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

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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.

Drugs used in psychoses and related disorders

Also known as antipsychotics, these drugs are used to treat psychoses and related disorders. These drugs are classified and described under the BNF 68 section 4.2:

• BNF paragraph 4.2.1 - Antipsychotic drugs
• BNF paragraph 4.2.2 - Antipsychotic depot injections
• BNF paragraph 4.2.3 - Drugs for mania and hypomania

Source: Quarterly Summary Tables - Quarterly table

3.32 million drugs used in psychoses and related disorders items were prescribed for the third quarter of financial year 2020/21. This was a 3.56% increase from 3.20 million items compared with the same quarter a year ago, and a 3.38% increase from 3.21 million items in the previous quarter.

The number of patients prescribed one or more drugs used in psychoses and related disorders items in quarter three 2020/21 was 632 thousand. This was a 4.16% increase from 607 thousand patients compared with the same quarter a year ago, and a 2.22% increase from 619 thousand patients in the previous quarter.

Both the number of items prescribed and number of patients receiving one or more drugs used in psychoses and related disorders show an upward long-term trend. This has resulted in a 16.4% increase equating to 89 thousand additional patients, and a 16.9% increase equating to 479 thousand additional items, from quarter three 2015/16.

Source: Quarterly Summary Tables - Monthly table

The monthly time series for drugs used in psychoses and related disorders 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 9.19% decrease in prescribed items. In 2020 there was also a significant decrease in the number of items prescribed between July and August of 8.94% from 1.11 million to 1.02 million items, which is not usually observed at this time of the year. In quarter three 2020/21 there was a 7.47% increase in the number of items prescribed between November and December 2020, from 1.07 million to 1.14 million items. This continues the gradual upwards trend seen in this BNF section, with December 2020 seeing the highest number of monthly items prescribed in this series.

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.

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.

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.

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.

Drugs used in psychoses and related disorders

People experiencing psychoses may report hallucinations (seeing or hearing things that other people cannot see or hear) or delusional beliefs (believing things that are not actually true), and may exhibit personality changes and thought disorder. As well this, they may experience difficulty with social interaction and impairment in carrying out daily life activities.

You can find more information about psychoses and related disorders on 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.

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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.

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