Abstract
BackgroundIn March 2018, NHS England published guidance for clinical commissioning groups (CCGs) to encourage implementation of policy to reduce primary care prescriptions of over-the-counter medications, including simple analgesia.AimTo investigate the impact of guidance publication on prescribing rates of simple analgesia (oral paracetamol, oral ibuprofen, and topical non-steroidal anti-inflammatory drugs) in primary care; CCG guidance implementation intentions; and whether the guidance has created health inequality based on socioeconomic status.Design and settingInterrupted time series analysis of primary care prescribing data in England.MethodPractice-level prescribing data from January 2015 to March 2019 were obtained from NHS Digital. Interrupted time series analyses were used to assess the association of guidance publication with prescribing rates. The association between practice-level prescribing rates and Index of Multiple Deprivation scores before and after publication was quantified using multivariable Poisson regression. Freedom of information requests were submitted to all CCGs.ResultsThere was a statistically significant 4.4% reduction in prescribing of simple analgesia following guidance publication (adjusted incidence rate ratio 0.96, 95% CI = 0.92 to 0.99, P = 0.027), adjusting for underlying time trend and seasonality. There was considerable diversity across CCGs in whether or how they chose to implement the guidance. Practice-level prescribing rates were greater in more deprived areas.ConclusionGuidance publication was associated with a small reduction in the prescribing rates of simple analgesia across England, without evidence of creating additional health inequality. Careful implementation by CCGs would be required to optimise cost saving to the NHS.
Highlights
In light of the current funding deficit in the NHS, it is imperative that spending is made more efficient1 — a sentiment acknowledged by The NHS Long Term Plan published in 2019.2 One previously identified key area for improvement is medication optimisation: ensuring medicines are both clinically effective and cost-effective.[3]
Guidance publication was associated with a small reduction in the prescribing rates of simple analgesia across England, without evidence of creating additional health inequality
NHS England published guidance in March 2018 specifying medications that should not be routinely prescribed in primary care, including items that are available for purchase over the counter.[5]
Summary
In light of the current funding deficit in the NHS, it is imperative that spending is made more efficient1 — a sentiment acknowledged by The NHS Long Term Plan published in 2019.2 One previously identified key area for improvement is medication optimisation: ensuring medicines are both clinically effective and cost-effective.[3] Pharmaceutical spending is a common source of financial strain on healthcare systems worldwide, and is one of the highest NHS expenditures, second only to staffing.[4] NHS England published guidance in March 2018 specifying medications that should not be routinely prescribed in primary care, including items that are available for purchase over the counter.[5] While this guidance allows for a nationally coordinated response, the decision to implement it as a policy, as well as the choice of implementation strategies, lies with clinical commissioning groups (CCGs) — statutory regional NHS bodies that are responsible for the planning and commissioning of healthcare services for their local area.[6]. March 2018, NHS England published guidance for clinical commissioning groups (CCGs) to encourage implementation of policy to reduce primary care prescriptions of overthe-counter medications, including simple analgesia
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