Regional Drug and Therapeutics Centre (RDTC Newcastle) access to HES and Medicines dispensed in Primary Care (NHSBSA)

Text removed is struck through; text added is underlined. Unchanged paragraphs are summarised rather than repeated.

Datasets: − COVID-19 General Practice Extraction Service (GPES) Data for Pandemic Planning and Research (GDPPR)

Objective for processing

The Regional Drug and Therapeutics Centre at Newcastle (RDTC) hosted by the [14 words unchanged] England Data Access Environment (DAE) to access pseudonymised, non-sensitive Hospital Episode Statistics (HES) (HES), Emergency Care Data Set (ECDS), and GPES Data for Pandemic Planning and Research (GDPPR) data. This agreement also permits access to the Medicine's dispensed in primary care data set (NHSBSA) which was not provided under data. Under the previous iterations iteration of this agreement. Agreement, RDTC accessed GPES Data for Pandemic Planning and Research (GDPPR) data , however the list of medications within the GDPPR data is too narrow to be useful for the purpose of this Agreement so RDTC no longer require access to the GDPPR data. Prescribing is the most common patient-level intervention in the NHS, and covers [70 words unchanged] optimisation which RDTC aligns with. These are presented in reports at regional (Sustainable Transformation Partnerships [STP]/ Integrated Care Systems [ICS]) and Sub ICB Location (SICBL) level (or defined practice groups of SICBL magnitude), in relation to particular conditions, such as diabetes. [1 paragraph unchanged] The use of GDPPR data is used to analyse significant increased pressure caused by the lack of knowledge of the impact of COVID-19 on both the short-term and long-term prescribing costs. The impact of COVID on prescribing and outcomes is not expected to be fully realised for many years. The specific costs presented for prescribing are also used by the sub Integrated Care Board Locations (SICBLs) to inform their budget discussions, planning and finance arrangements. All GP and Primary Care Network (PCN) colleagues within those SICBLs and stakeholders working within the contracted ICSs are able to receive RDTC reports. The researchers are actively seeking better ways to engage and work collaboratively with colleagues across the Northern region, in particular PCNs as their structures develop. All GP and Primary Care Network (PCN) colleagues within those SICBLs that have a Service Level Agreement (SLA) with the RDTC are able to receive RDTC reports. The researchers are actively seeking better ways to engage and work collaboratively with colleagues across the Northern region, in particular PCNs as their structures develop. Access to the Medicines Dispensed in Primary Care dataset (NHSBSA) enables RDTC to utilise the token ID function to link primary care dispensing data to HES data. These are both data sets which RDTC already have access to, and the objectives for processing and activities are as described within this current contract. Below are outlined some examples of how GDPPR data may be used to support the SICBL stakeholders. The RDTC utilise the data linkage facility within the DAE to link NHSBSA data to HES data to provide intelligence about the safety and effectiveness of medicines. Additional fields within the NHSBSA dataset acquired through NHS England, such as ethnicity and the token patient ID, will support intelligence around prescribing and health inequalities. • The prescribing reports present ePACT2 (an online application which gives authorised users access to prescription data, held by NHS Business Services Authority) data, HES data and relevant Quality and Outcomes Framework (QOF) prevalence, national audit data and public health data in a combined way that enables SICBLs to understand their specific prescribing behaviour over time, the impact of prescribing on outcomes (such as hospital admissions) and the impact of external factors (such as price changes and supply issues). Throughout the prescribing reports that RDTC produce, the researchers use weightings in many charts, to enable more specific interpretation of prescribing. For instance, antipsychotics weighted for the number of dementia patients. With the exception of dementia list size, most weightings (COPD/asthma patients, diabetes prevalence data etc.) are through Quality and Outcome Framework (QOF) or national audit and available annually at best. It has been noted that the large number of COVID-19 deaths will impact directly on practice list sizes for specific conditions. The researchers will be unable to correct the weightings in most of the charts to account for decreases in list size (due to COVID-19 deaths) for at least 12 months, when the next QOF data is released. This will make the charts potentially very inaccurate and meaningless for the SICBLs, thus removing one of the tools for managing and monitoring the safety of prescribing behaviour. Scatter charts incorporating the HES and NHSBSA data are included within the reports, and will be used to present the outcomes that may be attributed in some part to prescribing patterns within an area. In particular, the reports are useful for SICBLs to benchmark against others, identifying where they, for example, have an unusual or high prescribing pattern for a particular condition, which could have a higher-than-average cost. They can then use this information to investigate further, consider practice in other SICBLs, and make changes accordingly, with a view to being more cost effective. • In accessing the GDPPR