2. Methodology
2.1 Changes to the methodology
Previous Prescribing Costs in Hospitals and the Community (PCHC)
reports were delivered by NHS Digital. For the secondary care medicines
data, these covered the overall cost at list price, before any
discounts, of medicines used in hospitals. This data was provided by
IQVIA, who collect data on issues from pharmacies in most hospitals in
England and apply costs to this data using the Drug Tariff and standard
price lists. Therefore, all costs given in these reports were medicine
costs at list price, also known as Net Ingredient Cost (NIC) in Primary
Care – this is the basic price of a drug excluding VAT and is not
necessarily the price the NHS paid.
Starting with the 2020/21 release, this publication by the NHSBSA
will be produced using data which reflects the actual costs paid by
hospitals (including applicable VAT), including any discounts. This data
is collated by RX-Info and is accessed via their Define system. Primary
care data will continue to be extracted from the NHSBSA Enterprise Data
Warehouse (EDW) and is consistent with previous releases by NHS
Digital.
In previous releases of PCHC data was presented at a national level
only. To allow for further exploration into the data this will now be
broken down to both costs by BNF Chapter, Section and ICB.
2.2 Limitations
Owing to commercial confidentiality, it is not possible to present
the secondary care data any lower then BNF Section. Actual costs include
any discounts, these prices are commercially sensitive so are not
publicly available, however, they can be significant for specific types
of drugs.
3. 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.
3.1. Changes to geographies
In previous releases of this publication the geographies used were
Region and Sustainability and Transformation Plans (STPs). Changes to
the NHS Organisational Structure mean that Integrated Care Boards (ICBs)
will replace STPs from July 2022. Further details of the changes can be
found at the NHS Digital Organisation Data Service website.
3.2. Actual Cost
An additional table has been included in this publication showing the
actual cost for prescription items dispensed in the community at
national level. Previous publications only included the Net Ingredient
Cost (NIC) for prescriptions dispensed in the community.
4. Strengths and limitations
4.1. Strengths
The main strength of these statistics is the completeness of the
primary care dataset and accuracy of information captured during
processing activities carried out by the NHSBSA. This dataset covers all
prescribing that has been dispensed in the community in England, with
consistency in the way data has been captured across the whole dataset.
All the data has come from the same administrative source. This
administrative data is required to be as accurate as possible as it is
used for paying dispensing contractors for services provided to NHS
patients.
The NHSBSA’s decision to transition to a single source of drug
information in April 2020 also means that the accuracy of these
statistics has increased, with known issues and limitations with the
previous legacy system being eliminated. This incorporates items
previously captured as unspecified drugs now being captured correctly
and an increase in the accuracy of capture of quantity information about
prescribed drugs. Also due to the editorial policy of DM+D, there is now
greater consistency in the naming of presentations.
Starting with the 2020/21 release, the publication by the NHSBSA will
be produced using data that reflects the actual costs paid by hospitals,
including any discounts.
Rx-Info have ‘normalised’ the secondary care data across the
different trusts. This makes it available in an easily comparable format
which is available from one single location, their Define system.
4.2. Limitations
4.2.1 Exclusions
These statistics exclude prescriptions that were issued but not
presented for dispensing and prescriptions that were not submitted to
the NHSBSA for processing and reimbursement. Prescriptions issued and
dispensed in prisons, by dispensing doctors, items personally
administered by medical professionals and private prescriptions are also
excluded, and so do not give a full picture of all prescribing in
England.
4.2.2 Undefined data
Within the secondary care dataset there are drugs, dressing,
appliances, and medical devices issued within hospitals in England which
are not included in the BNF. These are drugs manufactured as specials,
dressing, appliances, and medical devices which are not authored on the
Dictionary of Medicines and Devices (dm+d).
4.2.3 Central Rebates
Owing to commercial sensitivity, the central rebate figures are only
available at a national level. It is not possible to calculate this down
to the ICB and BNF Section levels like the primary and secondary care
datasets.
4.3. Uses of PCHC
See our Official
Statistics guidance table for a short summary of the key criteria
covered by PCHC. To expand on the points outlined in that document, see
the below summaries for suitable/unsuitable uses for PCHC.
4.3.1 PCHC can be used for:
- Obtaining a national view of costs for prescriptions dispensed in
hospitals and the community in England across the calendar year.
- Analysis of cost trends in by BNF Chapter, BNF Section and ICB.
- Allowing public scrutiny of national prescribing habits.
Additional data tables have also been supplied as part of the release
which enable analysis of some key areas of interest.
4.3.1 PCHC cannot be used for:
- Providing breakdowns for more granular geographies than ICB.
