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 or Autism or both. The review has been written up as a case study (49KB PDF).

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.