Reducing NHS spending: how we identify cost-effective brand switches for CCGs

-by Veerle van Leemput & Greg Mills, Managing Directors at Analytic Health


How we help to identify cost savings for Clinical Commissioning Groups of the NHS, by demonstrating value-adding propositions for pharmaceutical companies.

Prescribing is the most common patient-level intervention in the National Health Service (NHS). The spend on prescribing in England in primary care was £9.5 billion in 2021 and has been rising year on year1. This growing cost burden on the NHS makes it increasingly important that savings are found where possible. One common and relatively straightforward approach to saving money is by switching patients from one branded medicine to a lower-priced, bioequivalent alternative brand.

In this blog, we will share the approach that we use at Analytic Health, where we developed a Clinical Commission Group (CCG) cost savings feature in our Pharmly Analytics2 web application.


Clinical Commissioning Groups

A Clinical Commissioning Group, or CCG for short, is responsible for commissioning hospital and community NHS services in the local areas that they serve3. All GPs belong to a certain CCG. As mentioned in one of our previous blog articles, the NHS is undergoing restructuring. Over time, CCGs have been merged to cover larger areas and currently, there are 106 active CCGs in England.

Each CCG has a local formulary; a list of medicines that have been approved for use within their area4. Ultimately this defines which medicines GPs will prescribe. This makes CCGs a collective organisation that can be approached to change prescribing habits in its GP practices.


The switch to Integrated Care Boards

As said previously, the NHS is undergoing restructuring and this restructuring goes further than merging CCGs. The Health and Care Bill5 sets out plans to put Integrated Care Systems (ICSs) in place. Each ICS will be led by an NHS Integrated Care Board (ICB), an organisation with responsibility for NHS functions and budgets. From the 1st of July 2022 onwards, CCGs will be absorbed by Integrated Care Boards (ICBs).

At Analytic Health we are well aware of the changes that will be happening, and from the 1st of July 2022 onwards we will not talk about CCG Savings anymore, but about ICB Savings. The wording changes, but our calculations and aim stay the same.

Whether we’re talking about CCGs or ICBs, the principle of cost savings by switching to other medicine brands does not change. GPs belong to a wider organisation with a formulary that plays a big part in prescribing habits and changes to this formulary can reduce cost burdens on these organisations.

Our aims

Now we know a bit more background about the organisations GPs belong (or will belong) to, we can dive into our CCG Savings feature. Let’s start with our aims.

With our CCG Savings feature we aim to achieve three things:

  1. Identify the CCGs that would save the most money by switching a portion of their prescriptions to a company’s brand and away from more expensive brands by other companies within the same product range. Hereby we contribute to realise savings to the health economy as a whole.
  2. Calculate the additional revenue that would be generated for a medicine supplying company, following the prescription switches. This will incentivize pharmaceutical companies to engage with CCGs and demonstrate their value-adding proposition.
  3. Identify the optimal set of General Practices (GPs) within the CCG that could help to reach the desired level of prescription switch. This limits the total number of GPs that need to be approached to make the switch and increases the likelihood that the desired level of switching is achieved.


The data

To achieve all of the above, we need data. We identify potential CCG savings by analysing prescribing data. This prescribing data contains information about the number of prescriptions written in each English GP practice. Each GP practice belongs to a CCG, so subsequently, this data gets grouped to CCG level to determine prescriptions written throughout the CCG.

Below you can find some details on the data that is being used:


Cost-effective brand switches

To identify cost savings we look at potential brand switches. With brand switches, we mean that we suggest replacing prescriptions for a set of brands (E.g. B1) with prescriptions for a cheaper brand (E.g. B2). Brand switches can be relatively straightforward because we only suggest a brand switch to a brand with the same active ingredient, dosage form and therapeutic area. This aids the confidence in making the switch while not compromising patient care. That being said, we advise to always support brand switch suggestions with the approval of a clinical expert.

Our algorithm aims to identify which GPs should switch brands, and the quantity of prescriptions they should switch. We do this based on the maximal feasible switch quantity. In our algorithm, individual GP practices are requested to switch a maximum of 80% of their prescriptions (of the more expensive brands B1) to brand B2. The 80% limit was set as it has been established to be unrealistic to expect 100% of patients to be suitable for switching brands or to accept the new brand. We will discuss this later in the limitations section.

