England April 2015 to December 2020
Quarterly Summary Statistics
Published 4 March 2021
Key findings
20.5 million antidepressant drugs were prescribed between October and December 2020. This was a 5% increase from 19.6 million items in the previous quarter, and a 6% increase from 19.3 million items when compared with the same quarter in 2019/20.
Prescribing of drugs for dementia continued to show a downward trend. 1.02 million items of drugs for dementia were prescribed between October and December 2020, a 5% decrease from the same quarter in 2019/20. There were 226 thousand identified patients between October and December 2020, a 4% decrease in patients from the same quarter in 2019/20.
All of the drug groups observed a larger increase in monthly prescribing between November and December 2020 than between November and December 2019. On average, this was 5 percentage points greater than the increases observed between November and December 2019.
1. Introduction
Mental health is a key area of the NHS Long Term Plan published in 2019.
This publication aims to describe the prescribing of medicines used to improve mental health, in a primary care setting in England that are subsequently dispensed in the community. They do not include data on medicines used in secondary care, prisons, or issued by a private prescriber.
These statistics use the BNF therapeutic classifications defined in the British National Formulary (BNF) using the classification system prior to BNF edition 70. Each January the NHSBSA updates the classification of drugs within the BNF hierarchy which may involve some drugs changing classification between years of data. Five sections of the British National Formulary (BNF) are covered within these statistics:
- Hypnotics and anxiolytics
- Drugs used in psychoses and related disorders
- Antidepressant drugs
- CNS stimulants and drugs used for ADHD
- Drugs for dementia
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. For example, some antidepressants can be used to treat people suffering from chronic primary pain. 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. Drug therapy is just one way that mental health conditions can be treated. These statistics do not give an indication of the number of patients accessing other mental health services, such as psychological therapies. Due to this, these statistics may not give an accurate estimation of the population receiving treatment for a specific mental health condition.
Throughout this publication the term ‘item’, short for ‘prescription item’, means a single instance of a drug that is listed as a separate entry on a prescription form. For example, Fluoxetine 20mg tablets x56.
There are many costs incurred when a dispensing contractor fulfils a prescription, such as the single activity fee or controlled drug fees. The costs reported in this publication represent the basic price of the item and the quantity prescribed. This is 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 not in Part VIII, the price is usually taken from the manufacturer, wholesaler or supplier of the product.
The first national lockdown introduced as a response to the coronavirus pandemic (COVID-19) was implemented between 23rd March and 4th July 2020, with the second national lockdown between 5th November and 2nd December 2020. Both of these periods are considered as part of this publication. The impact of the end of the Brexit transition period on 31st December 2020 will not be reflected in this publication. It is important to note that these statistics cannot infer causality of lockdown measures on the prescribing figures but any inferences made should consider the impact of changing restrictions across 2020.
This publication presents data from April 2015 to December 2020, the most recent available.
References to quarters in these statistics are:
- Q1 refers to the first quarter (April to June) of the given financial year. For example, Q1 2015/16 refers to the period April 2015 to June 2015.
- Q2 refers to the second quarter (July to September) of the given financial year. For example, Q2 2015/16 refers to the period July 2015 to September 2015.
- Q3 refers to the third quarter (October to December) of the given financial year. For example, Q3 2015/16 refers to the period October 2015 to December 2015.
- Q4 refers to the fourth quarter (January to March) of the given financial year. For example, Q4 2015/16 refers to the period January 2016 to March 2016.
You can go to the Medicines Used in Mental Health - England webpage to find the most recent annual summary, background information, and explanatory notes that apply to the statistics presented in this release.
Patient identification
When the NHSBSA processes prescriptions, the NHS number of the patient is identified for most, but not all, prescriptions. The proportion of items for which a patient could be identified is shown in table 1. This means that data relating to patient counts represents most, but not all, patients.
