Prescriptions in Wales: April 2020 to March 2021

There are two main sections in this report.

• ‘GP prescriptions’ which are items prescribed by GPs or on behalf of GPs in Wales, and dispensed within the community in Wales or elsewhere in the UK.
• ‘UK comparisons’ which use slightly different data called ‘prescriptions dispensed in the community’ which are items prescribed by any prescribing health professionals in the UK that were subsequently dispensed in the community in Wales.

GP prescriptions data are the primary focus of this report because it demonstrates which medicines and appliances are being prescribed by Welsh GP practices. Therefore it is recommended that the majority of readers should use GP prescriptions data for their analysis.

Prescriptions dispensed in the community are secondary data, but should be used when making comparisons across countries in the UK.

Items prescribed and dispensed within hospitals are not counted in either dataset, but if a prescription was written by a hospital doctor and later dispensed at a community pharmacy (i.e. a high street pharmacy), it would be counted in the secondary source of prescriptions dispensed in the community.

A comparison between the sources is provided in Table 1 and further details are provided in the Which data should I use? section. 

• 81.1 million items were prescribed by GPs, and dispensed in the community in 2020-21. This is 1.0 million (1.2%) lower than 2019-20.
• The long-term trend shows large increases in the number of items prescribed and dispensed over time but the increases have slowed in recent years. In the most recent five year period, the number of items increased by 1.3% compared to an increase of 9.0% in the previous five year period (2011-12 to 2015-16).
• The number of prescriptions per head of population registered with a GP was 25.1 in 2020-21. This is 0.3 items (or 1.2%) lower than the previous year.
• The British National Formulary (BNF) chapters with the most items prescribed by GPs in Wales and dispensed in the community has been unchanged over the past three years. These are cardiovascular system, central nervous system and endocrine system and combined they cover 60% of all items. 
• There is year-to-year volatility in the net ingredient cost (NIC) of the items prescribed by GPs and dispensed in the community, but the overall trend had been broadly stable since the mid-2000s. However in 2020-21, the net ingredient cost was £624.7 million, an increase of £30.7 million (or 5.2%) on the previous year, and the highest on record.
• There are differences between the number of items prescribed and dispensed and their cost at health board level. Cardiff and Vale had the lowest number of items prescribed per prescribing unit and the lowest net ingredient cost, but the highest cost per item.
• Cwm Taf Morgannwg, had the highest number of items prescribed and dispensed per prescribing unit, which cost an average of almost £28 per prescribing unit more than in Cardiff and Vale.
• Using supplementary data for prescriptions dispensed in the community, more prescription items per head of population were dispensed in Wales than any of the other UK countries. However, Wales had the lowest NIC per prescription item dispensed of all four countries, and only England had a lower NIC per head of population than Wales.

The latest data for Wales covers the financial year beginning in April 2020 and ending in March 2021, which coincides in-full with the coronavirus (COVID-19) pandemic. However, the pandemic appears to have little impact on the way data has been collected due to the nature of how items are prescribed and dispensed. There may be some effect from patients interacting with GPs in different ways to before the pandemic, with more telephone and virtual consultations, but the data for the number of items prescribed by GPs and dispensed in the community in Wales, in 2020-21, is in-line with recent trends.

Prescription items

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Latest data

• In 2020-21 there were 81.1 million (81,097,939) items prescribed by GPs in Wales and dispensed in the community, the second highest on record. This is equivalent to 25.1 items per head of the population registered with a GP in Wales.

Change since last year

• Just over 1 million (1,002,105) fewer items were prescribed in 2020-21 compared to 2019-20, a decrease of 1.2%.
• This is a decrease of 0.3 items (1.2%) per head of the population registered with a GP in Wales.

Change over the last 5 years

• 1.1 million (1,069,882) more items were prescribed in 2020-21 than in 2016-17, an increase of 1.3%.
• However, because of population changes, the number of items per head of population registered with a GP in Wales was nearly the same in both years.

Change since introduction of free prescriptions on 1 April 2007

• More than 19 million (19,086,764) additional items were prescribed in 2020-21 compared to 2007-08, an increase of 30.8%. This is an increase of 5.0 items (or 25.0%) per head of the population registered with a GP in Wales.
• The increase since free prescriptions were introduced is smaller than the increase of 27.7 million (or 80.7%) items prescribed in the previous 14 year period (1993-94 to 2007-08).

Net ingredient cost

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Latest data

• In 2020-21, the total net ingredient cost of all items prescribed by GPs in Wales and dispensed in the community was almost £625 million (£624,726,216), equivalent to £193.03 per head of population registered with a GP in Wales.