So how does it work? Let’s take a look at a simple demo example:

Table 1: example showing how we identify the practices that need to switch, and with what quantity


Creating win-win situations

From the example above it is clear that CCGs can save money while at the same time allowing pharmaceutical companies to identify value-adding opportunities. This is a win-win situation for both parties. Furthermore, if CCGs can save money on legacy medicines by switching to another cheaper brand, they also have more budget available to invest in innovative medicines that pharmaceutical companies have to offer. Overall this can improve patient care.


Limitations

Unfortunately, as discussed earlier, not all potential savings can be achieved and there can be multiple reasons for this:

  1. It is not possible to switch all patients to the proposed brand because sometimes there is a clinical justification for a specific patient for a specific brand.
  2. Changing between brands may cause patient concern, thereby limiting their willingness to switch brands.
  3. The administrative burden on GPs, that comes with changing prescriptions, may be too high compared to the potential cost savings for that specific GP.

All these reasons contribute to our decision to set the maximum achievable switch percentage per GP practice at 80%.


Pharmly Analytics

Our algorithm does all the hard work, and we nicely display the results of this algorithm in our web application: Pharmly Analytics.

Pharmly Analytics provides access to UK pharmaceutical market intelligence. The web application contains analyses for all the main healthcare datasets and has the option to build customised market views in the AI Console. In this AI Console, we help users to identify opportunities for their current and future product portfolio, ranging from green initiatives to brand optimisation, suggested product launches and potential CCG savings for selected brands.

The CCG Savings section of Pharmly Analytics enables the user to choose from any of their company’s brands. The user can view the analysis for any one of the CCGs that prescribe the product range related to the chosen brand.

There are a variety of inputs that can be used to model the switch over a variable number of months, beginning from a user-defined month – all based on your company’s capacity to supply the increased quantities and the estimated behaviour of the GPs within the CCG.

We know that sounds exciting! Are you part of a pharmaceutical company and eager to find out which CCGs can save money by switching to your brand? Or are you a representative of a CCG that wants to identify potential cost savings for your GPs? We’re more than happy to talk about what Pharmly Analytics can mean to you. Simply book a meeting with us and we’ll make it happen!


Feedback or questions?

Do you have any feedback or questions about this blog article? Feel free to reach out and we’re more than happy to discuss the content of this article in further depth.


Resources

1 https://www.nhsbsa.nhs.uk/prescription-data/prescribing-data/english-prescribing-data-epd

2 https://analytichealth.co.uk/pharmly-analytics/

3 https://www.england.nhs.uk/ccgs/

4 https://www.cnwl.nhs.uk/patients-and-carers/information-about-medicines/formulary

5 https://www.gov.uk/government/publications/health-and-care-bill-factsheets/health-and-care-bill-integrated-care-boards-and-local-health-and-care-systems

Pharmly Analytics or Pharmly Cloud Data: what’s right for me?

-by Veerle van Leemput, Managing Director at Analytic Health


From data insights to a live data connection- our apps provide it all

You’re probably reading this blog because you’re wondering which application, Pharmly Analytics or Pharmly Cloud Data, would be the right fit for you or your company. While both apps are great providers of marketing intelligence, they serve different purposes. In this blog we’ll lay out the key features of both apps and explain the difference between the two.


Pharmly Analytics 📊

Pharmly Analytics reimagines healthcare data analytics. The app gives access to UK pharmaceutical market intelligence. With all the main healthcare datasets available and the option to build your own view in the AI Console, this is the tool you need when you want to analyse the market.

With Pharmly Analytics we help you to identify opportunities for your product portfolio, ranging from green initiatives to brand optimisation and suggested product launches, and we’ll keep you up-to-date on the latest market changes like drug tariff price changes, shortages and new market entries.

Pharmly Analytics is a great fit for companies who are looking for support when it comes to analysing UK market data. We gather, clean, validate and store the data. Then we turn this data into actionable insights and make it available in Pharmly Analytics. By subscribing to Pharmly Analytics, you will take pressure off your salesforce and business development team and support your analysts by leveraging our AI analytics engine to determine the best strategic market opportunities.