In this release the term ‘patient/s’ is used to mean a unique, valid NHS number that has been captured from a prescription form and subsequently verified by the NHS Personal Demographics Service (PDS). Across 2020, use of the Electronic Prescription Service (EPS) has increased considerably during the COVID-19 pandemic. For example, in December 2019, 74% of medicines used in mental health items were prescribed using EPS, and by December 2020 this figure had increased to 90%. As this process captures NHS numbers digitally rather than through scanned paper forms, this has naturally led to an increase in the proportions of identified patients in 2020/21 than seen in previous years.
Table 1: The proportion of items for which an NHS number was recorded for listed BNF sections 2020/2021
2. Results and commentary
The charts in this report are interactive and allow you to isolate the topics that you are interested in by selecting or deselecting a series from the legend of the chart. For example, if you only want to view a single series on a chart, you can click the series names you are not interested in within the legend of the chart. This will remove the item from the charts. If you wish to subsequently include them just click their legend entry again.
Hypnotics and anxiolytics
Hypnotics are used to treat insomnia - a difficulty getting to sleep or staying asleep long enough to feel refreshed. Most hypnotics will sedate if given during the day. Anxiolytics are used in the treatment of anxiety states and if given at night will help to induce sleep. The drugs classified as hypnotics and anxiolytics are described in the BNF 68 section 4.1:
- BNF paragraph 4.1.1 - Hypnotics
- BNF paragraph 4.1.2 - Anxiolytics
- BNF paragraph 4.1.3 - Barbiturates
Source: Quarterly Summary Tables - Quarterly table
3.65 million hypnotics and anxiolytics items were prescribed during the third quarter of financial year 2020/21. This was a 1.11% decrease from 3.69 million items compared with the same quarter a year ago, but a 3.18% increase from 3.54 million items in the previous quarter. This continues the long-term trend for hypnotics and anxiolytics which have been steadily declining in usage since 2015/16. This has resulted in 432,000 fewer items per quarter since quarter three 2015/16, a decrease of 10.6%.
1.08 million patients were prescribed at least one hypnotic and anxiolytic item in the third quarter of 2020/21. This was a 2.44% decrease from 1.11 million patients compared with the same quarter a year ago, but a 3.14% increase from 1.05 million patients in the previous quarter. The long-term trends for patients receiving one or more hypnotic and anxiolytic items match that for prescribed items, resulting in 154 thousand fewer patients from quarter three 2015/16, a decrease of 12.5%.
Source: Quarterly Summary Tables - Monthly table
The monthly time series for hypnotics and anxiolytics show some regular patterns as well as month-to-month variation. Some of the regular changes may reflect seasonal patterns; most notably there tends to be less prescribing in months with fewer dispensing days, such as February.
The largest monthly decrease is usually observed from January to February, which in 2020 accounted for a 10.1% decrease in prescribed items. In quarter three, a decrease of 3.76% was observed in November, though this has been observed every November with the exception of 2016. 1.26 million hypnotics and anxiolytics were prescribed in December 2020. This was a 7.67% increase in items which is the highest month-on-month increase for December since 2015, which had a 9.41% increase from November 2015.
Prescribing during the COVID-19 pandemic - items
National lockdowns were implemented between 23rd March and 4th July 2020, and 5th November to 2nd December 2020, with varying local restrictions in the time after lockdown rules were relaxed. There were 12.0 million hypnotic and anxiolytic items prescribed in the 10 months March to December 2020. This was a 1.95% decrease from the 12.2 million items prescribed when compared with the same 10 months in 2019. This continued the decrease seen in this BNF section against the same months in previous years, where a 2.04% decrease was noted from March-December 2018 to March-December 2019.
The rate of change in items in 2019 was used to calculate how many items would expect to be prescribed in 2020 based on annual trends, and this figure was compared to 2020 actual figures. Across 2020 as a whole, the rate of decline in prescribing of hypnotics and anxiolytics accelerated - that is, fewer items were prescribed than would be expected based on trends in 2019. This resulted in 240 thousand fewer items prescribed in 2020 than would have been expected if it had followed the pattern of previous years.
