Thank you for your request for information about the following:

Request

I am asking for information on specific British National Formulary (BNF) 1304 topical corticosteroid items dispensed in the community at three levels of potency over a five-year period (2018-2023) by NHS England. This latest query has been updated based on NHSBSA feedback. It is also a response to the recent MHRA Drug Safety Update on topical steroids and the reference to what the MHRA described as uncertainties […] regarding the numbers of patients receiving repeat prescriptions.

I have selected only those BNF1304 descriptors, I believe to be the most common, both generic and branded, mono-presentations dispensed for dermatological conditions such as atopic dermatitis. The exact data requested are listed in the Excel Workbook attached. Each of the three Excel sheets include BNF chemical substance descriptor and potency percentage levels for specific presentations listed: Sheet 1 = moderate; sheet 2 = potent; and sheet 3 = very potent.

1. Excel Sheet 1 – moderate potency topical corticosteroids

1A. Will the NHSBSA please provide annual item totals for presentations of 30g and 100g listed in the two BNF chemical substance descriptors on Excel Sheet 1 dispensed for each year from 2018 to 2023? Data to be grouped for BNF chemical substance descriptor clobetasone butyrate 0.05%. Data to be grouped for BNF chemical substance descriptor betamethasone valerate 0.025%

1B. Can the NHSBSA provide the number of patients who were repeatedly dispensed 100g of any of the presentations on Sheet 1 for: up to 2 years; up to 3 years; up to 4 years; and for up to five years.

1C. Can the NHSBSA provide an analysis of the numbers of individual patients who have been repeatedly dispensed: a) 600g - 900g and b) 1000g - 1300g per annum of any BNF presentation descriptor on Sheet 1 for: up to 2 years; up to 3 years; up to 4 years; and for up to five years.

1. Excel Sheet 2 - potent topical corticosteroids

2A. Will the NHSBSA please provide annual item totals for presentations of 30g and 100g listed in the two BNF chemical substance descriptors on Excel Sheet 2 dispensed for each year from 2018 to 2023? Data to be grouped for BNF chemical substance descriptor betamethasone valerate 0.1%. Data to be grouped for BNF chemical substance descriptor mometasone furoate 0.1%

2B. Can the NHSBSA provide the number of patients who were repeatedly dispensed 100g of any of the presentations on Sheet 2 for: up to 2 years; up to 3 years; up to 4 years; and for up to five years.

2C. Can the NHSBSA provide an analysis of the numbers of individual patients who have been repeatedly dispensed: a) 600g - 900g and b) 1000g - 1300g per annum of any BNF presentation descriptor on Sheet 2 for: up to 2 years; up to 3 years; up to 4 years; and for up to five years.

1. Excel Sheet 3 - very potent topical corticosteroids

3A. Will the NHSBSA please provide annual item totals for presentations of 30g and 100g listed in the two BNF chemical substance descriptors on Excel Sheet 3 dispensed for each year from 2018 to 2023? Data to be grouped for BNF chemical substance descriptor diflucortolone valerate 0.3%. Data to be grouped for BNF chemical substance descriptor clobetasol propionate 0.05%

3B. Can the NHSBSA provide the number of patients who were repeatedly dispensed 100g of any of the presentations on Sheet 3 for: up to 2 years; up to 3 years; up to 4 years; and for up to five years.

3C. Can the NHSBSA provide an analysis of the numbers of individual patients who have been repeatedly dispensed: a) 600g - 900g and b) 1000g - 1300g per annum of any BNF presentation descriptor on Sheet 3 for: up to 2 years; up to 3 years; up to 4 years; and for up to five years.

The NHS Business Services Authority (NHSBSA) received your request on 17 July 2024.

We have handled your request under the Freedom of Information Act (FOIA) 2000.

On 21 August 2024, you clarified your request as follows:

• Use of the term 'per annum’: I am indeed requesting aggregated data across each year 2018-2023

• Use of 'repeatedly dispensed’: This was intended to refer to numbers of patients dispensed items with any form of ‘repeat’ flag.

I would like to request that any information you are able to provide is presented in publicly accessible formats

Our response

Part A

I confirm that the NHSBSA hold this information. Under Section 21 of the FOIA we are not required to provide information in response to a request if it is already reasonably accessible to you.

For 2018, the information you requested is available from the following link:

https://www.nhsbsa.nhs.uk/prescription-data/dispensing-data/prescription-cost-analysis-pca-data

Columns C and D can be filtered to show the desired substance, and column G displays the number of items. Please note that for 2018, only monthly data is available.

From 2019 onwards you can use the annual summary data:

https://www.nhsbsa.nhs.uk/statistical-collections/prescription-cost-analysis-england

On the Presentations tab, column C can be used to filter to the desired substance. The number of items is shown in column K (2019/20) or column R (2021 onwards).

Please see the following link to view the section 21 in full:

https://www.legislation.gov.uk/ukpga/2000/36/section/21

Parts B & C

I can confirm that the NHSBSA holds the information you have requested and a copy of the information and notes explaining it is attached.

Please read the below notes to ensure correct understanding of the data.

NHS Prescription Services process prescriptions for Pharmacy Contractors, Appliance Contractors, Dispensing Doctors and Personal Administration with information then used to make payments to pharmacists and appliance contractors in England for prescriptions dispensed in primary care settings (other arrangements are in place for making payments to Dispensing Doctors and Personal Administration). This involves processing over 1 billion prescription items and payments totalling over £9 billion each year. The information gathered from this process is then used to provide information on costs and trends in prescribing in England and Wales to over 25,000 registered NHS and Department of Health and Social Care users.

Data Source

The data source was the NHSBSA Information Services Data Warehouse.