Pharmly Analytics is fully customisable: our AI Console works with Smart Views so you can build the Console with products that matter to you. Think about your own company view, but also views related to a specific therapy area, active ingredient, other companies of interest or a specific set of metrics.


Pharmly Cloud Data ☁️

Pharmly Cloud Data is the UK healthcare data marketplace. The app provides instant access to a wide range of high-quality UK pharmaceutical market datasets. You can download the data via a simple web interface or even access the data programmatically via a REST-API, for those more technically minded.

We developed Pharmly Cloud Data because there was huge demand for easily accessible, cleaned and validated healthcare data. Analysts and Data Science teams may have their own analytical tools to gather insights, but often lack the continuously updated stream of data that is needed as input for these tools.

Pharmly Cloud Data is a great fit for companies who already have the resources to do their own analysis, but are looking to get data in a reliable way. With Pharmly Cloud Data you get access to our data warehouse, meaning that you don’t have to gather, clean, validate and store the data on your own systems. With a live data connection you can access our data at any time. And you can even store our data in your own databases if you want to.

By providing both an easy to use web interface and a programmatic REST API the app is great for users who prefer to download datasets to Excel and also for users who prefer to write their own programs.


The difference

Both apps serve a different purpose: Pharmly Analytics provides intelligence, and Pharmly Cloud Data provides data. In Pharmly Analytics you will see graphs, maps, trend analysis, opportunities and summary tables. In Pharmly Cloud Data you will see all our datasets with an option to download them.


You don’t have to choose

Both apps work great together: Pharmly Cloud Data provides the data and Pharmly Analytics provides insights on top of that data. If you want to have the best of both worlds, you don’t have to choose. You can help your team with a continuous data stream AND analytics. A subscription to both apps comes with a 20% discount 💡


Still in doubt?

It’s always easier to see things live! We’re more than happy to show you both apps during one of our demos. You can also try both of them out during our one-week trial. Simply book a meeting with us and we’ll make it happen!


The Patient and Medicine Journey

-by Veerle van Leemput and Greg Mills, Managing Directors at Analytic Health


It all starts with the patient

In this blog we’ll guide you through the Patient and Medicine Journey. The aim is to help you understand how patients in the United Kingdom get their medicines and where these medicines originate from. Pharmly Cloud Data offers a range of datasets that cover (parts of) this journey.


The full journey


Primary care

The patient’s journey starts when they need medical support and generally begins in the Primary Care system at a General Practice (GP).

The GP can either be a practice that also dispenses medicines (known as Dispensing Doctors) or a practice that only writes prescriptions. If there is no specialist referral needed, the patient’s journey ends by collecting their medicines at a community pharmacy (or directly from the GP in the case of Dispensing Doctors).

All this data is available in Pharmly Cloud Data’s Prescribing dataset, either grouped by Primary Care Organisation (known as Clinical Commissioning Group (CCG) in England) or individual GP practice. Information about the volume and value going through a Dispensing Doctor is available in our Prescriptions Cost Analysis (PCA) data*.


Secondary care

If the patient gets referred from Primary Care to a specialist, they arrive in a hospital (or other similar NHS Trust) for Secondary Care medical support. Depending on the urgency, the patient may have begun their journey in the Secondary Care system (e.g. accident and emergency (A&E)). Hospitals can both prescribe (for later use) and dispense (for immediate use) medicines to a patient.

Information about the number of patients admitted to hospitals is available in our Hospital Episodes Statistics (HES) data. The quantities and values of medicines used in hospitals are available in our Secondary Care Medicines Data (SCMD). Data on the prescriptions written in hospitals but dispensed at community pharmacies is available in our Hospital Prescriptions Dispensed in Community data*. This is particularly important in understanding the prescribing rates for each brand in each hospital.