Prescribing during the COVID-19 pandemic - patients
As patients can appear in more than one month of data, adding the patients for different months together would result in an inaccurate estimate of the number of unique patients that have received prescribing in this period. Therefore, we have calculated the mean average number of patients for comparison purposes. This average is calculated by summing the number of patients for the periods in question and dividing that by the number of months in the period.
The number of patients each month is consistent with the long-term trend for hypnotics and anxiolytics, which have been decreasing in usage since April 2015. In the 10 months between March and December 2020, there were an average of 694 thousand patients per month, a 1.10% decrease against the same months in 2019 which averaged 702 thousand patients per month. This shows a slowing down to the rate of reduction against previous years, with March-December 2019 showing a 2.39% decrease in average monthly patients compared to 2018, and a 3.38% reduction in 2018 compared to 2017.
The expected number of monthly patients were calculated by extrapolating from monthly patient numbers in 2019 as if the trend continued for 2020, and comparing this against 2020 actual monthly figures. Across 2020 as a whole the rate of decrease in identified patients receiving hypnotics and anxiolytics slowed down. This resulted in up to an additional 10,200 identified patients per month than expected based on 2019 trends.
Antidepressant drugs
Antidepressant drugs are effective for treating moderate to severe depression. Antidepressant drugs are not generally advised for the routine treatment of mild depression, and psychological therapy should be considered initially. However, a trial of antidepressant therapy may be considered in cases resistant to psychological treatments or associated with other problems.
Antidepressant drugs are described in the BNF 68 section 4.3:
- BNF paragraph 4.3.1 - Tricyclic and related antidepressant drugs
- BNF paragraph 4.3.2 - Monoamine-oxidase inhibitors (MAOIs)
- BNF paragraph 4.3.3 - Selective serotonin re-uptake inhibitors (SSRIs)
- BNF paragraph 4.3.4 - Other antidepressant drugs
Source: Quarterly Summary Tables - Quarterly table
20.5 million antidepressant drug items were prescribed in the third quarter of financial year 2020/21. This was a 5.78% increase from 19.3 million items compared with the same quarter a year ago, and a 4.51% increase from 19.5 million items in the previous quarter. Antidepressant drugs have been steadily increasing in usage since 2015, with an increase of 4.46 million items per quarter from quarter three 2015/16 to quarter three 2020/21, an increase of 27.9%.
6.16 million patients were prescribed at least one antidepressant drug item in quarter three of 2020/21. This was a 4.54% increase from 5.89 million patients when compared with the same quarter in 2019/20, and a 2.54% increase from 6.01 million patients in the previous quarter. The long-term trends for patients receiving antidepressant drugs are similar to the overall prescribing of items. 1.15 million more patients received an antidepressant item in quarter three 2020/21 compared to quarter three 2015/16, an increase of 22.8%.
Source: Quarterly Summary Tables - Monthly table
The monthly time series for antidepressant drugs show some regular patterns as well as month-to-month variation. Some of the regular changes may reflect seasonal patterns; most notably there tends to be less prescribing in months with fewer dispensing days, such as February.
The largest monthly decrease is usually observed from January to February, which in 2020 accounted for a 9.02% decrease in prescribed items. However, in 2020 there was larger decrease in the number of items prescribed from July to August of 9.30% from 6.77 million to 6.15 million items, which is not usually observed at this time of the year. There was a month-on-month increase from November to December 2020 of 7.32% from 6.58 million items per month to 7.06 million items per month. This is a larger month-on-month increase than seen between November and December 2019, where there was a 1.65% increase from 6.33 million items to 6.43 million items.
Prescribing during the COVID-19 pandemic - items
National lockdowns were implemented between 23rd March and 4th July 2020, and 5th November to 2nd December 2020, with varying local restrictions in the time after lockdown rules were relaxed. There were 66.1 million antidepressant items prescribed in the 10 months March to December 2020. This was a 5.11% increase from 62.8 million items when compared with the same 10 months in 2019.