- Providing breakdowns further down the BNF hierarchy than BNF
Section.
- Providing a final figure representative of the total cost to the
NHS. For prescriptions issued in primary care, net ingredient cost
(NIC), does not consider all elements that contribute towards the final
cost to the NHS, for example remuneration to contractors, discounts,
advance payments, and patient charges.
- Providing analysis of the method of dispensing.
For prescriptions issued in primary care users should note that it is
only assumed that the items claimed for on the prescription forms are
the same as those dispensed to patients. Whilst it would break the
dispensing contractor terms of service to dispense another item (except
in instances where a Serious Shortage Protocol is in place), the NHSBSA
has no way of confirming this.
For medicines issued in hospitals data is reliant upon accurate
submission by hospitals to Rx-Info. This data is taken from the point in
time when the data becomes available but, hospital data can continue to
change past this point. Any changes would be reflected in the reporting
for the following financial year.
5. Revisions
Any revisions that we make to these statistics will be made in line
with our Revisions and
Corrections policy. Any significant errors that are identified
within these statistics after their publication that would result in the
contradiction of conclusions previously drawn from the data will be
notified of prominently on our website and any other platforms that host
these statistics, corrected as soon as possible, and communicated
clearly to users and stakeholders.
In line with principle Q2.5 – Sound methods, within the Code of
Practice of Statistics and our Revisions and Corrections policy we
are releasing data from 2016 to 2020 with this publication to maintain
as consistent a time series as possible for users after the changes in
methodology have been applied to these statistics.
7. Quality of the statistics
We aim to provide users of this publication with an evidence-based
assessment of its quality and the quality of the data from which it is
produced. We do so to demonstrate our commitment to comply with the UK
Statistics Authority’s (UKSA) Code of Practice for Statistics,
particularly the pillar of Quality and its principles.
Q1 Suitable data sources – Statistics should be
based on the most appropriate data to meet intended uses. The impact of
any data limitations for use should be assessed, minimised, and
explained.
Q2 Sound methods – Producers of statistics and data
should use the best available methods and recognised standards and be
open about their decisions.
Q3 Assured quality – Producers of statistics and
data should explain clearly how they assure themselves that statistics
and data are accurate, reliable, coherent, and timely.
This is an assessment of the quality of these statistics against the
European standard for quality reporting and its dimensions specific to
statistical outputs, particularly:
- Relevance
- Accuracy and reliability
- Timeliness and punctuality
- Accessibility
- Coherence and comparability
These principles guide us and are complimented by the UKSA’s
regulatory standard for the Quality Assurance of Administrative Data
(QAAD). You can view our QAAD assessment of prescription data on our
website.
7.1. Relevance
This dimension covers the degree to which the product
meets user need in both coverage and content
The PCHC publication, released annually, summarises the total costs
of all NHS prescriptions which have been issued in England for the
preceding financial years. The statistics also give cost breakdowns to
both BNF Section and ICB levels. The statistics cover from the 2016/17
financial year onwards, allowing the analysis of cost trends over time.
We believe that they can be used to inform policy decisions at a
national and local level, by the public to scrutinise prescribing
habits, and by academia and applied health researchers for matters
relating to public health.
We will be gathering feedback from users of these statistics on an
on-going basis to help shape them and ensure that they remain relevant
and of use.
7.2 Accuracy and Reliability
This dimension covers the statistics proximity between an
estimate and the unknown true value
7.2.1. Accuracy
These statistics are derived from data collected during processing
activities carried out by the NHSBSA to reimburse dispensing contractors
for providing services to NHS patients. Prescriptions are scanned and
subject to rigorous automatic and manual validation processes to ensure
accurate payments are made to dispensing contractors. Where electronic
prescriptions are used the scope for manual intervention and input into
data is reduced dramatically.
The figures used are collected as an essential part of the process of
reimbursing dispensing contractors (mainly pharmacists and dispensing
doctors) for medicines supplied. All prescriptions which are dispensed
in England need to be submitted to the NHSBSA if the dispenser is to be
reimbursed, and so coverage should be complete. Due to the manual
processes involved in the processing of prescriptions there may be
random inaccuracies in capturing prescription information which are then
reflected in the data. NHS Prescription Services, a division of NHSBSA,
internally quality assures the data that is captured from prescriptions
to a 99.70% level via a statistically valid random sample of 50,000
items that are reprocessed monthly. The latest reported Prescription
Processing Information Accuracy from NHS Prescriptions services,
which covers the 12 month period July 2021 to June 2022, is 99.92%.
