Domain 2:

Safety and Quality: Prescribing

Where to get Information

Having identified an area of practice where change may be required, you need to review this area. This review should consist of an analysis of the current situation, and comments on any areas where change would be appropriate.

Review of Prescribing Data

You may need to look at your prescribing data in detail. This section tells you about possible sources of information.

Sources of Data

Details of all NHS prescriptions dispensed in Scotland are stored on a central database. PRISMS (PRescribing Information SysteM for Scotland) is a software package which allows NHS staff access to prescribing data. SPA (Scottish Prescribing Analysis) data was one form of data extracted from the database. This is no longer posted to doctors (with their own cipher), but it remains available through PRISMS.

PRISMS can be used to obtain more information than was available from the old SPA system, and information can be made available in a more useful form. For instance, if your SPA level 1 report had suggested that you were prescribing a lot of antibiotics, you might wish to look at that area. Using PRISMS, you could obtain details of what you prescribed, and compare this with your practice, your CHP, or Scotland as a whole. Before you perform the search, think very carefully about exactly what you want to know. If you are unsure, your prescribing adviser would be keen to help!

If no one in your practice has been trained to access PRISMS, consider visiting their website to enlist for training, or contact your local prescribing adviser who will be able to help you. (NB: The PRISMS site can only be accessed from NHS computers).

Remember this data reflects prescriptions that are dispensed, and this will vary from what is actually prescribed. Accuracy also depends upon your practice's policy for allocating prescriptions. (Does the patient's usual doctor, or registered doctor, take responsibility for repeat prescriptions, or acute prescriptions?)

Practice Computers

The search facilities on practice computer systems can provide a limited analysis of prescribing, and for some questions this may be entirely adequate. Of course it will only reflect drugs prescribed, not drugs dispensed; and will not offer the cost-benefit analysis. On the other hand it can provide you with the names of individual patients for whom you have prescribed a drug and allow you to audit clinical indications and the outcome.

Prescribers who do not have a Cipher Number

Doctors working as sessional doctors, or out-of-hours doctors, will not have access to personal data within the computerised prescribing database. However, it would be possible to reflect upon a manually collected series, for instance the analgesics or antibiotics prescribed in your last 20 surgeries. The simplest way to do this is to retain and annotate the prescription counterfoils: remember to dispose of them as confidential waste after use. Additional value could be added by working in a small study group with other sessional GPs to compare your results. There are some worked examples in the sessional doctors section.

Alternatively you may wish to analyse prescribing data for your organisation as a whole, and this would be acceptable provided that the interpretation had a personal impact and relevance.

This page was last updated on: 15/05/2015