What is the NHSBSA Polypharmacy Comparator tool?
The NHSBSA Polypharmacy Comparator tool consists of measures which show CCGs, GP practices and Primary Care Networks how many patients they have on 8 or more, 10 or more, 15 or more, and 20 or more medicines.
The polypharmacy comparators also identify patients taking a combination of medicines known to increase risk of harm, such as multiple anticoagulants or medicines which, when taken together, can increase risk of cumulative anticholinergic cumulative side effects. These side effects can increase the risk of falls, confusion, constipation and other issues. See the Medicines Safety portal for more information: https://www.medicinesafety.co.uk/p/welcome.html
The purpose of the Polypharmacy Prescribing Comparator tool is to highlight variation and to support CCGs and GP practices in addressing their polypharmacy work in the context of their other medicine safety priorities.
In addition, the comparators can be used to evaluate the impact and effectiveness of efforts made to already to address polypharmacy.
These polypharmacy prescribing comparators have been designed to be easy to understand, easy to interpret and easy to navigate.
The polypharmacy prescribing comparators can help PCNs and primary care identify patients deemed to be at-risk who take multiple medicines and may require a structured medication review.
How to access the NHSBSA Polypharmacy Comparator tool
PCN pharmacists across England can access the polypharmacy comparators via ePACT2. To register or access ePACT2, visit here.
Latest update (Feb 2021)
For over five years, the national Academic Health Science Network, led by Wessex AHSN, has been working with the NHS Business Services Authority (NHSBSA) and NHS Digital to create a suite of Polypharmacy Prescribing Comparators.
The comparators were developed by a multidisciplinary team of clinicians and NHSBSA analysts, to exploit the capability of ePACT2 prescribing data, and produce a tool aimed at helping GPs and pharmacists to identify patients deemed to be at-risk of harm from problematic polypharmacy. The first set of national polypharmacy comparators in England were published in June 2017. The polypharmacy comparators were made available to all CCGs and GP practices in England.
These case studies show how practices have used this data to successfully identify patients at risk from harm and review their medicines usage:
Over the last 12 months, the working group has reviewed the current comparators, added three new comparators and provided additional functionality. This will help PCNs with their contractual obligations.
New comparators
In addition to the volume and previous therapeutic comparators, this updated tool will help to identify:
This second iteration has new, additional functionality for searching age bands.
Can the NHSBSA Polypharmacy Comparator tool identify patients?
The tool can be used to access the NHS numbers of the patients identified.
Once Primary Care Networks (PCNs) have identified their priority areas, the NHSBSA can provide the NHS number of the patients who have been highlighted via the polypharmacy comparators.
How can the Polypharmacy Prescribing Comparator tool help PCNs to meet DES requirements?
The new PCN Contract Directed Enhanced Service (DES) Specification states that, from 1 October 2020, a PCN is required to:
“…use appropriate tools to identify and prioritise the PCN’s patients who would benefit from a structured medication review (referred to in this Network Contract DES Specification as a “SMR”), which must include patients:
These patients should be offered a structured medication review.”
The NHSBSA Polypharmacy Prescribing Comparators were highlighted within the NHS England PCN DES guidance as a means to support Structured medication Reviews:
https://www.england.nhs.uk/wp-content/uploads/2020/09/SMR-Spec-Guidance-2020-21-FINAL-.pdf
What’s happening in Wessex?
Wessex AHSN (on behalf of the AHSN Network) led the work to develop the NHSBSA Polypharmacy Prescribing Comparator tool and is the official custodian of the work. It steers the Polypharmacy Prescribing Comparators working group which meets quarterly to advance work in this area and develop more comparators for publication and use.
Since their official launch in 2017, Wessex AHSN has supported CCGs and GP practices in their adoption and spread. Wessex AHSN has also started to provide GP practices with individualised reports through the Action Learning Sets. These ‘data packs’ help GP practices to identify areas to prioritise but also encourage conversations around how they are doing compared to their peers. These reports and engagement around the comparators help Wessex AHSN ‘start a conversation’ in a safe sharing environment.
Through this engagement locally, Wessex AHSN was able to further identify that GPs need support in better understanding high-risk medications and their risk in older people. This has helped develop e-learning modules on University Hospital Southampton’s Medicines Information e-learning portal with an anticholinergic module under development.
For information on the Polypharmacy Action Learning Sets see here.
The Wessex AHSN Medicines Optimisation team also produced an animated video to encourage patients taking multiple medicines to seek a medicines review. You can view the first in the Mo series below, or visit the Meet Mo page for the full suite of resources.
