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England 2019

Published 16 April 2020

Last reviewed and updated 9 December 2020


Key findings

  • In 2019 the cost of the prescriptions dispensed in the community in England was £9.08 billion. This was an increase of 2.81% (£248 million) from £8.83 billion in 2018.

  • The overall number of prescription items dispensed in the community in England in 2019 was 1.12 billion. This was an increase of 0.98% (10.9 million) from 1.109 billion in 2018.


This is a National Statistic

National statistics status means that our statistics meet the highest standards of trustworthiness, quality and public value, and it is our responsibility to maintain compliance with these standards.

National Statistics comply with all aspects of the Code of Practice for Statistics and are awarded National Statistics status following an assessment by the Office for Statistics Regulation (OSR), part of the UK Statistics Authority (UKSA). It is the NHSBSA’s responsibility to ensure that full compliance with the code is maintained for these statistics, raising any concerns with OSR promptly. National Statistic status can be withdrawn at any point when these high standards are not maintained.

The designation of this release as a National Statistic was confirmed in January 2012 following a full assessment against the Code of Practice by OSR.

This release is currently subject to a further assessment by OSR which will conclude in the next few months. We will publish our plan to address any requirements made from this assessment and detail the improvements completed in line with the relevant policy.

You can find out more about the UKSA, the OSR, and the Code of Practice for Statistics from the UKSA website.


1. Introduction

This publication includes information about the costs and volumes of prescriptions that were dispensed in the community in England in 2019.

In March 2020 the NHSBSA changed the way it classifies its pharmaceutical product information. Therefore statistics for each year from 2014 to 2018 have been represented to allow consistent comparisons between different years.

These statistics describe prescription items that were prescribed in a primary care setting in England, Scotland, Wales, Northern Ireland and the Channel Islands and subsequently dispensed in the community in England. Dispensed in the community means a prescription was dispensed in a pharmacy, by an appliance contractor, by a dispensing doctor or as a personally administered item. If a prescription item has been prescribed in England but has been dispensed elsewhere in the United Kingdom it will not be included within these statistics.

Throughout this publication the term ‘item’, short for ‘prescription item’, means a single instance of a drug, appliance or dressing that is listed as a separate entry on a prescription form. For example, Paracetamol 500mg tables x56.

There are many costs involved in the dispensing of a prescription item by a dispensing contractor. The costs displayed in this publication are the amount that would be paid using the basic price of the prescribed drug or appliance and the quantity prescribed, sometimes called the ‘Net Ingredient Cost’ (NIC). The basic price is given either in the Drug Tariff or is determined from prices published by manufacturers, wholesalers or suppliers. Basic price is set out in Parts VIII and IX of the Drug Tariff. For any drugs or appliances not in Part VIII, the price is usually taken from the manufacturer, wholesaler or supplier of the product.


2. Main findings

Total number of items and costs

There were 1.12 billion prescriptions items dispensed in England in 2019. These items had a total cost of 9.08 billion. Both the number of items dispensed and the costs of those items increased when compared to 2018. The number of items increased 0.98% from 2018 whilst costs increased by 2.81%.

The number of items dispensed in the community in England has increased each year since 2014.

Costs have fluctuated, with 2019’s total cost being lower than the cost in 3 of the previous 5 years.

Source: PCA 2019 - Presentation Data 2014 to 2019

  • There were 1,120 million prescription items dispensed in England in 2019.
  • There was a 0.98% increase in items dispensed in England between 2018 and 2019.
  • There was a 5.16% increase in items dispensed in England between 2014 and 2019.

Source: PCA 2019 - Presentation Data 2014 to 2019

  • The cost of prescription items dispensed in England for 2019 was £9,079 million.
  • This was an increase of 2.81% (£248 million) from 2018.
  • There was also an increase of 2.55% (£226 million) from 2014.

Prescribing by British National Formulary (BNF) chapter

These statistics use the therapeutic classifications defined in the British National Formulary (BNF) using the classification system prior to edition 70. Information on why a drug is prescribed is not available in this dataset. Since drugs can be prescribed to treat more than one condition, it may not be possible to separate the different conditions for which a drug may have been prescribed. NHS Prescription Services have created pseudo BNF chapters for items not included in BNF chapters 1 to 15. The majority of such items are dressings and appliances, which have been classified into six pseudo BNF chapters (18 to 23).

The BNF is a standard classification of medicines into conditions of primary therapeutic use. The broadest grouping of this classification is a BNF chapter. Figures 3 and 4 show the distribution of items and costs across these chapters. To find out what these chapters are you can go to the ‘England totals by BNF chapter’ table in the summary tables of this publication.