Community Pharmacies and Pricing

Community pharmacies get their medicines supply from wholesalers (such as AAH Pharmaceuticals). They buy medicines at a certain price from the wholesaler and after dispensing to the patient they get financially reimbursed by the Department of Health and Social Care (DHSC) at the Drug Tariff price or, in case of a supply shortage, the Concessionary Price. Knowing these prices is important to understand buying decisions of community pharmacies and identify patterns of medicines shortages.

Pharmly Cloud Data provides access to Drug Tariff prices and Concessionary prices.


The Manufacturer and the Supply Chain

The medicines that the patient eventually receives are produced by a pharmaceutical manufacturer. The manufacturer sells their product to wholesalers, hospitals and pharmacy chains. When sold to hospitals, the manufacturer generally needs to be granted a tender for the supply.

The List Price is the basic price for a medicine, as defined by the manufacturer. Manufacturers sell their product using the List Price as a baseline but generally offer contractual discounts, depending on the level of competition or National Health Service (NHS) negotiations. This makes List Prices an important piece of information in the healthcare system.

All List Prices are available in our List Price dataset.


Dictionary of Medicines and Devices

The Dictionary of Medicines and Devices (DM+D) is a large repository of all the medicines and devices used across the NHS. When any company would like to supply a medication or medical device they must first register their product, including detailed characteristics, with the DM+D; making the dataset a vital piece in understanding the market.

The full DM+D database is available via Pharmly Cloud Data.


The Pharmly Code

All the vital elements of this patient and medicine journey are covered in Pharmly Cloud Data and our Pharmly Code ties all the pieces together.

We developed our pharmaceutical coding system (the Pharmly Code), as an enhancement to the DM+D, out of a necessity to combine, manage and make available our wide range of healthcare data via Pharmly Cloud Data. Our Pharmly Code allows you to combine datasets and to identify Active Ingredients, Brands, Product Packs, Companies and more. It’s the underlying infrastructure of all the data in the patient and medicine journey.

Pharmly Cloud Data allows you to simply browse through all Pharmly Codes so you can easily identify the products and companies you need.


Want to keep this for reference? Download our Patient and Medicine Journey here!

*this is currently under development and expected in early 2022.

Using the Pharmly Cloud Data API in Excel

– By Greg Mills, Founder of Analytic Health

Accessing healthcare data is a simple and enjoyable process...

… when you have the right tools for the job🛠

Our programmatic REST API

Data-driven healthcare decisions are more important than ever but accessing the data is not always as simple as we would like. So let’s take a look at how simple this can be with a REST API, which in simple terms means a process to share data, or not-so-simple terms… an Application Programming Interface for Representational State Transfer (let’s stick to the former).

Along with my business partner (and data-science star ⭐) Veerle van Leemput, we created a REST API to make an enriched set of England prescribing data freely available. Here we’ll demonstrate how to access that data, and as Microsoft Excel is still one of the most commonly used tools we’ll base the demo in Excel.

So, let’s see how we can impress all our colleagues by using a REST API to get some live data! You can follow these 7 simple steps to create the Excel workbook yourself or even download a fully working demo version here*. 

* You will need to adjust privacy settings for this example to work (step 2 below). Excel displays the warning: ‘this setting could expose sensitive or confidential data’. So I recommend you only adjust these if you have permission and know what you’re doing. We can’t access your data, it is merely a requirement from Excel, to enable the API functionality. Chis Webb gives some nice background in his article here. We don’t record any personal information relating to the requests to this data source and we don’t ask for any of your details to use the service.


7 Simple Steps

  1. Open Excel.
  2. Click Data > Get Data > Query Options > Privacy > Ignore the Privacy Levels and potentially improve performance > OK
Set privacy levels in Excel

3. Click Data > From Web > copy and paste this URL: https://apps.analytichealth.co.uk/REST_API_tryout/prescribing-pco?active_ingredients=aciclovir > click OK

Get Data From Web

4. If you see this pop-up, just click Connect

If you see a pop-up, just click on Connect

5. A new window will open. Click To Table > OK (leave the default settings)

A new window will open where you have to click To Table and OK, leaving the default settings.

6. Click the button to expand the columns > Untick the column prefix option > click OK.

Click the expand button to expand columns, untick the column prefix option, then OK

7. Click Close & Load, which will show you the full table in an Excel sheet 😎.

Click Close & Load, which will show you the full table in an Excel sheet


Great work! You should now have a fully automated workbook of England prescribing data. Each month just hit the Refresh button to keep the data live!