data, it is hoped that analysis of the medication prescribed both at the time of diagnosis and over time following a diagnosis could be used by SICBL stakeholders to understand the impact of changes in prescribing throughout the COVID-19 pandemic and for the foreseeable future, as the Mid to long term effects of post COVID-19 recovery health needs are seen, and therefore assist with forecasting SICBL spend and cost growth. These areas are usually determined through analysis of ePACT2 data, however, ePACT2 data is only available with a 3 month delay (the SICBLs need the information now) and does not provide the level of differentiation needed to understand costs due to COVID-19 infection and short term costs due to changes in prescribing behaviour (e.g. stocking up on medicines). • RDTC also undertake deep dive research for stakeholders, to understand specific therapeutic area prescribing in greater detail where there is concern or a change in behaviour detected. Currently, the COVID-19 impact is a great unknown. Being able to differentiate the data to understand which type of patients, e.g. age group, co-morbidities etc. will help to direct research and be used in conjunction with the ePACT2 prescribing data (released 3 months later) to support the SICBLs with specific actions to manage the impact of COVID-19 on prescribing and future strategic planning that may be required to meet the post-COVID-19 infection long term needs. The addition of the Medicines Dispensed in Primary Care dataset (NHSBSA) will enable RDTC to utilise the token ID function to link primary care dispensing data to HES data. These are both data sets which RDTC already have access to, and the objectives for processing and activities are as described within this current contract. The RDTC will utilise the data linkage facility within the DAE to link NHSBSA data to HES data to provide intelligence about the safety and effectiveness of medicines. Additional fields within the NHSBSA dataset acquired through NHS England, such as ethnicity and the token patient ID, will support intelligence around prescribing and health inequalities. The RDTC would like this dataset through NHS Digital. The RDTC require both NHSBSA and GDPPR data sets as the first is dispensed data, but GDPPR data is prescribed data, these are different sets which will enable RDTC to undertake population health analysis to understand the impact of health inequalities on medicines use and their associated outcomes, specifically by linking drug and admissions data to understand the impact of COVID-19 on prescribing behaviours. Scatter charts incorporating the HES, GDPPR and NHSBSA data are included within the reports, and are used to present the outcomes that may be attributed in some part to prescribing patterns within an area. In particular, the reports are useful for SICBLs to benchmark against others, identifying where they, for example, have an unusual or high prescribing pattern for a particular condition, which could have a higher-than-average cost. They can then use this information to investigate further, consider practice in other SICBLs, and make changes accordingly, with a view to being more cost effective. [2 paragraphs unchanged] The RDTC have found some SCIBLs demonstrate lower prescribing costs in diabetes [67 words unchanged] reports created by the RDTC will allow better communication between the SICBLs. The RDTC will also utilise this data for pharmacy and medicines optimisation research, for publication and presentation through journals and conferences. [1 paragraph unchanged] There are no other funders or commissioners involved in this work that are not mentioned in this agreement. RDTC prescribing support funding primarily comes from NHS bodies i.e. ICBs, NHS Foundation Trusts, and NHS England. Funding may also come from grant and research bodies. [1 paragraph unchanged] The aim of this work is to highlight variation in prescribing between [58 words unchanged] cost. National data is specifically required in order to enable benchmarking of SICBLs. SICBLs and cohort of practices equivalent to SICBL magnitude. [2 paragraphs unchanged] The RDTC requires HES, HES and NHSBSA and GDPPR data from NHS England, as it is the only avenue available. [1 paragraph unchanged] The datasets requested are required to cover the diversity of therapeutic areas [22 words unchanged] data may be required to understand and demonstrate trends in prescribing behaviour. The geography used is directly related to the SICBL stakeholders. However, in In order to benchmark prescribing, access to the 10 most similar SICBLs nationally [7 words unchanged] is required. Different therapeutic areas and prescribing analysis may necessitate access to stakeholder SICBLCs or defined stakeholder cohorts different age and clinical factors. Similarly, all patient episodes are required to enable quantification of the scale of an outcome related to a prescribing behaviour. [1 paragraph unchanged] The data requested is necessary for the performance of a task carried [9 words unchanged] of prescribing services in local areas (covered by Article 6 (1)(e) of GDPR)). GDPR). The Trust is a public body and can rely on this legal [88 words unchanged] to see if differences in patterns have an impact on hospital admissions. [1 paragraph unchanged] RTDC is hosted by the Newcastle Upon Tyne Hospitals NHS Foundation Trust. [41 words unchanged] processor as it hosts and manages access to data accessed under this Agreement. Agreement via the NHSE Data Access Environment (DAE).