Change since last year

• Total net ingredient costs rose by more than £30 million (£30,739,198) or 5.2% in 2020-21 compared with the previous year; the cost per head of population registered with a GP in Wales increased by £9.50 (5.2%).

Change over the last 5 years

• Total net ingredient costs rose by more than £48 million (£48,051,788) or 8.3% in 2020-21 compared to 2016-17. The cost per head of population registered with a GP in Wales has increased by £12.69 (7.0%).

Change since introduction of free prescriptions on 1 April 2007

• The total net ingredient cost has increased by just over £40 million (£40,311,602), or 6.9% since 2007-08, when free prescriptions were introduced in Wales. The cost per head of population registered with a GP in Wales has increased by £7.53 (4.0%).
• The increase since free prescriptions were introduced is much smaller than the increase of £352.8 million (or 152.2%) in NIC in the previous 14 year period (1993-94 to 2007-08).

Average net ingredient costs

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• In 2020-21 the net ingredient cost per item (mean) was £7.70. This is 47p (6.5%) more than in 2019-20 but £2.20 (18.3%) less than in 2007-08, when free prescriptions were introduced.
• The mean cost per item had been on an overall downward trend over the longer term, but it has now increased for the second year in a row. 
• The median cost per item in March 2021 was £2.30, up 21p (10.0%) from the previous March. It has been less than £3 since March 2008 and this is only the second time it has been above £2 since March 2015.

Note

Mean: The mean cost per item shows the total net ingredient cost for all prescription items, divided by the total number of prescription items for the whole calendar year.

Median: The median cost per item is the middle amount when all costs per item are ranked in order from cheapest to most expensive; half of all costs are less than or equal to this amount, and the other half are more than or equal to this amount. The median is less affected by extreme values than the mean.

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• Half of all items prescribed in Wales were for the treatment of conditions of the cardiovascular or central nervous systems.
• 23.5 million items were prescribed for treatment of the cardiovascular system, equal to 7.3 items per head of population registered with a GP in Wales.
• 17.1 million items were prescribed for the treatment of the central nervous system, equal to 5.3 items per head of population registered with a GP in Wales.
• Although the number of items prescribed for treatment of the cardiovascular and central nervous systems accounted for half of the total items prescribed (Chart 4), the net ingredient cost (NIC) for the same classes only accounted for a third (33.1%) of the total (Chart 5).

The following chart shows the numbers of items prescribed by GPs contracted to Welsh health boards together with the associated net ingredient cost (NIC). Rather than comparing items per head of population registered with a GP, the chart shows items and NIC per prescribing unit (PU). Prescribing units are calculated by giving a greater weight (by a factor of three) to the registered population aged 65 or over. They have been adopted to take account of elderly patients’ greater needs for medication and so to make more meaningful comparisons between health boards. The remaining differences may be related to relative need and local culture and practice.

GP registration data for 2019 (StatsWales) shows that 20.7% of the population in Wales were aged 65 or over. This varied between health boards, with a relatively greater percentage of older people in Powys (26.7%), Hywel Dda (24.2%), and Betsi Cadwaladr (22.7%); and a relatively smaller percentage of older people in Swansea Bay (20.3%), Aneurin Bevan (19.9%), Cwm Taf Morgannwg (19.6%) and Cardiff and Vale (15.7%).

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• The number of items prescribed per prescribing unit in 2020-21 was 17.7 for Wales, and varied across the health boards from 14.9 in Cardiff & Vale to 20.1 in Cwm Taf Morgannwg.
• The cost per item was £7.70 across Wales, and ranged from £7.32 in Aneurin Bevan to £8.47 in Cardiff & Vale.
• GPs in Cardiff & Vale prescribed fewer items per prescribing unit than in other health boards but at a higher cost per item. In contrast, Cwm Taf Morgannwg had the highest rates per prescribing unit for both number of items and NIC but the fourth lowest cost per item.
• The net ingredient cost per prescribing unit in 2020-21 was £136.58 in Wales, and ranged from £126.58 in Cardiff & Vale to £154.33 in Cwm Taf Morgannwg.

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• Atorvastatin was the most prescribed item in 2020-21, with it being prescribed more than 3 million times (3,016,616), an increase of 146,924 (or 5.1%) since 2019-20.
• The ten most prescribed items in 2020-21 were the same ten items as in 2019-20. The five most prescribed items also remained in the same order as in 2019-20.

Charts 8 to 10 compare the number of prescription items dispensed, per head of population, the NIC per head of population and the cost per prescription item across the four UK countries.