Exclusions

The Data excludes:

• Items not dispensed, disallowed and those returned to the contractor for further clarification.

• Prescriptions prescribed and dispensed in Prisons, Hospitals and Private prescriptions.

• Items prescribed but not presented for dispensing or not submitted to NHS Prescription Services by the dispenser.

Time Period

Reporting on calendar years 2018-2023 using data from April 2015 (when the NHSBSA has records including NHS numbers) to December 2023

Organisation Data

The data provided is for prescriptions dispensed in the community in England.

Drug Groupings

Drug group 1 is limited to the following BNF presentations; '1304000H0BBABBA', '1304000H0BBAAAA', '1304000H0AABABA', '1304000H0AAAAAA', '1304000F0BBAHBB', '1304000F0BBADAB', '1304000F0AABBBB' and '1304000F0AAABAB'

Drug group 2 is limited to the following BNF presentations; '1304000F0AABABA', '1304000F0AAAAAA', '1304000F0BBAEBA', '1304000F0BBAAAA', '1304000F0BGABBA', '1304000F0BGADAA', '1304000Y0AABABA', '1304000Y0AAAAAA', '1304000Y0BBABBA', and '1304000Y0BBAAAA'

Drug group 3 is limited to the following BNF presentations; '1304000L0AABCBC', '1304000L0AAACAC', '1304000L0BBAEBC', '1304000L0BBACAC', '1304000G0BFACBA', '1304000G0BFADAA', '1304000G0BFABBA', '1304000G0BFAAAA', '1304000G0BBABBA', '1304000G0BBAAAA', '1304000G0AABABA', and '1304000G0AAAAAA'

Data is limited to drugs within the three drug groupings

BNF Code

The BNF Code is a 15-digit code in which the first seven digits are allocated according to the categories in the BNF and the last 8 digits represent the medicinal product, form, strength and the link to the generic equivalent product. NHS Prescription Services has created pseudo BNF chapters, which are not published, for items not included in BNF chapters 1 to 15. The majority of such items are dressings and appliances which NHS Prescription Services has classified into four pseudo BNF chapters (20 to 23).

Prescribed Quantity

Quantity normally shows the quantity of a product prescribed. However, where a product is packed in a 'special container' (see Drug Tariff Part II Clause 10) the pharmacist is not required to split the pack and may supply the number of containers or original packs which provide the quantity nearest to that prescribed. In some circumstances these items show quantity as the number of units supplied i.e. 1 or 2 even though a pack may contain 56 tablets.

Data is limited to items with a prescribed quantity of either 100, between 600 and 900 or between 1000 and 1300

Treatment Type

Prescribing is split by treatment type - Repeat Prescribing, Repeat Dispensing or Acute.

Acute and Repeat Prescribing (RP) can be identified only on electronic prescriptions.

Repeat Dispensing (RD) can be identified from electronic and paper prescribing.
"Unknown" prescriptions are paper prescriptions not marked as repeat dispensing.

Repeat Dispensing allows a patient to obtain repeat supplies of NHS prescriptions without the need for their GP practice to issue a prescription each time a supply is required. The GP can authorise a prescription with a specified number of ‘issues’ each issue contains the same prescribed items and allows the prescriber to authorise and issue a batch of repeat prescriptions for use up to 12 months.

Repeat Prescribing is where the patient still needs to obtain an NHS prescription from their GP practice each time, they require their medication or appliances and data is only available via EPS messages. It requires the prescriber to select the appropriate treatment code indicating it is repeat prescribing and these figures should be used with caution.

This data request has been limited to items with a treatment type of Repeat Prescribing or Repeat Dispensing.

Identified patients

Data is limited to items where an NHS Number was recorded during NHSBSA processing. For this request the percentage of items where an NHS Number was records (by calendar year) is as follows;

2015 from April 99.8881%
2016            99.9702%
2017            99.9851%
2018            99.9926%
2019            99.9925%
2020            99.9957%
2021            99.9980%
2022            99.9987%
2023            99.9990%

Patient Counts

A Patient is counted for a calendar year if they have prescribing in the given drug group for an item with the prescribed quantity at any point with the calendar year.

For a patient to be counted in the five consecutive years measure they must have had prescribing in the given year and each of the four years prior.

For a patient to be counted in the four consecutive years measure they must have had prescribing in the given year and each of the three years prior but not in the fourth year prior.

For a patient to be counted in the three consecutive years measure they must have had prescribing in the given year and each of the two years prior but not in the third year prior.

For a patient to be counted in the two consecutive years measure they must have had prescribing in the given year and each of the year prior but not in the second year prior.

This calculation is to ensure patients are counted once for each year.

Patients will appear in multiple years, i.e. a patient with 5 consecutive years in 2023 must have at least 4 consecutive years in 2022.

Data Queries

If you have any queries regarding the data provided, or if you plan on publishing, the data please contact foidata@nhsbsa.nhs.uk ensuring you quote the above reference. This is important to ensure that the figures are not misunderstood or misrepresented.

Reusing the data and copyright

If you plan on producing a press or broadcast story based upon the data please contact communicationsteam@nhsbsa.nhs.uk. This is important to ensure that the figures are not misunderstood or misrepresented.

The information supplied to you continues to be protected by the Copyright, Designs and Patents Act 1988 and is subject to NHSBSA copyright. This information is licenced under the terms of the Open Government Licence detailed at:

http://www.nationalarchives.gov.uk/doc/open-government-licence/version/3/

Should you wish to re-use the information you must include the following statement: “NHSBSA Copyright 2024” Failure to do so is a breach of the terms of the licence.

Information you receive which is not subject to NHSBSA Copyright continues to be protected by the copyright of the person, or organisation, from which the information originated. Please obtain their permission before reproducing any third party (non NHSBSA Copyright) information.