Friday, 19 May 2023
Researchers from the Universities of Nottingham and Oxford have found that despite substantial disruption to primary care services, the safety of GP prescribing in England was largely unaffected by the Covid-19 pandemic.
The study, published in the BMJ Medicine, is the most comprehensive assessment of medication safety during the Covid-19 pandemic in England, covering 95% of the population.
The research also demonstrates the power of analysing NHS GP data on a national scale to generate insights on service delivery.
The NHS has a phenomenal coverage and quality of data that can be used to help answer important questions to inform our response to Covid-19.
The findings are based on the application of the 13 national PINCER prescribing safety indicators to the electronic health records of almost 57 million NHS patients in England between September 2019 and September 2021 using the OpenSAFELY platform.
PINCER is an evidence-based, pharmacist-led complex intervention to identify and correct hazardous prescribing in primary care. PINCER was rolled out nationally to GP practices in England between 2018 and 2021 by PRIMIS at the University of Nottingham in collaboration with the Academic Health Science Network. PRIMIS is a specialist team of health informaticians within the School of Medicine at the University of Nottingham providing expert advice on the intelligent use of primary care data to the NHS, academics, and industry partners.
OpenSAFELY is a secure, transparent open-source software platform for the analysis of electronic health records developed in collaboration with GP software suppliers TPP and EMIS Health to address urgent Covid-19 research questions.
The Covid-19 pandemic disrupted the delivery of primary care services within the NHS in the UK from March 2020, with a 30% reduction in GP consultations, a 74% reduction in routine referrals and a 43% reduction in urgent cancer referrals. The extent of disruption varied by clinical context, though most primary care services were restored by September 2020.
Monthly trends and between-practice variation for compliance with the PINCER indicators were investigated. Findings showed that 1,813,058 (3.1%) patients registered across 6,367 practices were identified as being at risk of at least one potentially hazardous prescribing event at any point during the study period.
Hazardous prescribing remained largely unchanged during the Covid-19 pandemic, with no evidence of increases in indicators of harm as captured by the PINCER indicators. There were transient delays in blood test monitoring for some medications, particularly ACE inhibitors. However, all indicators exhibited substantial recovery by September 2021.
These findings are testament to the hard work and dedication of the pharmacists, pharmacy technicians and GPs working in primary care during this time.
Kerry Oliver, PRIMIS Managing Director at the University of Nottingham, said “This study underlines the success of the national roll out of the PINCER Intervention, which harnessed the power of data and feedback to support positive, sustained change, of which PRIMIS has a long history of supporting”.
Brian MacKenna, Director for NHS Service Analytics at Oxford's Bennett Institute for Applied Data Science, added: “The NHS has a phenomenal coverage and quality of data that can be used to help answer important questions to inform our response to Covid-19. While using this data, it is important that we keep patient’s data secure. That’s why we have built OpenSAFELY, a new highly secure model that takes the analytics to where the data already resides”.
Dr Sarah Rodgers, PRIMIS Head of Research Services, said, “Despite all the challenges that general practice faced during the Covid-19 pandemic, prescribing safety obviously remained high on the agenda. These findings are testament to the hard work and dedication of the pharmacists, pharmacy technicians and GPs working in primary care during this time”.
A full copy of the paper, Fisher L, Hopcroft LEM, Rodgers S, et al. Changes in medication safety indicators in England throughout the covid-19 pandemic using OpenSAFELY: population based, retrospective cohort study of 57 million patients using federated analytics. BMJMED 2023;2:e000392. doi:10.1136/bmjmed-2022-000392, can be found here.
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For further information, please contact Dr Sarah Rodgers, PRIMIS Head of Research Services, School of Medicine at the University of Nottingham.
Adam Mallaby - Media Relations Manager for the Faculty of Medicine and Health Sciences (Maternity Cover)
Email: adam.mallaby@nottingham.ac.uk
Phone: 0115 748 5719
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About the University of Nottingham
Ranked 32 in Europe and 16th in the UK by the QS World University Rankings: Europe 2024, the University of Nottingham is a founding member of the Russell Group of research-intensive universities. Studying at the University of Nottingham is a life-changing experience, and we pride ourselves on unlocking the potential of our students. We have a pioneering spirit, expressed in the vision of our founder Sir Jesse Boot, which has seen us lead the way in establishing campuses in China and Malaysia - part of a globally connected network of education, research and industrial engagement.
Nottingham was crowned Sports University of the Year by The Times and Sunday Times Good University Guide 2024 – the third time it has been given the honour since 2018 – and by the Daily Mail University Guide 2024.
The university is among the best universities in the UK for the strength of our research, positioned seventh for research power in the UK according to REF 2021. The birthplace of discoveries such as MRI and ibuprofen, our innovations transform lives and tackle global problems such as sustainable food supplies, ending modern slavery, developing greener transport, and reducing reliance on fossil fuels.
The university is a major employer and industry partner - locally and globally - and our graduates are the second most targeted by the UK's top employers, according to The Graduate Market in 2022 report by High Fliers Research.
We lead the Universities for Nottingham initiative, in partnership with Nottingham Trent University, a pioneering collaboration between the city’s two world-class institutions to improve levels of prosperity, opportunity, sustainability, health and wellbeing for residents in the city and region we are proud to call home.
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