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National Prescribing Indicators

National Prescribing Indicators
The All Wales Medicines Strategy Group (AWMSG) has endorsed the National Prescribing Indicators (NPIs) as a means of promoting safe and cost-effective prescribing since 2003. NPIs have historically focused on primary care prescribing; however, in 2015 a set of secondary care NPIs were developed by the All Wales Prescribing Advisory Group (AWPAG) and launched by AWMSG for use in 2016–2017. This report contains data relating to the primary and secondary care NPIs for the first quarter of 2017–2018. 
Background information supporting the choice of NPIs is detailed in the document National Prescribing Indicators 2017–2018 available from the AWMSG website. 

The National Prescribing Indicators 2017–2018: Analysis of Prescribing Data to June 2017 document has been prepared by the Welsh Analytical Prescribing Support Unit and can be accessed on the link below:

Primary Care

• For 2017–2018, there are 14 primary care NPIs focusing on seven areas of prescribing and the reporting of adverse events (Yellow Cards)*. Four of the indicators – high strength inhaled corticosteroids (ICS), opioid patches, anticholinergic burden, and NSAIDs and CKD – are new for 2017–2018. 

• A threshold level of prescribing/reporting is set for 11 of the 14 NPIs based upon quarter three data for 2016–2017.* 

• Due to the unavailability of historical data, the threshold for the anticholinergic burden and NSAIDs and CKD NPIs will be based upon quarter one data for 2017–2018. 

• Of the 11 NPIs that currently have a threshold, there was an overall improvement (in line with the aim of each indicator) across Wales in 10 NPIs, compared to the equivalent quarter of the previous year (quarter ending June 2016). The NPI that did not show an improvement was gabapentin and pregabalin where prescribing increased in all health boards (6.94% national increase). 

• At a national level, the NPIs associated with the largest improvements in prescribing compared to the equivalent quarter of the previous year were NSAIDs (ADQs per 1,000 STAR-PUs) (12.3% reduction), co-amoxiclav (items per 1,000 patients) (9.20% reduction), hypnotics and anxiolytics (ADQs per 1,000 STAR-PUs) (9.0% reduction) and tramadol (DDDs per 1,000 patients) (8.07% reduction). 

• In line with the aim of the indicator, high strength ICS prescribing decreased in all of the health boards compared to the equivalent quarter of the previous year. The largest decrease was seen in Aneurin Bevan UHB (13.2% reduction). 

• Prescribing of tramadol decreased in all of the health boards compared to the equivalent quarter of the previous year (in line with the aim of the NPI). The largest decrease of 10.6% was seen in Cwm Taf UHB. 

• Yellow Card reporting by GPs increased 58% compared to the equivalent quarter of the previous year, and Yellow Card reporting for all health board reporters increased by 43%.