The rate of change in items in 2019 was used to calculate how many items would expect to be prescribed in 2020 based on annual trends, and this figure was compared to 2020 actual figures. Across 2020 as a whole, the rate of increase in prescribing of antidepressants slowed - that is, fewer items were prescribed than would be expected based on trends in 2019. This resulted in 1.64 million fewer items prescribed in 2020 than would have been expected if it had followed the pattern of previous years.
Prescribing during the COVID-19 pandemic - patients
As patients can appear in more than one month of data, adding the patients for different months together would result in an inaccurate estimate of the number of unique patients that have received prescribing in this period. Therefore, we have calculated the mean average number of patients for comparison purposes. This average is calculated by summing the number of patients for the periods in question and dividing that by the number of months in the period.
The monthly average number of patients receiving at least one antidepressant item in the 10 months March to December 2020 was 4.23 million. This was an increase of 6.24% from an average of 3.98 million patients when compared with the same 10 month period in 2019.
This is broadly consistent with the long-term trend for antidepressants, which have seen an increase in monthly patient numbers since April 2015 though this is a bigger increase than seen in previous years. The increase in average monthly patients from March-December 2018 to March-December 2019 was 4.72%, and from March-December 2017 to March-December 2018 the increase was 4.11%.
The expected number of monthly patients were calculated by extrapolating from monthly patient numbers in 2019 as if the trend continued for 2020, and comparing this against 2020 actual monthly figures. Across 2020 as a whole the rate of increase in identified patients receiving antidepressants accelerated. This resulted in up to an additional 38,500 more identified patients per month than expected based on 2019 trends.
Central nervous system stimulants and drugs used for attention deficit hyperactivity disorder
CNS stimulants and drugs used for ADHD are described in the BNF 68 section 4.4:
- BNF chemical substance 0404000D0 - Caffeine
- BNF chemical substance 0404000E0 - Caffeine citrate
- BNF chemical substance 0404000L0 - Dexamfetamine sulfate
- BNF chemical substance 0404000M0 - Methylphenidate hydrochloride
- BNF chemical substance 0404000R0 - Modafinil
- BNF chemical substance 0404000S0 - Atomoxetine hydrochloride
- BNF chemical substance 0404000T0 - Dexmethylphenidate hydrochloride
- BNF chemical substance 0404000U0 - Lisdexamfetamine dimesylate
- BNF chemical substance 0404000V0 - Guanfacine
- BNF chemical substance 0404000W0 - Pitolisant hydrochloride
Source: Quarterly Summary Tables - Quarterly table
487 thousand CNS stimulants and drugs used for ADHD were prescribed in the third quarter of financial year 2020/21. This was a 6.14% increase from 459 thousand items compared with the same quarter a year ago, and a 10.6% increase from 440 thousand items in the previous quarter.
130 thousand patients were prescribed at least one CNS stimulant and drugs used for ADHD item in the third quarter of 2020/21. This was a 7.52% increase from 121 thousand patients compared with the same quarter a year ago, and a 7.25% increase from 121 thousand patients in the previous quarter.
These increases in the numbers of items prescribed and patients identified are consistent with the long-term trends for CNS stimulants and drugs used for ADHD following a sharp decrease in quarter one of 2020/21.
Source: Quarterly Summary Tables - Monthly table
The monthly time series for CNS stimulants and drugs used in ADHD show some regular patterns as well as month-to-month variation. Some of the regular changes may reflect seasonal patterns; most notably there tends to be less prescribing in months with fewer dispensing days, such as February.
The largest monthly decrease is usually observed from January to February, which in 2020 accounted for an 8.11% decrease in prescribed items. In 2020 there was also a significant decrease in the number of items prescribed between July and August of 9.34% from 149 thousand to 135 thousand items, which is not usually observed at this time of the year. There was a month-on-month increase from November to December 2020 of 4.04% from 159 thousand items per month to 166 thousand items per month. This is a larger month-on-month increase than seen between November and December 2019, where there was a 0.89% increase from 151 thousand items to 153 thousand items.
