Our original visualisation showing prescribing of antibiotics across England has been picked up by the respected national broadsheet, The Guardian, and an article has been published detailing some of the key findings of our analysis. In conjunction with the team from The Guardian, we produced additional pages to the dashboard to illustrate the points, and have included the expanded dashboard below.
Antibiotic prescription by GP practice
UK map shows areas where GPs are most, or least, likely to prescribe antibiotics to patients
It matters how often GPs prescribe antibiotics to patients because of the increasing danger posed to general public health by the growing resistance some infections are showing to many established types of antibiotics.
Here, for the first time, is a map which shows the areas where GPs are most, or least, likely to give a patient a prescription for antibiotics. The map, drawn up by James Ambler of the firm Moor Consulting, uses a variety of NHS data sources to show which areas in 2012 handed out the most and fewest prescriptions.
The area which prescribed antibiotics the most was where local health services have been commissioned since April by the Newcastle West clinical commissioning group (CCG). The incidence rate of prescribing by GP surgeries there was 8.4%. That is, across the year on average, one in 12 patients was given antibiotics, though Ambler’s dataset shows that the rate was 1 in 11 in several months and one in 14 months in September.
By contrast, GP practices in Camden, north London, prescribed antibiotics the least. Throughout 2012 their incidence rate was just 4%, roughly 1 in 25 of their population.
However, the percentage figures for Camden, Newcastle West and every part of England are not absolutely exact when expressed as proportions of local people because some patients will receive several lots of antibiotics but the NHS’s data collection system only tracks “items” – packets of tablets – and not how many different people received them.
The data shows that Newcastle West is way above the national average of 6.39%, and Camden way below it. These percentages, or incidence rates, have emerged from Ambler dividing the number of units prescribed by the number of patients listed per GP practice.
Readers keen to know whether their own GP practice is a high or low prescriber of antibiotics – in medical terms the lower the better, as a general rule – can use the dropdown menu on the right to identify the area they live in and then find their own surgery and check its incidence rate.
There is a pronounced north/south divide on this, with northern GPs much more likely to prescribe antibiotics than their southern counterparts. Ambler’s research shows that 69% of northern CCG areas prescribe more than the national average, compared with 39% of southern ones.
But it is a mixed picture. GPs in South Worcestershire CCG area, a southern one under Ambler’s calculations, had a prescribing incidence rate of 8.1%, which is close to that of Newcastle West. Similarly, some northen CCGs, such as Southern Derbyshire, Erewash and Rushcliffe, are all on 5.3%, well below the national average.
What is worrying is the wide differences in prescribing rates this research has unveiled. Keith Ridge, NHS England’s chief pharmaceutical officer, calls it “inappropriate variation”. In simple terms, that means too many GPs in too many places are handing out too many antibiotics too often.
However, Dame Sally Davies, England’s chief medical officer, says: “It has long been accepted that there will always be some valid variation in prescribing due to differing resistance patterns to different antibiotics in different areas of the country.”
London is the region where patients are least likely to be prescribed antibiotics. CCGs there had an average incidence rate of 5.4% in 2012, a lot lower than the 6.6% seen in the rest of England.
James Ambler, founding partner of Moor Consulting, issued the following statements regarding the analysis & Guardian article:
” My hope in putting this analysis together is that it shows the value of public bodies sharing their data with the public, and that the findings can be used to improve public services, not just those of the NHS. Differences in prescribing antibiotics need to be examined further, especially considering the impending problems highlighted by Sally Davies regarding bacterial resistance and what that could mean to healthcare provision in the UK over the coming years.
Whilst I applaud the government for its open data policy, having put this analysis together & worked with other data available under the FOI, I would call for the government, NHS & all public bodies issuing data to improve the conformity of data-sources, improve accessibility & foster greater understanding of what is available. In doing so, public engagement & learning will be improved – whilst ensuring greater accuracy & ease of analysis.
Our analysis shows the regional differences in prescribing; both between North & South, and between the London area & the rest of England. Our intention is certainly not to highlight what could be mis-interpreted as good/bad practice, as so many additional factors need to be considered. Rather it is to foster greater understanding & help the different bodies involved. We need to run further analysis to see if it’s possible to determine correlations & predictors, and thus help with healthcare provision – and plan to repeat this exercise with other areas of prescribing, not just antibiotics, and welcome any contributors to this effect. What is seen here should only be seen as the first step; ideally we would like to examine further the outliers, inconsistencies and external factors to create a robust model.
Without further, more detailed, examination it is very difficult to say what might be causing the differences in prescribing. But questions I would like to explore further would include:
• has the high number of hospitals in the London area impacted prescribing by GPs?
• could increased waiting times/difficulty booking appointments with GPs be of impact?
• do areas with lower GP prescribing incidences exhibit higher prescribing by hospital physicians?
• are there correlations in recorded admissions for bacterial infections, or outbreaks within care centres, with the prescribing seen here amongst the general public?
• what external factors, such as demographics, are impacting prescribing? ”
We would like to like to thank James Ball, Denis Campbell & Leo Hickman from The Guardian for their support & guidance – and for featuring our analysis & visualisation.