FOI-01111

Thank you for your request for information about the following:

I would like to request the following information on Hormone replacement therapy (HRT) prescriptions in England please.

1 - Monthly and yearly data on the number of HRT prescription items, identified patient rate, the number of identified patients, total net ingredient cost.

Monthly and yearly HRT prescription data broken down by BNF paragraph and identified patients, by chemical substance and identified patients, and by presentation.

2 - Financial year data on the number of identified patients, Mid-year Population Year, Mid-year Population Estimate, and Patients per 1,000 Population.

For the monthly data, please provide the latest available figures for the months beginning in July 2022 and historical monthly data until March 2015.

For financial year data, please provide them for the year 2022/2023, and the years before (not including ) 2015/2016.

You clarified your request with the following:
Thank you very much for getting back to me. I will wait until you have all of the data for 2022/2023.
You said you had no identifiable patients for before April 2015 so cannot provide any historical data. Do you have historical data on the other information I requested? Please do include what you have. Many thanks.

Can I also ask you to please include an age breakdown of identifiable patients for the year 2022/2023 in groups 0-4, 5-9, 10-14, 15-19, 20-24, 25-29, 30-34, 35-39, 40-44, 45-49, 50-54, 55-59, 60-64, 65-69, 70-74, 75-79, 80-84, 85-89, 90+?

Your clarified request was received on 1 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. The data for question 1 has been split up as follows:

[part a] Monthly and yearly data on the number of HRT prescription items, identified patient rate, the number of identified patients, total net ingredient cost.

Monthly and yearly HRT prescription data broken down by [part b] BNF paragraph and identified patients, [part c] by chemical substance and identified patients, and [part d] by presentation.

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 2014 - March 2015 and April 2022 - March 2023.

Yearly data is provided for the financial years 2014/2015 and 2022/2023 

Monthly data is provided for periods January 2014 - March 2015 (except for patient counts) and June 2022 - March 2023

###Drugs
Limited to drugs prescribed in the following BNF Paragraphs:

	060401 - female sex hormones and their modulators

	070201 - preparations for vaginal and vulval changes  

There is not one singular definition of HRT medications and many other products may be used in the treatment of the menopause that are not included in this data.

These medicines are classified by their primary therapeutic indication. However, it is possible that they can be prescribed for other reasons outside of this primary therapeutic indication. The clinical indication of a prescription is not captured by NHSBSA during processing, and therefore we cannot determine the reason that a prescription was issued.

###Organisation Data	
Prescribing is limited to prescribing in English Primary Care settings only, but no limits on dispensing.

###Identified patients/patient counts
Patients have been counted only if their NHS number was captured during NHSBSA processing.  The patient's NHS number may not be captured if, for example, it was not known at the time of writing the prescription, or it was hand-written on a paper prescription and the OCR scanners were unable to read it.  

NHS numbers were not captured in the data before April 2015, so patient counts are not able to be provided for any time before this.

0.91% of all items prescribed in this data set after March 2015 were unable to be attributed to an NHS number.

Patients may appear in more than one count, for example across time periods, BNF presentations or age bands.  Aggregating patient counts will likely result in double counting of individuals. Therefore you may not present these patient counts in any way other than is done so in these data sets.

###Identified Patient rate
The identifeid patient rate is calculated by dividing the number of items attributed to an identified NHS number by the total number of items, multiplied by 100.


###Age
The age used for this analysis is the age that is captured during NHSBSA processing.  Patient age has then been grouped into five-year age bands.  Note that a patient may appear in more than one age band if their age changes in the time period. Therefore patient counts should not be aggregated across age bands.

NHSBSA stores information on the age of the recipient of each prescription as it was read by computer from images of paper prescriptions or as attached to message sent through the electronic prescription system. The NHSBSA does not validate, verify or manually check the resulting information as part of the routine prescription processing. However an additional check is carried out on a yearly basis to check the capture rate and accuracy of the stored patient information. The results of this check for the most recent time period available (January 2020 to December 2020) show that for both paper and electronic prescriptions patient age was captured from 94.88% of prescription forms and the accuracy of age data captured was 99.95%. Checks revealed issues in the reliability of age data in particular the quality of the stored age data was poor for patients recorded as aged 2 years and under. When considering the accuracy of age data it is expected that a small number of prescriptions may be allocated against any given patient age incorrectly. 

###Population Data
NHSBSA does not hold population data - this can be sourced from the Office for National Statistics (ONS). Therefore parts of this request relating to mid-year population, mid-year population estimates and patients per 1,000 population were not answered

###Items
Items shows the number of times a product appears on a prescription form not the quantity prescribed.

###Net Ingredient Cost (NIC) GBP
Net Ingredient cost (NIC) is the basic price of a drug as stated in Part II Clause 8 of the Drug Tariff but please note that where a price concession for items listed in Part VIIIA of the Drug Tariff has been agreed between the Department of Health and Social Care (DHSC) and the Pharmaceutical Services Negotiating Committee the NIC will reflect the concession price rather than the Drug Tariff price.

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 nhsbsa.communicationsteam@nhs.net. 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: NHS Prescription Services, NHS Prescriptions
Organization: Freedom of Information Disclosure Log