Source: PCA 2019 Additional Analysis - Table A8

There was an increase in the number of items prescribed between 2018 and 2019 in 13 of the 23 BNF chapters, with the largest increase of 4.1 million items in chapter 02 - ‘Cardiovascular system’. This increased by 1.24% compared to 2018.

The largest decrease in items was in chapter 13 - ‘Skin’, which fell by 1.9 million items, or 6.07% compared to 2018.

Source: PCA 2019 Additional Analysis - Table A8

Chapter 02 - ‘Cardiovascular system’ saw the largest increase in cost between 2018 and 2019 of £119.6 million. This increased by 9.59%. Chapter 02 - ‘Cardiovascular system’ has also seen the greatest increase in cost from 2014 and 2019 of £362.9 million, an increase of 36.17%.

The cost of some chapters has also decreased between 2018 and 2019. The cost of items in chapter 04 - ‘Central Nervous System’ decreased the most, by 3.66% (£55.4 million). Chapter 04 - ‘Central Nervous System’ saw the greatest decline in cost between 2014 and 2019 of 22.21% (£417 million).

Generic prescribing

Prescribers are encouraged to prescribe generic or unbranded products where possible and where it is clinically appropriate to do so. Generic prescribing can save money for the NHS as generic drugs are often cheaper than their proprietary, or ‘branded’ equivalents, especially those listed in the Drug Tariff for England and Wales.

Figure 5 shows the generic prescribing rates of items dispensed in the community in England between 2014 and 2019.

Source: PCA 2019 Additional Analysis - Table A5

Generic prescribing rates have remained consistent between 2014 and 2019. Generically prescribed items made up a smaller proportion of costs in 2019 than in 2014, having fallen by 2.2%.

The 10 most prescribed drugs

Figures 6 and 7 show the ten most prescribed products based on the total number of items dispensed and total cost respectively. These charts exclude dressings and appliances and show data aggregated to a chemical substance level.

Source: PCA 2019 Summary tables - England 2019 total by chemical substance.

Atorvastatin was the most prescribed product in England in 2019 with 45.8 million items dispensed. Atorvastatin is a type of statin that is used to lower cholesterol and to prevent heart disease.

Source: PCA Summary tables - England 2019 total by chemical substance.

Apixaban had the highest total cost for items dispensed in the community in England in 2019 of £290 million. Apixaban is an anticoagulant, used to treat people who have had a health problem caused by a blood clot or to prevent future blood clots. Drugs used to treat respiratory illnesses feature heavily in the top 10, making up 4 of the top 10 (Beclometasone dipropionate, Fluticasone propionate (Inhalation), Budesonide, Tiotropium bromide).


3. About these statistics

Changes made to this publication

In March 2020 the NHSBSA consolidated its sources of information on pharmaceutical products. As a result of this the format of the individual preparation, dressing and appliance names in this publication will be different to previous issues of this publication released by NHS Digital, and will be aligned with the Dictionary of Medicines and devices (DM+D).

Further changes were also made to the recording of quantities for certain presentations, particularly in relation to items dispensed in special containers, and also to the positions of some presentations in the BNF hierarchy.

These changes will not have any impact on the overall number of items and total cost reported in these statistics, but will impact the distribution of these items across the different levels of the BNF and the total quantity reported for some items.

To enable users to access consistent statistics over time this publication represents data from 2014 to 2019 in the new format.

These changes have improved the quality and relevance of these statistics by improving the accuracy of the data captured during the processing of prescriptions and allowing comparisons to be drawn more easily across other datasets, such as those used in secondary care, by using naming conventions aligned with DM+D.

Planned changes to this publication

Following the release of this publication the NHSBSA will be launching a public consultation on the statistical methodology that is used in these statistics and will be seeking feedback from users and stakeholders.

More information about these statistics

Further information about these statistics, including a glossary of terms and details on the methodologies used, can be found in the ‘Background information and methodology’ document included with this publication.


4. Rounding

The high level figures in this statistical summary narrative have been rounded where appropriate for clarity, in most cases to three significant figures. This is to make this narrative as accessible as possible to all readers. The summary tables released with this publication allow users to investigate this data at lower levels of granularity. Figures in these summary tables have not been rounded.


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6. Revisions to this document

14 September 2020:

  • Minor typographical changes made to correct spelling mistakes.
  • Information has been added to the introduction regarding the previous assessment of these statistics by OSR.
  • Link to continuous feedback survey added to feedback section.
  • Revisions section added.

9 December 2020:

  • Added an accessibility section.

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