Processing activities

[2 paragraphs unchanged] Data is extracted from NHS England DAE aggregated at SICBL level. level or cohorts of SICBL magnitude. The extraction and processing of data is carried out by a substantive [19 words unchanged] within a secure environment and stored at the approved trust premises. (Newcastle-upon-Tyne). [9 paragraphs unchanged] The data will not be linked with any record level data. to other study data held by the recipient. [2 paragraphs unchanged] Access is being requested to HES, GDPPR HES and NHSBSA data, as this will provide the Trust with the data required for analysis. These data are used to produce linked datasets and the scatter charts detailed above. Data is only required for the last [13 words unchanged] that The Trust will filter this to only include the exact SICBLs or cohorts of practices at SICBL magnitude, they require as not all SICBLs nationally fit the top 10 most similar SICBLs, SICBLs or to reflect CORE20+5 national agenda, for example Central London (Westminster) SCIBL does not feature in the top 10 similar SICBLs of any of the applicant's stakeholders so the data could be filtered out. HES Data will be filtered by the applicant for specific conditions using ICD-10 [19 words unchanged] codes. Procedure codes will also be used to filter data where appropriate. [10 paragraphs unchanged]

Expected output

RDTC Prescribing reports report outputs containing aggregated HES data will be provided through a combination of the [10 words unchanged] via open access as prescribing reports, bulletins and other publications when required. The output for the addition of the GDPPR data will be through the current therapeutic and financial reports, COVID-19 specific reports and response to SICBL's. [1 paragraph unchanged] Prescribing reports and publications will be provided to stakeholder organisations across the North of England and other organisations that SICBLs ICSs were content to share with, via the secure area of the RDTC [21 words unchanged] to the fact that a new report is available from the website. These outputs have been delayed as DAE access was delayed for some time. The RDTC twitter account also alerts stakeholders that a new report has [12 words unchanged] RDTC cardiovascular report is now available to stakeholders on the RDTC website”. Outputs will also be used for research, published externally, and presented at conferences. Aggregated outputs may also be published via posters, conferences and journal publications. [2 paragraphs unchanged] SICBL ICS medicines optimisation teams use the information within the report to benchmark their [50 words unchanged] there appear to be "better" outcomes and seek to replicate this success. [1 paragraph unchanged]

Expected measurable benefits

In accessing the GPES data, it is hoped that analysis of the medication prescribed both at the time of diagnosis and over time following a diagnosis could be used to understand and assist with forecasting SICBL spend and cost growth to support the SICBL. The provision of accurate Medicines Dispensed in Primary Care (NHSBSA) data appropriately contextualised, is needed at a SICBL level or cohorts of practices at SICBL magnitude to improve prescribing in line with guidance, detect trends and feed into strategic work plans. The provision of accurate prescribing data appropriately contextualised, is needed at a SICBL level to improve prescribing in line with guidance, detect trends and feed into strategic work plans. The provision of health services within an Integrated Care System relies on information pertaining to the prescribing of medicines and those changes associated with prescribing of medicines for its population. In order to demonstrate how this is happening RDTC look at medicines dispensed data against outcome measures such as hospital admissions for condition X. The research team plot as scatters and this enables NHS organisations to compare themselves in terms of spend on drug X vs admissions to hospital for reason Y, which enables NHS organisations to identify efficiencies and improvements in treatment efficacy. Using the GPES information in conjunction with other data sources may enable statisticians to calculate a COVID-19 adjustment to the weightings. This is essential and may support the NHS SICBL stakeholders to be able to continue to monitor and change their prescribing behaviour to meet the targets set out in the NHS long term plan. The GPES data is expected to help predict increased usage of different medicines groups due to COVID-19 in the long term and by attributing usage to COVID-19 impact in the short-term. This may help to manage the impact of the virus and thus ease pressures in the NHS system. Part of supporting the SICBLs with specific actions to help manage the impact of COVID-19 on prescribing and future strategic planning includes noting where SICBLs are prescribing in a manner different to their peers. This helps to identify areas where the quality of prescribing may be improved and similarly potential unsafe practice. One of the particular areas that the researchers are interested in looking at further is the use of antipsychotics during the COVID-19 pandemic. Preliminary data highlighted this as an area of potential concern as it appeared that there was increased prescribing. It is likely that this is a mis-representation of the data due to a significant change in the dementia patient list size. However, without the GPES data, the researchers are unable to confirm this and clarify what is happening in a timescale that is going to assist with patient care and safety. The vast majority of this research is about improving population health through the optimised use of treatments. The population health work focusing on the Covid-19 population undertaken by RDTC will be supported through access to this the GPES dataset i.e. the impact of Covid-19 of prescribing medicines within this Covid-19 patient population. The provision of health services within an Integrated Care System relies on information pertaining to the prescribing of medicines and those changes associated with prescribing of medicines for its population. In order to demonstrate how this is happening RDTC look at prescribed/dispensed data against outcome measures such as hospital admissions for condition X. The research team plot as scatters and this enables NHS organisations to compare themselves in terms of spend on drug X vs admissions to hospital for reason Y, which enables NHS organisations to identify efficiencies and improvements in treatment efficacy. [1 paragraph unchanged] By highlighting to medicines optimisation teams any potential relationship between prescribing patterns [82 words unchanged] systems need to be able to see primary care spend and choice (NSA (NHSBSA data) against outcomes delivered as measured through secondary care (HES data). [1 paragraph unchanged] Through linkage of HES data with the Medicines Dispensed in Primary Care data set, actual outcomes will be presented, providing stakeholders with actual outcomes of an intervention i.e. drug choice in specified population. [10 paragraphs unchanged]

Unchanged: Benefits reported.

