Herbal medicines For techie reasons, we’re quite excited about the herbal medicines measure. We don’t like to write measures that require a manually managed list of preparations, as these require a lot of curation, and can quickly become inaccurate if a new drug is released. Therefore for most (if not all) of our measures we use the hierarchical BNF codes provided by the NHS Business Services Authority (you can read more on these here).
When in 2017 we wrote our measures for the NHS England guidance on Items which should not be routinely prescribed in primary care, we were only able to create measures for 17 of the 18 areas. This was because the 18th – herbal medicines – were not classified in any simple hierarchy in the BNF code structure, and given that there were a couple of hundred preparations on the list, we felt that to do so manually was both a lot of work, and possibly would quickly become inaccurate.
Since then we’ve been doing a lot of work understanding the NHS Dictionary of Medicines and Devices (dm+d), which has detailed information about each individual medicine (you can see how comprehensive the schema is here). The BSA provide a map to link BNF codes to the dm+d, and we’ve now got the ability to use the dm+d to built measures. One of the fields in the dm+d is the type of product licence a pharmaceutical product has, and one option is the “Traditional Herbal Registration” (THR). Any herbal product must have a THR with the MHRA before it’s marketed in the UK.
Using this field, we were able create a measure showing all the herbal medicines prescribed in England. This approach is currently in development, and we are using the herbal medicines measure as a prototype with a static extract from the dm+d. We plan to link our measures data directly to the dm+d download, so that as the dm+d is updated regularly, any additions to the THR list will automatically be added to our measure.
Hopefully the richer dataset in the dm+d will allow us to create varied and unusual measures. If you have any suggestions please get in touch.
Freestyle Libre Our second new measure, although technologically more simple (it was one BNF code), will be of interest as it is one of the most popular bespoke e-mail alerts created by our users (you can create these alerts yourself on the analyse page). Freestyle Libre is a new flash blood glucose monitoring system for people with diabetes, which reduces the amount of times a person may need to use a ‘finger prick test’. It is relatively expensive, and there has been some debate about its place in therapy. Consequently CCGs have different funding policies, although from April 2019 NHS England has confirmed that funding will be available to patients who meet the clinical criteria.
We don’t make any comment on whether high prescribing is “good” or “bad”. However, given the increasing cost to the NHS, along with the different commissioning policies currently in place, we thought it would be worthwhile showing the variation of prescribing levels across England. As always, we welcome your feedback, and would be delighted to hear of any measures you think may be useful. To get in touch, drop us an email firstname.lastname@example.org or visit us on Twitter at @openprescribing.