Primary care prescribing varies significantly across CCGs, with some rates well over the recommended level according to the 2015 Atlas of Variation, released by PHE.
The 2015 Atlas of Variation, the third and biggest published, found that the number of key antibiotics prescribed in primary care by CCGs varied by as much as 10% across regions. The lowest observed was 6.8% compared with 16.8% in other areas, a difference of 2.5 fold. The Antimicrobial Prescribing Quality Measure stated that this should be less than 10%. The atlas showed that general practices were responsible for 79% of all prescriptions in England.
John Newton, chief knowledge officer at PHE, said: ‘Variations are not always bad. Some can be explained by local circumstance or patient-centred care, but unwarranted variation is very different. While some patients are missing out on the right care, others are being given care they do not need.’
The atlas also showed an increase in the number of prescriptions in community settings, with a rise of 32% observed since the last atlas was published in 2010. However, community prescribers still represent only 6% of the total in England. General practices also saw a 4% increase in the number of antibiotics prescribed. The most commonly prescribed antibiotics were penicillins, tetracyclines, and macrolides. The atlas also noted that between 2010 and 2013, prescriptions of nitrofurantoin for the treatment of urinary tract infections increased by 41%.
Sir Bruce Keogh, national medical director of NHS England, said: ‘This atlas exposes some inconvenient truths about the extent of clinical practice variation in care for some common conditions. The good news is that – at a time of financial pressure across the health service – hospitals, GPs and mental health providers have substantial opportunities to unleash greater value from their existing NHS budgets.’
The atlas also observed a 2.7 fold variation in the provision of the enhanced dementia service available from general practices across CCGs, meaning patients with dementia may be unfairly disadvantaged in some areas. It noted that the number of offers of the enhanced services ranged from 251.9 to 667.8 per 1000 patients across England.
It also found that the average number of the NICE-recommended processes for foot checks for patients with diabetes performed varied, with an average of four performed in some areas, compared to an average of seven in better performing CCGs. The atlas found that the percentage of people in the National Diabetes Audit with type 1 and type 2 diabetes who received the care processes ranged from 30.4% to 76.4% (2.5-fold variation).
Chief medical officer Dame Sally Davies said: ‘Our challenge now is to consider how we can better understand and tackle the underlying causes. This is not a straightforward task, but exploring the data that lies behind these variations will be an important starting point.’