Text removed is struck through; text added is underlined. Unchanged paragraphs are summarised rather than repeated.

Datasets: + HES-ID to MPS-ID HES Admitted Patient Care; + Medicines dispensed in Primary Care (NHSBSA data)

Objective for processing

The Regional Drug and Therapeutics Centre at Newcastle (RDTC) hosted by the Newcastle Upon Tyne Hospitals Foundation Trust (the Trust) require continued access to the NHS Digital Portal (Data England Data Access Environment; DAE) Environment (DAE) to access pseudonymised, non-sensitive Hospital Episode Statistics (HES) and GPES Data for Pandemic Planning and Research (GDPPR) data. This agreement also permits access to the Medicine's dispensed in primary care data set (NHSBSA) which was not provided under previous iterations of this agreement. Prescribing is the most common patient-level intervention in the NHS, and covers [13 words unchanged] second highest area of spending in the NHS, after staffing costs (NHS Digital). England). The Regional Drug and Therapeutics Centre at Newcastle (RDTC) hosted by the Newcastle Upon Tyne Hospitals Foundation Trust (the trust) extracts drives linkage of medicines data with other data sets to provide intelligence about safety and analyses prescribing data to identify trends and variation, and to support effectiveness of medicines. These are core principles of medicines optimisation. optimisation which RDTC aligns with. These are presented in reports at regional (Sustainable Transformation Partnerships [STP]/ Integrated Care Systems [ICS]) and Clinical Commissioning Group (CCG) Sub ICB Location (SICBL) level (or defined practice groups of SICBL magnitude), in relation to particular conditions, such as diabetes. Access to HES data is required to aid with report writing and [9 words unchanged] provides secure access to the health and care data held by NHS Digital England and it reduces the need for it to leave NHS Digital. England. Users can access the data within the NHS Digital Portal England DAE remotely and it ensures that the correct person, with the correct permissions accesses this data. The NHS Digital Portal England DAE caters for standard users with access to standard data sets. The use of GDPPR data is broadly to enable continued provision of accurate prescribing information which is needed to support the NHS at a primary care / Integrated Care Systems (ICS) level to fulfil their statutory duties. RDTC will be required to process and provide the data previously provided on a CCG footprint to whatever structures becomes the Integrated Care Systems. It is not known what these ICS will be yet. CCG footprints are expected to be followed until the ICS are well established. Any changes to data processing that need to be brought about due to this new structure will be reported to NHS Digital via an amendment to the Data Sharing Agreement before they are implemented. The use of GDPPR data is used to analyse significant increased pressure caused by the lack of knowledge of the impact of COVID-19 on both the short-term and long-term prescribing costs. The impact of COVID on prescribing and outcomes is not expected to be fully realised for many years. The specific costs presented for prescribing are also used by the sub Integrated Care Board Locations (SICBLs) to inform their budget discussions, planning and finance arrangements. There is significant increased pressure caused by the lack of knowledge of the impact of COVID-19 on both the short-term and long-term prescribing costs. The specific costs presented for prescribing are also used by the Clinical Commissioning Groups (CCGs) to inform their budget discussions, planning and finance arrangements. All GP and Primary Care Network (PCN) colleagues within those SICBLs that have a Service Level Agreement (SLA) with the RDTC are able to receive RDTC reports. The researchers are actively seeking better ways to engage and work collaboratively with colleagues across the Northern region, in particular PCNs as their structures develop. All GP and Primary Care Network (PCN) colleagues within those CCGs that have a Service Level Agreement (SLA) with the RDTC are able to receive RDTC reports. The researchers are actively seeking better ways to engage and work collaboratively with colleagues across the Northern region, in particular PCNs as their structures develop. Below are outlined some examples of how GDPPR data may be used to support the SICBL stakeholders. Below are outlined some examples of how GDPPR data may be used to support the CCG stakeholders. • The prescribing reports present ePACT2 (an online application which gives authorised users access to prescription data, held by NHS Business Services Authority) data, HES data and relevant Quality and Outcomes Framework (QOF) prevalence, national audit data and public health data in a combined way that enables SICBLs to understand their specific prescribing behaviour over time, the impact of prescribing on outcomes (such as hospital admissions) and the impact of external factors (such as price changes and supply issues). Throughout the prescribing reports that RDTC produce, the researchers use weightings in many charts, to enable more specific interpretation of prescribing. For instance, antipsychotics weighted for the number of dementia patients. With the exception of dementia list size, most weightings (COPD/asthma patients, diabetes prevalence data etc.) are through Quality and Outcome Framework (QOF) or national audit and available annually at best. It has been noted that the large number of COVID-19 deaths will impact directly on practice list sizes for specific conditions. The researchers will be unable to correct the weightings in most of the charts to account for decreases in list size (due to COVID-19 deaths) for at least 12 months, when the next QOF data is released. This will make the charts potentially very inaccurate and meaningless for the SICBLs, thus removing one of the tools for managing and monitoring the safety of prescribing behaviour. • The prescribing reports present ePACT2 (an online application which gives authorised users access to prescription data, held by NHS Business Services Authority) data, HES data and relevant