7.2.2. Reliability
Within the primary care data, as there is a manual data entry element
to this system then inevitably some small errors may occur in the data.
The NHSBSA and NHS Prescription Services take measures to minimise these
errors. This includes the presence of a permanent dedicated accuracy
team within NHS Prescription services which provides feedback to
operators around any errors identified to help prevent regular
occurrence.
7.3. Timeliness and punctuality
Timeliness refers to the time gap between publication and
the reference period. Punctuality refers to the gap between planned and
actual publication dates
The PCHC publication is published annually. The publication date is
determined by the availability of the datasets.
Primary care data is dependent on the completion of processing by NHS
Prescription Services, allowing adequate time for the compilation and
quality assurance of the publication. The data is usually available six
weeks after the end of the month that the data relates to.
Secondary care data is collated from hospital trusts by Rx-Info.
Rx-Info run an annual exercise where data is finalised for a financial
year and any further ‘backtracking’ cannot occur, this occurs in July
every year. We will look to bring the release forward in the year where
available resource allows and in line with user feedback.
Future releases will be announced in advance in line with our statistical
release calendar.
7.4. Accessibility and clarity
Accessibility is the ease with which users can access the
data, also reflecting the format in which the data are available and the
availability of supporting information. Clarity refers to the quality
and sufficiency of the metadata, illustrations, and accompanying
advice
The statistical summary narrative for this publication is presented
as an HTML webpage, with supporting documentation also released in HTML
format. Summary data and additional analysis is presented in tables in
Excel files.
The R code used to produce the publication will also be made
available from the NHSBSA GitHub in due
course.
Clarity
A glossary of terms is included in this document.
7.5. Coherence and comparability
Coherence is the degree to which data have been derived
from different sources or methods but refer to the same topic or
similar. Comparability is the degree to which data can be compared over
time and domain
7.5.1. Comparisons over time
Changes to the figures displayed in these statistics over time should
be interpreted in the context of the wider prescribing system, including
the availability of medicines, release of new medicines and their costs,
and changing national and regional prescribing guidelines.
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 PCA data. This data is
therefore correct at the time of publication but may differ in the
following year. The NHSBSA publishes the latest BNF information each
year via its information systems.
The data for secondary care is provided by Rx-Info. Rx-Info use an
extract from the dm+d to obtain BNF classifications. This data is only
available back to April 2016. This differs from other NHSBSA releases,
but the time series will be expanded each year until a full rolling
10-year period is achieved.
8. Glossary of terms used in these statistics
Actual costs within primary care
Actual cost is the cost recharged to NHS commissioners for the
provision of drugs, appliances, and medical devices by dispensing
contractors. It is calculated as the basic price of a product (Net
Ingredient Cost) less the national average discount percentage (NADP)
plus payments for consumables, out of pocket expenses (OOPE), and
payments for containers:
Actual cost = net ingredient cost * (1 – NADP) + payments for
consumables + OOPE + payment for containers
The NADP is calculated using the discount rates applied to individual
dispensing contractors according to the Drug Tariff for England and
Wales for Pharmacy and Appliance contractors and the General Medical
Services Statement of Financial Entitlement Annex G Part 1 for
Dispensing Doctors and Personal Administration accounts.
Actual cost is not reflective of the payment made to a dispensing
contractor for the cost of the individual drugs dispensed and excludes
other fees paid that a prescription item may attract.
Actual costs within secondary care
Actual amount paid by the NHS for the medicines, taking into account
any local, regional or national contract prices, Patient Access Scheme
(PAS) or commercial access agreements.
Costs at list price – net ingredient cost
In British pound sterling (GBP). The amount that would be paid using
the basic price of the prescribed drug or appliance and the quantity
prescribed, sometimes called ‘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.
Dispensed in hospitals
When a prescription item is dispensed in a hospital this means that
it has been dispensed via the hospital pharmacy, homecare companies and
outsourced out-patient pharmacy partnerships.
Integrated Care Board (ICB)
Integrated care boards (ICBs) are a statutory NHS organisation
responsible for developing a plan in collaboration with NHS
trusts/foundation trusts and other system partners for meeting the
health needs of the population, managing the NHS budget and arranging
for the provision of health services in the defined area. They took over
the functions of Sustainability and Transformation Partnerships (STPs)
in July 2022.
Population estimates
The Office for National Statistics (ONS) produces annual estimates of
the resident population of England and on 30 June every year. The most
authoritative population estimates come from the census, which takes
place every 10 years in the UK. Population estimates from a census are
updated each year to produce mid-year population estimates (MYEs), which
are broken down by local authority, sex and age.