Prescribing during the COVID-19 pandemic - items
National lockdowns were implemented between 23rd March and 4th July 2020, and 5th November to 2nd December 2020, with varying local restrictions in the time after lockdown rules were relaxed. There were 1.52 million CNS stimulants and drugs used for ADHD items prescribed in the 10 months March to December 2020. This was a 3.64% increase from 1.47 million items when compared with the same 10 months in 2019.
The rate of change in items in 2019 was used to calculate how many items would expect to be prescribed in 2020 based on annual trends, and this figure was compared to 2020 actual figures. Across 2020 as a whole, the rate of increase in prescribing of CNS stimulants and drugs used for ADHD slowed - that is, fewer items were prescribed than would be expected based on trends in 2019. This resulted in 118 thousand fewer items prescribed in 2020 than would have been expected if it had followed the pattern of previous years.
Prescribing during the COVID-19 pandemic - patients
As patients can appear in more than one month of data, adding the patients for different months together would result in an inaccurate estimate of the number of unique patients that have received prescribing in this period. Therefore, we have calculated the mean average number of patients for comparison purposes. This average is calculated by summing the number of patients for the periods in question and dividing that by the number of months in the period.
The monthly average number of patients receiving at least one CNS stimulant or drug used for ADHD item in the 10 months March to December 2020 was 87,700. This was an increase of 9.14% from an average of 80,400 patients when compared with the same 10 month period in 2019.
This is broadly consistent with the long-term trend for CNS stimulants and drugs used for ADHD, which have seen an increase in monthly patient numbers since April 2015, though this has slowed down since last year. The increase in average monthly patients from March-December 2018 to March-December 2019 was 13.5%, a much higher increase than in other years, and from March-December 2017 to March-December 2018 the increase was 7.25%.
The expected number of monthly patients were calculated by extrapolating from monthly patient numbers in 2019 as if the trend continued for 2020, and comparing this against 2020 actual monthly figures. Across 2020 as a whole the rate of increase in identified patients receiving CNS stimulants and drugs used for ADHD slowed down. This resulted in up to 3,660 fewer identified patients per month than expected based on 2019 trends.
Drugs for dementia
Dementia is a progressive clinical syndrome characterised by a range of cognitive and behavioural symptoms that can include memory loss, problems with reasoning and communication, a change in personality, and a reduced ability to carry out daily activities such as washing or dressing. Alzheimer’s disease is the most common type of dementia; other common types of dementia include vascular dementia (where dementia is due to cerebrovascular disease), dementia with Lewy bodies (where dementia is due to protein deposits in the brain), mixed dementia, and frontotemporal dementia (where dementia is due to progressive nerve loss in either the frontal or temporal lobes of the brain).
Drugs for dementia are described in the BNF 68 section 4.11:
- BNF chemical substance 0411000D0 - Donepezil hydrochloride
- BNF chemical substance 0411000E0 - Rivastigmine
- BNF chemical substance 0411000F0 - Galantamine
- BNF chemical substance 0411000G0 - Memantine hydrochloride
Source: Quarterly Summary Tables - Quarterly table
1.02 million drugs for dementia were prescribed in the third quarter of financial year 2020/21. This was a 5.28% decrease from 1.08 million items compared with the same quarter a year ago, but a 2.13% increase from 1.00 million items in the previous quarter.
226 thousand patients were prescribed at least one drugs for dementia item in quarter three of 2020/21. This was a 3.77% decrease from 235 thousand patients compared with the same quarter a year ago, and a 0.95% increase from 224 thousand patients in the previous quarter.
Typically, the pattern of prescribing follows a decrease between quarter three and four, followed by three consecutive increases from quarter four to quarter three of the next year. However, this year only quarter three has seen an increase in items against the previous quarter following three consecutive quarters of decreases from quarter three 2019/20.
Source: Quarterly Summary Tables - Monthly table
The monthly time series for drugs used in dementia show some regular patterns as well as month-to-month variation. Some of the regular changes may reflect seasonal patterns; most notably there tends to be less prescribing in months with fewer dispensing days, such as February.