Quality and Outcomes Framework (QOF) prevalence, national audit data and public health data in a combined way that enables CCGs to understand their specific prescribing behaviour over time, the impact of prescribing on outcomes (such as hospital admissions) and the impact of external factors (such as price changes and supply issues). Throughout the prescribing reports that RDTC produce, the researchers use weightings in many charts, to enable more specific interpretation of prescribing. For instance, antipsychotics weighted for the number of dementia patients. With the exception of dementia list size, most weightings (COPD/asthma patients, diabetes prevalence data etc.) are through QOF or national audit and available annually at best. It has been noted that the large number of COVID-19 deaths will impact directly on practice list sizes for specific conditions. The researchers will be unable to correct the weightings in most of the charts to account for decreases in list size (due to COVID-19 deaths) for at least 12 months, when the next QOF data is released. This will make the charts potentially very inaccurate and meaningless for the CCGs, thus removing one of the tools for managing and monitoring the safety of prescribing behaviour. • In accessing the GDPPR data, it is hoped that analysis of the medication prescribed both at the time of diagnosis and over time following a diagnosis could be used by SICBL stakeholders to understand the impact of changes in prescribing throughout the COVID-19 pandemic and for the foreseeable future, as the Mid to long term effects of post COVID-19 recovery health needs are seen, and therefore assist with forecasting SICBL spend and cost growth. These areas are usually determined through analysis of ePACT2 data, however, ePACT2 data is only available with a 3 month delay (the SICBLs need the information now) and does not provide the level of differentiation needed to understand costs due to COVID-19 infection and short term costs due to changes in prescribing behaviour (e.g. stocking up on medicines). • With respect to the COVID-19 pandemic, CCG stakeholders are currently without sufficient information to make informed decisions around both the short-term cost impact of changes in prescribing over the last few months and additionally the impact of changes in prescribing throughout the COVID-19 pandemic and for the foreseeable future, as the Mid to long term effects of post COVID-19 recovery health needs are seen. In accessing the GDPPR data, it is hoped that analysis of the medication prescribed both at the time of diagnosis and over time following a diagnosis could be used to understand and assist with forecasting CCG spend and cost growth. These areas are usually determined through analysis of ePACT2 data, however, ePACT2 data is only available with a 3 month delay (the CCGs need the information now) and does not provide the level of differentiation needed to understand costs due to COVID-19 infection and short term costs due to changes in prescribing behaviour (e.g. stocking up on medicines). • RDTC also undertake deep dive research for stakeholders, to understand specific therapeutic area prescribing in greater detail where there is concern or a change in behaviour detected. Currently, the COVID-19 impact is a great unknown. Being able to differentiate the data to understand which type of patients, e.g. age group, co-morbidities etc. will help to direct research and be used in conjunction with the ePACT2 prescribing data (released 3 months later) to support the SICBLs with specific actions to manage the impact of COVID-19 on prescribing and future strategic planning that may be required to meet the post-COVID-19 infection long term needs. • RDTC also undertake deep dive research for stakeholders, to understand specific therapeutic area prescribing in greater detail where there is concern or a change in behaviour detected. Currently, the COVID-19 impact is a great unknown. Being able to differentiate the data to understand which type of patients, e.g. age group, co-morbidities etc. will help to direct research and be used in conjunction with the ePACT2 prescribing data (released 3 months later) to support the CCGs with specific actions to manage the impact of COVID-19 on prescribing and future strategic planning that may be required to meet the post-COVID-19 infection long term needs. The addition of the Medicines Dispensed in Primary Care dataset (NHSBSA) will enable RDTC to utilise the token ID function to link primary care dispensing data to HES data. These are both data sets which RDTC already have access to, and the objectives for processing and activities are as described within this current contract. Scatter charts incorporating the HES data are included within the reports, and are used to present the outcomes that may be attributed in some part to prescribing patterns within an area. In particular, the reports are useful for CCGs to benchmark against others, identifying where they, for example, have an unusual or high prescribing pattern for a particular condition, which could have a higher-than-average cost. They can then use this information to investigate further, consider practice in other CCGs, and make changes accordingly, with a view to being more cost effective. The RDTC will utilise the data linkage facility within the DAE to link NHSBSA data to HES data to provide intelligence about the safety and effectiveness of medicines. Additional fields within the NHSBSA dataset acquired through NHS England, such as ethnicity and the token patient ID, will support intelligence around prescribing and health inequalities. The RDTC would like this dataset through NHS Digital. The RDTC require both NHSBSA and GDPPR data sets as the first is dispensed data, but GDPPR data is prescribed data, these are different sets which will enable RDTC to undertake population health analysis to understand the impact of health inequalities on medicines use and their associated outcomes, specifically by linking drug and admissions data to understand the impact of COVID-19 on prescribing behaviours. Reducing unwarranted variation and increasing value through medicines optimisation is a crucial element