Doxycycline, Clarithromycin
Practice Level, PCN Level, SUB ICB Level, total patients over full calendar year 2022

Your request was subsequently clarified as follows:

Please can we base the analysis on the following (Closed Triple Therapy) or (LABA/LAMA) or LAMA (Excluding Spiriva)

The antibiotic element of the data refers to patients who are prescribed OCS (prednisolone) + (Triple, LABALAMA,LAMA) + Antibiotic in the same month. 

Just for info – Antibiotics: 
Doxycycline 100mg
Amoxicillin – 250mg or 500mg
Clarithromycin 500mg

Your request was received on 23 May 2023 and has been dealt with under the terms of the Freedom of Information Act 2000.

###Response

A copy of the information is attached.

NHS Prescription Services process prescriptions for Pharmacy Contractors, Appliance Contractors, Dispensing Doctors, and Personal Administration with information then used to make payments to pharmacists and appliance contractors in England for prescriptions dispensed in primary care settings (other arrangements are in place for making payments to Dispensing Doctors and Personal Administration). This involves processing over 1 billion prescription items and payments totalling over £9 billion each year. The information gathered from this process is then used to provide information on costs and trends in prescribing in England and Wales to over 25,000 registered NHS and Department of Health and Social Care users.

###Data Source    
The data source was the NHSBSA Information Services Data Warehouse.

###Exclusions
The Data excludes: 

•	Items not dispensed, disallowed and those returned to the contractor for further clarification.
 
•	Prescriptions prescribed and dispensed in Prisons, Hospitals and Private prescriptions.

•	Items prescribed but not presented for dispensing or not submitted to NHS Prescription Services by the dispenser.

###Time period
January 2022 – December 2022 inclusive 

###Organisation Data
Data is limited to GP Practices in England. Patient counts have been aggregated to each organisation level and will therefore not match when summed up.

###Drugs
For a full list of drugs at BNF Presentation level please see the CVS FOI01164_DRUG_LIST.  The drugs are in separate categories

###Inhalers
Inhalers are limited to those in the NHSBSA Central Drugs Reference with CMSD Therapeutic Grouping of 'ICS/LABA/LAMA','LABA/LAMA' or with CMSD Therapeutic Grouping of 'LAMA' but within LAMA (only) excluding those with Spiriva in the DMND (Dictionary of medicines and devices) name description.

###Antibiotics
Limited to the following BNF Presentations

    0501013B0AAAAAA	Amoxicillin 250mg capsules
    0501013B0AAABAB	Amoxicillin 500mg capsules
    0501030I0AAABAB	Doxycycline 100mg capsules
    0501050B0AAADAD	Clarithromycin 500mg tablets
and all shared proprietary versions of the generic.

###Prednisolone
Limited to BNF presentation 0603020T0AAACAC Prednisolone 5mg tablets and all shared proprietary versions of the generic. For Prednisolone (only) data is limited to items with a quantity of 60 or less

###Patient Counts
Data is limited to prescriptions where an NHS Number was captured during NHSBSA prescription processing within the dataset 99.31% of prescription items had an identified NHS number
The figures for the number of identifiable patients should not be combined and reported at any other level than provided as this may result in the double-counting of patients.  For example, a single patient could appear in the results for multiple SICBLs.

Patients are counted if they have prescribing for both or all of the drug groupings in the same month within the same organisation structure.  For example, a patient has prescribing in the same month at two different practices in the same SICBL.  They have Prednisolone and Inhaler prescribing at the first practice and Antibiotic prescribing at the second.  At practice level they will show only in the PREDNISOLONE_AND_INHALER_PATIENT_COUNT for the first practice only.  At SCIBL level they will show in both the PREDNISOLONE_AND_INHALER_PATIENT_COUNT and the PREDNISOLONE_AND_INHALER_AND_ANTIBIOTIC_PATIENT_COUNT.

###Fewer Than 5 Patients

Please be aware that I have decided not to release the practice details where the total number of patients falls below 5.  This is because the patients could be identified, when combined with other information that may be in the public domain or reasonably available.

This information falls under the exemption in section 40 subsections 2 and 3A (a) of the Freedom of Information Act.

This is because it would breach the first data protection principle as:

a)  it is not fair to disclose patients personal details to the world and is likely to cause damage or distress.

b) these details are not of sufficient interest to the public to warrant an intrusion into the privacy of the patients.

Please click the below web link to see the exemption in full.

https://www.legislation.gov.uk/ukpga/2000/36/section/40 

###Breach of Patient confidentiality

Please note that the identification of patients is also a breach of the common law duty of confidence.  A patient who has been identified could make a claim against the NHSBSA or yourself for the disclosure of the confidential information.

The information requested is therefore being withheld as it falls under the exemption in section 41(1) ‘Information provided in confidence’ of the Freedom of Information Act. 

Please click the below web link to see the exemption in full.

https://www.legislation.gov.uk/ukpga/2000/36/section/41 

If you have any queries regarding the data provided, or if you plan on publishing the data, please contact foidata@nhsbsa.nhs.uk ensuring you quote the above reference. This is important to ensure that the figures are not misunderstood or misrepresented.

If you plan on producing a press or broadcast story based upon the data please contact communicationsteam@nhsbsa.nhs.uk This is important to ensure that the figures are not misunderstood or misrepresented.

The information supplied to you continues to be protected by the Copyright, Designs and Patents Act 1988 and is subject to NHSBSA copyright. This information is licenced under the terms of the Open Government Licence detailed at:
http://www.nationalarchives.gov.uk/doc/open-government-licence/version/3/ 

Should you wish to re-use the information you must include the following statement:
“NHSBSA Copyright 2023” This information is licenced under the terms of the Open Government Licence:

http://www.nationalarchives.gov.uk/doc/open-government-licence/version/3/ 

Failure to do so is a breach of the terms of the licence.

Information you receive which is not subject to NHSBSA Copyright continues to be protected by the copyright of the person, or organisation, from which the information originated.  

Please obtain their permission before reproducing any third party (non NHSBSA Copyright) information.

Tags: Drug data, NHS Prescriptions
Organization: Freedom of Information Disclosure Log