The largest monthly decrease is usually observed from January to February, which in 2020 accounted for a 9.18% decrease in prescribed items. In 2020 there was also a significant decrease in the number of items prescribed between April and May of 8.64% and July and August of 7.98%, which are not usually observed at this time of the year. There was a month-on-month increase from November to December 2020 of 6.30% from 330 thousand items per month to 351 thousand items per month. This is a larger month-on-month increase than seen between November and December 2019, where there was a 1.00% increase from 354 thousand items to 358 thousand items.
Prescribing during the COVID-19 pandemic - items
National lockdowns were implemented between 23rd March and 4th July 2020, and 5th November to 2nd December 2020, with varying local restrictions in the time after lockdown rules were relaxed. There were 3.42 million drugs for dementia items prescribed in the 10 months March to December 2020. This was a 2.39% decrease from 3.50 million items when compared with the same 10 months in 2019.
The rate of change in items in 2019 was used to calculate how many items would expect to be prescribed in 2020 based on annual trends, and this figure was compared to 2020 actual figures. Across 2020 as a whole, the rate of increase in prescribing of drugs for dementia slowed - that is, fewer items were prescribed than would be expected based on trends in 2019. This resulted in 438 thousand fewer items prescribed in 2020 than would have been expected if it had followed the pattern of previous years.
Prescribing during the COVID-19 pandemic - patients
As patients can appear in more than one month of data, adding the patients for different months together would result in an inaccurate estimate of the number of unique patients that have received prescribing in this period. Therefore, we have calculated the mean average number of patients for comparison purposes. This average is calculated by summing the number of patients for the periods in question and dividing that by the number of months in the period.
The monthly average number of patients receiving at least one drug for dementia in the 10 months March to December 2020 was 189 thousand. This was a decrease of 0.30% from an average of 189 thousand patients when compared with the same 10 month period in 2019, and the first year to record a decrease since March-December 2016. The increase in average monthly patients from March-December 2018 to March-December 2019 was 4.78% and from March-December 2017 to March-December 2018 the increase was 3.52%.
The expected number of monthly patients were calculated by extrapolating from monthly patient numbers in 2019 as if the trend continued for 2020, and comparing this against 2020 actual monthly figures. Across 2020 as a whole the trend changed from an increase in patients in 2019 to a decrease in patients in 2020. This resulted in up to 11,100 fewer identified patients per month than expected based on 2019 trends.
3. Background
Hypnotics and anxiolytics
Hypnotics and anxiolytics are used to treat insomnia and anxiety respectively.
Insomnia is difficulty getting to sleep or staying asleep for long enough to feel refreshed the morning, despite there being enough opportunity to sleep. The most common problem with insomnia is difficult falling asleep (sleep-onset insomnia). An insomniac may also experience:
- waking in the night
- not feeling refreshed after sleep and not being able to function normally during the day
- feeling irritable and tired and finding it difficult to concentrate
- waking when they have been disturbed from sleep by pain or noise
- waking early in the morning
Anxiety is a feeling of unease, such as worry or fear, which can be mild or severe. Everyone experiences feelings of anxiety at some point in their life and feeling anxious is sometimes perfectly normal. However, people with generalised anxiety disorder (GAD) find it hard to control their worries. Their feelings of anxiety are more constant and often affect their daily life. There are several conditions for which anxiety is the main symptom. Panic disorder, phobias and post-traumatic stress disorder can all cause severe anxiety.
You can find more information about insomnia and anxiety from the NHS website.
Antidepressant drugs
Antidepressant drugs are licensed to treat major depression. Health professionals use the words depression, depressive illness or clinical depression to refer to depression. It is a serious illness and very different from the common experience of feeling unhappy or fed up for a short period of time. Depressed people may have feelings of extreme sadness that can last for a long time. These feelings are severe enough to interfere with daily life, and can last for weeks, months or years, rather than days.
It should be noted that antidepressant drugs are used for indications other than depression, for example migraine, chronic pain, myalgic encephalomyelitis (ME), or a range of other conditions. Clinical indication isn’t captured by the NHSBSA. Therefore, the statistics on these drugs do not relate solely to prescribing for depression.