of NHS RightCare’s innovation work (further information can be found on the NHS RightCare website). RDTC prescribing reports were developed in response to requests from CCGs (and this work is funded by the CCGs) so that variation in prescribing between CCGs could be illustrated, so CCGs can benchmark their performance against other CCGs both regionally and nationally. Identifying variation at this level prompts CCGs to investigate the causes of variation locally. They can then identify the better performing CCGs (those with lower prescribing costs and fewer hospital admissions) and make contact with them to share best practice, which can be implemented locally with an aim to improve prescribing and outcomes in the CCGs area. Scatter charts incorporating the HES, GDPPR and NHSBSA data are included within the reports, and are used to present the outcomes that may be attributed in some part to prescribing patterns within an area. In particular, the reports are useful for SICBLs to benchmark against others, identifying where they, for example, have an unusual or high prescribing pattern for a particular condition, which could have a higher-than-average cost. They can then use this information to investigate further, consider practice in other SICBLs, and make changes accordingly, with a view to being more cost effective. The RDTC produces a series of reports and publications for RDTC stakeholders across the North of England, primarily utilising EPACT2 data, Quality Outcomes Framework (QOF) and Hospital Episodes Statistics (HES) data (from NHS Digital), but also incorporating relevant data sets including public health, ONS and national audit data. Reducing unwarranted variation and increasing value through medicines optimisation is a crucial element of NHS RightCare’s innovation work (further information can be found on the NHS RightCare website). RDTC prescribing reports were developed in response to requests from SICBLs (and this work is funded by the SICBLs) so that variation in prescribing between SICBLs could be illustrated, so SICBLs can benchmark their performance against other SICBLs both regionally and nationally. Identifying variation at this level prompts SICBLs to investigate the causes of variation locally. They can then identify the better performing SICBLs (those with lower prescribing costs and fewer hospital admissions) and make contact with them to share best practice, which can be implemented locally with an aim to improve prescribing and outcomes in the SICBLs area. The RDTC have found some CCGs demonstrate lower prescribing costs in diabetes realising lower hospital admissions whereas other CCGs are demonstrating higher admissions with higher prescribing costs. RDTC believe it would be of benefit for CCGs demonstrating higher admissions with higher prescribing costs to communicate with those better performing CCGs (or those CCGs demonstrating lower prescribing costs and lower hospital admissions) to understand steps that can be taken to improve the CCGs prescribing and outcome position. Prescribing reports created by the RDTC will allow better communication between the CCGs. The RDTC produces a series of reports and publications for RDTC stakeholders across the North of England, primarily utilising EPACT2 data, Quality Outcomes Framework (QOF) and Hospital Episodes Statistics (HES) data (from NHS England), but also incorporating relevant data sets including public health, ONS and national audit data. The RDTC have found some SCIBLs demonstrate lower prescribing costs in diabetes associated with realising lower hospital admissions whereas other SICBLs are demonstrating higher admissions with higher prescribing costs. RDTC believe it would be of benefit for SICBLs demonstrating higher admissions with higher prescribing costs to communicate with those better performing SICBLs (or those SICBLs demonstrating lower prescribing costs and lower hospital admissions) to understand steps that can be taken to improve the SICBLs prescribing and outcome position. Prescribing reports created by the RDTC will allow better communication between the SICBLs. [2 paragraphs unchanged] HES data is supplied to stakeholders within the form of charts presented as a minimum at CCG SICBL level. This work was instigated in response to stakeholder requests that it [13 words unchanged] episodes of hospital admissions. This data is presented at a minimum of CCG SICBL level, and is only extracted for processing at CCG SICBL level. The aim of this work is to highlight variation in prescribing between CCGs. SICBLs. More specifically the use of HES data within these reports aims to [14 words unchanged] the data suggests that higher prescribing costs within a therapeutic area by CCG SICBL A do not lead to reduced hospital admissions compared to CCG SICBL B who is prescribing at a lower cost. National data is specifically required in order to enable benchmarking of CCGs. SICBLs. RDTC were previously granted access to HES data in October 2013 and [7 words unchanged] reports since October 2014 via the data depot system and the NHS Digital Portal England DAE system. [1 paragraph unchanged] The RDTC requires HES HES, NHSBSA and GDPPR data from NHS Digital, England, as it is the only avenue available. [1 paragraph unchanged] The datasets requested are required to cover the diversity of therapeutic areas [30 words unchanged] trends in prescribing behaviour. The geography used is directly related to the CCG SICBL stakeholders. However, in order to benchmark prescribing, access to the 10 most similar CCGs SICBLs nationally (for each CCG) SICBL) and a national benchmark, is required. Different therapeutic areas and prescribing analysis [17 words unchanged] quantification of the scale of an outcome related to a prescribing behaviour. [2 paragraphs unchanged] This data is only extracted as aggregated data at CCG SICBL level. The RDTC does not extract record level data. RTDC is hosted by the Newcastle Upon Tyne Hospitals NHS Foundation Trust. [24 words unchanged] organisations access the record-level data or determine the means for data processing. NHS England is a data processor as it hosts and manages access to data accessed under this Agreement.