The prescription data for these charts is based on prescriptions dispensed in the community, rather than prescriptions issued by GPs meaning figures for Wales will differ from those presented in the other charts in the release. Prescriptions dispensed data is the only available data for comparison purposes in England, Scotland and Northern Ireland.

For consistency in population data across each country, the Office for National Statistics (ONS) mid-year population estimates for 2020 are used in this section, rather than the number of people registered to a GP practice.

Note that the latest data for Wales and England refers to 2020-21, for Scotland it refers to 2019-20 and for the calendar year 2020 in Northern Ireland.

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• More prescription items per head of population were dispensed in Wales than any of the other UK countries, but Wales had the lowest NIC per prescription item.
• The net ingredient cost (NIC) of items dispensed in Wales, per head of population in Wales was higher than in England, but lower than in Scotland and Northern Ireland.

Detailed quality and methodology information is published in the accompanying quality report.

Prior to 2019, prescriptions data had been published in two separate statistical releases, Prescriptions by GPs last published on 19 September 2018 and Prescriptions dispensed in the community last published on 23 May 2018.

Combining the two datasets in one release with more contextual information aims to provide users with a clear analysis of prescriptions in Wales.

NHS Shared Service Partnership also publish data on GP prescriptions every month, based on the same data which is presented in this publication.

An interactive data tool that allows users to search data on BNF chapters, sections, and sub paragraphs, based on GP prescriptions is published alongside this release. Previously this data was published in Excel files using only prescriptions dispensed in the community data.

Data for other countries:

Prescription Cost Analysis: England 2020/21 (NHS Business Services Authority)

Dispenser payments and prescription cost analysis: Financial year 2019/20 (Public Health Scotland)

Prescription Cost Analysis (Business Services Organisation, Northern Ireland)

Which data should I use?

Source: NHS Wales Shared Services Partnership

Table 1 shows a comparison between the two sources. In general, when analysing prescriptions data for Wales, GP prescriptions should be used as the primary source. This is because the data shows what is being prescribed to people registered with Welsh GP practices and this activity is monitored and influenced by health boards. This data includes items that are prescribed in Wales by GPs and non-medical prescribers that have prescribed on behalf of the GP practice.

‘Prescriptions dispensed in the community’ should be used for more specific purposes where users are interested only in the items actually dispensed in Wales, and if direct comparisons are being made between different UK countries. While broadly the number of items prescribed by GPs is close to the number of items prescribed and dispensed in Wales it does not exactly match for a number of reasons including:

• prescriptions written in Wales but dispensed elsewhere in the UK (including the Isle of Man) are counted in GP prescriptions but not ‘prescriptions dispensed in the community’. This is particularly common for specialist items such as stomas and incontinence appliances which are often dispensed by appliance contractors rather than pharmacies, many of which are not located in Wales.
• prescriptions written in another UK country (including the Isle of Man) but dispensed in Wales are not included in GP prescriptions, but are included in ‘prescriptions dispensed in the community’
• people who have had a hospital appointment and have their prescription items dispensed in their local community pharmacy rather than the hospital one will not be included in GP Prescriptions, but they would be in ‘prescriptions dispensed in the community’

Note that both ‘GP prescriptions’ and ‘prescriptions dispensed in the community’ capture prescriptions which are dispensed by dispensing doctors, appliance contractors and community (high street) pharmacies. Neither source contains data for items prescribed and dispensed in hospitals. Also note that net ingredient costs (NIC) are not adjusted for inflation.

Well-being of Future Generations Act (WFG)

The Well-being of Future Generations Act 2015 is about improving the social, economic, environmental and cultural wellbeing of Wales. The Act puts in place seven wellbeing goals for Wales. These are for a more equal, prosperous, resilient, healthier and globally responsible Wales, with cohesive communities and a vibrant culture and thriving Welsh language. Under section (10)(1) of the Act, the Welsh Ministers must (a) publish indicators (“national indicators”) that must be applied for the purpose of measuring progress towards the achievement of the Well-being goals, and (b) lay a copy of the national indicators before Senedd Cymru. The 46 national indicators were laid in March 2016.

Information on the indicators, along with narratives for each of the wellbeing goals and associated technical information is available in the Wellbeing of Wales report.

Further information on the Well-being of Future Generations (Wales) Act 2015.

The statistics included in this release could also provide supporting narrative to the national indicators and be used by public services boards in relation to their local wellbeing assessments and local wellbeing plans.

Statistician: Craig Thomas
Telephone: 0300 025 1646
Email: stats.healthinfo@gov.wales

Media: 0300 025 8099

SFR 274/2021