You need to click refresh if you want to see the live data


Available data

As part of this demo, we made a selection of active ingredients available, including Aciclovir, Baclofen, Paracetamol and Risperidone. Why not see if you can build a more dynamic way to retrieve the data for each of these! (This article might help you get started).

(This list of active ingredients may change- you can always contact us to enquire what is currently available)


I hope this helps you to better understand what a REST API is and how it can be used to access data. And if you’ve managed to follow the process yourself, then well done you for learning some great techie skills! ⭐️


For more details about Pharmly Cloud Data – the application that inspired this demo – take a look at our website here. We also wrote a white paper about the challenges of accessing high-quality data and some of our solutions, which you might find interesting. You can download it here.

We’ll be following up on this example with a Tableau dashboard using the same dataset to see how we can analyse prescribing trends across the UK.


See you next time!



References

https://analytichealth.co.uk/cloud-data/

https://easy-excel.com/how-to-create-a-refresh-all-button-in-excel/

https://helpcenter.itmplatform.com/project/use-parameters-in-api-calls-from-excel-cells-named-ranges/


A good time for a major restructure of the NHS?

– By Greg Mills, Founder of Analytic Health


In this article we take a brief look into the ever-changing landscape of NHS England and the Clinical Commissioning Groups (CCGs), which are groups of General Practices (GPs) that work together to define the best services for their patients and population1.


What exactly is happening?

In November 2020, NHS England released plans for major structural changes to its organisation. In April 2021 this change took effect when 38 of the CCGs were consolidated to become 9, taking the total number of CCGs down to 106.2


A one-off adjustment or part of a bigger picture?

In short, it’s part of a much bigger picture. Since the introduction of the CCGs with the Health and Social Care act of 2012, which aimed to strengthen competition within healthcare by creating a complex, localised structure3, there has been a notable reversal in policy4. From over 200 CCGs, initially, there are now likely to be just 42 by April 2022, as NHS England moves towards its vision of a fully Integrated Care System (ICS).


Why make these changes?

There are suggested to be many benefits to an ICS, including that the action will support the pandemic recovery by removing unnecessary bureaucracy, empowering local bodies and tackling health inequalities5.  However, others question the timing of such a shakeup, as the NHS continues to struggle with Covid-19- one of the biggest challenges in its history. There are also concerns over the loss of local knowledge and community partnerships, even the threat of privatisation that critics say the consolidation may lead to6.


What does it mean for Pharmly Analytics?

Pharmly Analytics is an application that provides analysis of prescribing habits and healthcare trends around the UK, with maps, graphs and insights aiming to support decision making for a range of organisations. We wrote another article about how the prescribing data can be useful and also some of its challenges here

As the prescribing data is released 2 months in arrears, we are now gearing up for the new data structure. The April data for England will be released in the middle of June, so as soon as that happens we will switch our setup to include the new CCG structure: 106 CCGs instead of the current 135. The historical data for the 38 CCGs which technically no longer exist will be integrated into the 9 newly introduced CCGs, so no data will be lost. 


How can I learn more?

Please contact us if you have any questions regarding the restructure, how it affects the Pharmly Analytics application, or to collaborate on projects which help to accelerate innovation in healthcare.


Details of all the mergers:


CCG change summary
Figure 1. CCG change summary (source: NHS Digital)

References

  1. https://www.england.nhs.uk/commissioning/who-commissions-nhs-services/ccgs/
  2. https://digital.nhs.uk/services/organisation-data-service/change-summary-reconfiguration-2021-ccg-mergers
  3. BMJ 2021; 372 doi: https://doi.org/10.1136/bmj.n248
  4. https://www.theguardian.com/society/2021/feb/11/matt-hancock-lays-out-his-plan-for-wholesale-reorganisation-of-nhs
  5. https://www.gov.uk/government/news/blueprint-launched-for-nhs-and-social-care-reform-following-pandemic
  6. https://keepournhspublic.com/covid-nhs-restructuring-ics/