Processing activities

All organisations party to this Agreement must comply with the Data Sharing Framework Contract requirements, including those regarding the use (and purposes of that use) by “Personnel” (as defined within the Data Sharing Framework Contract i.e.: employees, agents and contractors of the Data Recipient who may have access to that data). The NHS England DAE is a secure method giving access to datasets and associated analytical tools. It is accessed via a secure authentication method to named users. Users are only able to access the datasets detailed within this Agreement. Users log onto the DAE and are presented with analysis tools which allow them to access the relevant data sets and reference data tables so that they can return appropriate descriptions to the coded data. The access and use of the system is fully auditable and all users must comply with the use of the data as specified in this Agreement. The NHS Digital Portal is a secure method giving access to datasets and associated analytical tools. It is accessed via a secure authentication method to named users. Users are only able to access the datasets detailed within this Agreement. Users log onto the portal and are presented with analysis tools which allow them to access the relevant data sets and reference data tables so that they can return appropriate descriptions to the coded data. The access and use of the system is fully auditable and all users must comply with the use of the data as specified in this Agreement. Data is only handled as per the agreed processes set out in the protocol and data flow map provided to NHS England. Details of the data flow map are included below. Any changes to protocol deemed significant by the Trust Information Governance team that changes the processing activities or purposes of this Agreement will be communicated to NHS England and subsequent amendments will be made to the Agreement. Data is only handled as per the agreed processes set out in the protocol and data flow map provided to NHS Digital. Details of the data flow map are included below. Any changes to protocol deemed significant by the Trust Information Governance team that changes the processing activities or purposes of this Agreement will be communicated to NHS Digital and subsequent amendments will be made to the Agreement. Data is extracted from NHS England DAE aggregated at SICBL level. The extraction and processing of data is carried out by a substantive employee appropriately trained in data protection as required by the Trust. The data is processed by the RDTC at within a secure environment and stored at the approved trust premises. (Newcastle-upon-Tyne). Data is extracted from NHS Digital Portal aggregated at CCG level. The extraction and processing of data is carried out by a substantive employee appropriately trained in data protection as required by the Trust. The data is processed by the RDTC at within a secure environment and stored at the approved trust premises. (Newcastle-upon-Tyne). Record-level data cannot be downloaded and, in line with the HES Analysis Guide suppression rules, small numbers will be suppressed at the point of extraction from NHS England DAE and will not include any description of a cell size between 1 and 7. If national total is greater than or equal to 8, then all other counts will be rounded to the nearest 5. Data is saved within a restricted access folder within a restricted drive as per the Protocol - RDTC Management of Hospital Episode Statistics (HES) data. The original downloads are password protected. All downloads are recorded in the extraction log including: Record-level data cannot be downloaded and, in line with the HES Analysis Guide suppression rules, small numbers will be suppressed at the point of extraction from NHS Digital Portal and will not include any description of a cell size between 1 and 7. If national total is greater than or equal to 8, then all other counts will be rounded to the nearest 5. Data is saved within a restricted access folder within a restricted drive as per the Protocol - RDTC Management of Hospital Episode Statistics (HES) data. The original downloads are password protected. All downloads are recorded in the extraction log including: [4 paragraphs unchanged] Data is imported into a specific database which only holds hospital data and aggregates the data to latitude (LAT), ICB, Region and North of England level. The data then flows via linked [40 words unchanged] for all chart data and finally copied into the prescribing report spreadsheet. [1 paragraph unchanged] Data will only be accessed by individuals within the prescribing reports team of the prescribing support unit at the RDTC who have authorisation from NHS Digital England to access the data for the purpose(s) described, all of whom are [10 words unchanged] has the authority and thus the log in details to access NHS Digital England Portal system and will be the only user. HES data will be primarily plotted against EPACT2 prescribing data, quality and [9 words unchanged] The plotted data is displayed as charts. It will be presented at CCG SICBL level as a minimum but in some instances up to National level depending on the report format. [3 paragraphs unchanged] Access is being requested to HES HES, GDPPR and NHSBSA data, as this will provide the Trust with the data required to [8 words unchanged] only required for the last 5 years, national data (via the NHS Digital Portal) England DAE) is required in order that The Trust will filter this to only include the exact CCGs SICBLs they require as not all CCGs SICBLs nationally fit the top 10 most similar CCGs, SICBLs, for example Central London (Westminster) CCG SCIBL does not feature in the top 10 similar CCGs SICBLs of any of the applicant's stakeholders so the data could be filtered out. [1 paragraph unchanged] The following conditions apply to NHS Digital Portal England DAE access: 1) Access to NHS Digital Portal England DAE will be restricted to approved users agreed with the NHS Digital England in a controlled manner. Only users who have undergone Information Governance training may be permitted to access NHS Digital Portal. England DAE. [2 paragraphs unchanged] 4) NHS Digital England will monitor use of the NHS Digital Portal England DAE system as part of ongoing access and any excessive use will be reviewed and access could be withdrawn with data destruction notices issued if that occurs. [1 paragraph unchanged] 6) Where any record level data may have been downloaded previously from NHS Digital Portal, England DAE, such data must be securely destroyed and a certificate of data destruction provided to NHS Digital England within 2 months of this Agreement. 7) Where downloaded aggregated data contains small numbers, such data must be [7 words unchanged] Data Sharing Agreement, and a certificate of data destruction supplied to NHS Digital. England. [2 paragraphs unchanged]