You can find more information about depression on the NHS website.
Central nervous system stimulants and drugs used for ADHD
Attention deficit hyperactivity disorder (ADHD) and attention deficit disorder (ADD) refer to a range of problem behaviours associated with poor attention span. These may include impulsiveness and hyperactivity, as well as inattentiveness; behaviours that often prevent children and adults from learning and socialising. ADHD is sometimes referred to as hyperkinetic disorder (HD).
You can find more information about ADHD on the NHS website.
Drugs for dementia
Dementia is a disease that leads to progressive loss of brain function typified by memory loss, confusion, speech difficulties and problems in understanding. There are over 100 different types of dementia. The most common forms are:
- Alzheimer’s disease
- Vascular dementia
- Dementia with Lewy bodies
- Pick’s disease
- Huntington’s disease
- Alcohol-related dementia
- HIV/AIDS related dementia
Dementia mainly affects older people but can also occur in people as young as thirty due to either alcohol abuse or HIV/AIDS. No cure for dementia currently exists. However, drugs may slow the rate of decline or in some patients make a small improvement in symptoms. Despite this, disease progression is inevitable.
You can find more information about the various types of dementia on the NHS website.
4. About these statistics
This publication is part of a new series by NHSBSA. This quarterly summary is intended to supplement the annual summary statistics released in September 2020 and previous quarterly summaries.
Patient counts
The patient counts shown in these statistics should only be analysed at the level at which they are presented. Adding together any patient counts is likely to result in an overestimate of the number of patients. A person will be included, or counted, in each category or time period in which they received relevant prescriptions. For example, if a patient received a prescription item for an antidepressant drug in Q1 2020/21, and another in Q2 2020/21 then adding together those totals would count that patient twice. For the same reason, data on patient counts for different BNF sections should not be added together.
Item trends during COVID-19
The number of items prescribed for each BNF section in 2020 was compared to the number of items that would be expected to be prescribed based on 2019 trends. The monthly data was used for January to December 2019 to extrapolate expected figures for 2020 based on the rate of increase or decrease in prescribing in 2019. This method of forecasting meant that seasonality was averaged across the whole period and so the figures stated are for 2020 as a whole rather than the 10 months of March to December 2020, the time period considered elsewhere as the ‘COVID-19 period’. This model states expected figures if trends had continued as before but doesn’t confirm causation of any differences. Factors other than COVID-19 may have influenced prescribing, such as:
- Changes in patient behaviour, demographics or morbidity
- External environmental factors that could drive prescribing
- Any (and all) policy initiatives and guidance
- Other local priorities and resources
Identified patient trends during COVID-19
Where the average number of identified patients per month has been stated as an increase, this gives the upper limit of expected change due to prescribing pattern changes. Due to the increase in use of EPS and the subsequent increase on proportions of patients identified, identified patient volumes would naturally be expected to increase though we are unable to tell if those are patients that would have been identified already if they have received another prescription that month. Where identified patients per month have been stated as a decrease, the identified patient percentage change has been factored in to give a comparable figure. The narrative states figures as ‘up to’ to indicate to the reader that these are the maximum changes against trend rather than an absolute figure.
Averages
Where this document refers to ‘average’, this is the mean unless otherwise stated. This is calculated by adding the number of items/patients/months together and dividing this by the number of items/patients/months.
Planned changes to this publication
This is an experimental official statistic release. Experimental statistics are newly developed or innovative statistics. These are published so that users and stakeholders can be involved in the assessment of their suitability and quality at an early stage. We will regularly be reviewing the methodology used within the statistics.
We will be introducing measures relating to defined daily doses (DDDs) in a future release to allow for easier international comparisons.
5. Statistical disclosure control
Statistical disclosure control has been applied to these statistics. Patient count, items, and net ingredient cost (NIC) have been redacted in the supporting summary tables if they relate to fewer than 5 patients. Further information about our statistical disclosure control protocol can be found on our website.
The high level figures in this statistical summary 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 the supplementary tables have not been rounded.
6. Accessibility
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