Quality improvement: prescribing and patient safety reports

The RCGP and Clinical Practice Research Datalink (CPRD) have developed confidential bespoke practice and patient-level drug prescribing reports, available for free for GP practices contributing to CPRD. There are two sets of reports, distributed every six months to practices in all four nations of the UK. You can sign up to receive the reports on the CPRD website.

Aims of the project

The project supports quality improvement within general practice by developing and distributing innovative data reports for GPs that focus on prescribing and patient safety.

Key outputs

The Heart and Circulatory System report includes three indicators taken from the RCGP patient safety toolkit and one that was suggested by NICE: 

  • Prescription of glitazones to patients with heart failure
  • Prescription of NSAIDs to patients with heart failure
  • Prescription of NSAIDs to patients with chronic kidney disease (CKD)
  • Aspirin monotherapy for stroke prevention in patients with atrial fibrillation

See an example of the Heart and Circulatory System report (986 KB PDF).

The Learning Disabilities report includes indicators developed from the Stopping over medication of people with a learning disability, autism or both (STOMP) project:

  • Prescription of anti-psychotics to over-16s with Learning Disabilities and/or Autism
  • Prescription of anti-depressants to over-16s with Learning Disabilities and/or Autism

Example of the Learning Disabilities and/or Autism reports for practices using EMIS (1MB PDF).

Example of the Learning Disabilities and/or Autism reports for practices using Vision (1MB PDF).

Both the Learning Disabilities and Heart and Circulatory System reports show: 

  • The practice’s prescription rate benchmarked against all practices in the CPRD network
  • Pseudonymised identifiers to enable re-identification of patients whose care might need review
  • Recommendations for next steps, based on NICE guidance
  • Links to further information 

The reports are distributed to GP practices in the CPRD network every six months. As the reports are based on the CPRD data extract, practices that are not already in the CPRD network will need to sign up by completing the application form on the CPRD website (please tick the box ‘RCGP/quality improvement’ under ‘How did you hear about us?’ on the joining form).

Participating practices are surveyed every time the reports are sent out, and qualitative feedback is also gathered face to face and by phone. From this feedback, we know that the reports are used in these ways:

  • To review the care of individual patients highlighted in the reports – where necessary, patients have their treatment changed.
  • As the starting-point for discussions involving all clinicians within the practice around safe prescribing
  • As evidence for annual appraisals, under Domain 2 – Safety and Quality.

This work uses data provided by patients and collected by the NHS as part of their care and support.

How practices use the reports

"The CPRD/RCGP QI Reports are so helpful. They look at some of these ‘hard to remember’ issues, and send us an easy-to-read report, benchmarking our practice’ prescribing against other CPRD practices, and also giving us a trend line over time, so we can see if changes we have introduced have made a difference. I was pleased to see our figures on all of the indicators had improved on the second report, and that we were doing well compared to others." - Joanna Bircher, Clinical Director, Greater Manchester GP Excellence Programme.

You can find out more about how practices are using the reports for quality improvement below:

In the video below, Dr Scott Jamieson, RCGP Scotland Quality Improvement lead, provides an overview of the data reports and how they can be used by practices. 

  • Dr Tommy Hunter has written a blog on how he has used the reports as part of his work to improve outcomes for patients within his practice.
  • David Mullett, the RCGP Champion for this project, has written a blog about how the project uses patient data to improve patient safety for Understanding Patient Data, which is aimed at patients and the public.
  • A primary care pharmacist in Wales used the reports to review the prescribing of psychotropic drugs for patients with a learning disability, autism, or both. The review has been written up as a case study.

"I work as a Cluster Pharmacist in Wales and carried out an audit for one of my practices by using the RCGP/CPRD quality improvement report it had received. This particular report looks at two cohorts of patients on the Learning Disabilities Register – patients prescribed antipsychotics and those prescribed antidepressants.

"The report is linked to a wider project called STOMP, which looks to improve quality of life of patients with a disability, autism or both by reducing the potential harm of inappropriate psychotropic drugs. (This is an NHS England project but is relevant to primary care across all nations of the UK.) Using the report, I looked at prescribing for those patients with a learning disability, autism or both that had been specifically highlighted for review.

"At the practice there appeared to be a significant reduction in the prescribing of antipsychotics in these patients from September 2014 to August 2018, and a slight increase in the prescribing of antidepressants during the same time period.

"For antipsychotic prescribing, the report highlighted 18 patients for me to review and I found that:

  • 15 were still under the care of Mental Health (MH) services
  • 1 patient had been signed off by MH as 'stable' and had been reviewed by the GP in the last 12 months
  • For 1 it was unclear whether they were still under MH, but their care had been reviewed by the GP
  • 1 had not been reviewed by MH or the GP

"Therefore, 17 out of 18 patients had been reviewed in the previous 12 months. Indications for the prescribing of the antipsychotics included schizophrenia, personality disorders, Asperger's, dysmorphia and behavioural problems. All indications were appropriate.

"Next, I looked at the section of the report highlighting 27 patients being prescribed antidepressants. However, as one is prescribed amitriptyline 10mg for neuropathic pain, not depression, I excluded that one patient from my findings.

"Of the 26 patients, 21 were still being reviewed by MH services and 21 had been reviewed by their GP in the last 12 months. One remaining patient had recently moved to the area and their care had already been reviewed by the GP and would be transferred to our local MH team.

What happens next?

I found these figures encouraging as they demonstrate that the majority of patients are receiving the care they should be. Recall letters were sent out to the patients whose reviews were outstanding, so the report is a useful extra as part of a patient care process."

There is also a project page on the CPRD website. 

Support materials

To accompany our report on prescription of valproate to patients of childbearing potential, there is a template letter for use by practices to invite patients to make an appointment for a treatment review. The letter is in Microsoft Word, so that you can easily adapt it to use with your patients.

Valproate template letter (12 KB DOCX).

Please note that you will need to delete ‘epilepsy’ or ‘mental health’ as appropriate for the patient in line 4 of paragraph 1.

Project evaluation 

A description of the pilot stage of the project has been published in the British Journal of General Practice. The paper concluded that: ‘Electronic health record data can be used to provide standardised, reproducible reports that can be delivered at scale with minimal resource requirements. These can be used in a national QI initiative that impacts directly on patient care.’

Quality improvement of prescribing safety: a pilot study in primary care using UK electronic health records.

Post written by

RCGP Quality Improvement team

Find out more of the work of the QI team on the RCGP website.