Expected output

Due to the abolishment of CCGs from July 1st 2022, this Agreement needs to reflect the new NHS structures and statutory bodies. The output target audience for RDTC reporting will now include all NHS and associated organisations working within and across integrated care systems and integrated care boards e.g., academic health science networks, public health teams. RDTC will be required to process and provide the data previously provided on a CCG footprint to whatever structures becomes the Integrated Care Systems. It is not known what these ICS will be yet. CCG footprints are expected to be followed until the ICS are well established. Any changes to data processing that need to be brought about due to this new structure will be reported to NHS Digital via an amendment to the Data Sharing Agreement before they are implemented. [1 paragraph unchanged] Throughout the report where CCGs are referred to, this will become "sub-ICS" from 1st July 2022. The output for the addition of the GDPPR data will be through the current therapeutic and financial reports, COVID-19 specific reports and response to SICBL's. The output for the addition of the GDPPR data will be through the current therapeutic and financial reports, COVID-19 specific reports and response to CCG's. The following outputs will be produced: The following outputs will be produced: Prescribing reports will be provided to stakeholder organisations across the North of England and other organisations that CCGs SICBLs were content to share with, via the secure area of the RDTC [34 words unchanged] outputs have been delayed as DAE access was delayed for some time. [3 paragraphs unchanged] CCG SICBL medicines optimisation teams use the information within the report to benchmark their prescribing against their neighbouring CCGs, SICBLs, comparator CCGs SICBLs and regionally and nationally. The hospital admissions data enable CCGs SICBLs to identify whether their prescribing practice is leading to improved outcomes for patients via a reduction in hospital admission for that condition. CCG SCIBL medicines optimisation teams can also look to those CCGs SICBLs where there appear to be "better" outcomes and seek to replicate this success. [1 paragraph unchanged]

Expected measurable benefits

The short-term cost impact of changes in prescribing over the last few months and additionally the impact of changes in prescribing throughout the pandemic and for the foreseeable future, as the Mid to long term effects of post COVID-19 recovery health needs are seen. In accessing the GPES data, it is hoped that analysis of the [11 words unchanged] following a diagnosis could be used to understand and assist with forecasting CCG SICBL spend and cost growth to support the CCG in meeting their statutory functions during the pandemic. SICBL. The provision of accurate prescribing data appropriately contextualised, is needed at a CCG SICBL level to improve prescribing in line with guidance, detect trends and feed into strategic work plans. Using the GPES information in conjunction with other data sources may enable statisticians to calculate a COVID-19 adjustment to the weightings. This is essential and will may support the NHS CCG SICBL stakeholders to be able to continue to monitor and change their prescribing behaviour to meet the targets set out in the NHS long term plan. It will also support identification of potential mis-management of prescribing in COVID-19 infection and subsequent management, which is needed to ensure optimum patient care. The GPES data will is expected to help to fight against the pandemic by predicting predict increased usage of different medicines groups due to COVID-19 in the long term and by attributing usage to COVID-19 impact in the short-term. This will may help to manage the impact of the virus and thus ease pressures in the NHS system. Part of supporting the CCGs SICBLs with specific actions to help manage the impact of COVID-19 on prescribing and future strategic planning includes noting where CCGs SICBLs are prescribing in a manner different to their peers. This helps to [96 words unchanged] a timescale that is going to assist with patient care and safety. The vast majority of this research is about improving population health through the optimised use of treatments. The population health work focusing on the Covid-19 population undertaken by RDTC will be supported through access to this the GPES dataset i.e. the impact of Covid-19 of prescribing medicines within this Covid-19 patient population. The provision of health services within an Integrated Care System relies on information pertaining to the prescribing of medicines and those changes associated with prescribing of medicines for its population. In order to demonstrate how this is happening RDTC look at prescribed/dispensed data against outcome measures such as hospital admissions for condition X. The research team plot as scatters and this enables NHS organisations to compare themselves in terms of spend on drug X vs admissions to hospital for reason Y, which enables NHS organisations to identify efficiencies and improvements in treatment efficacy. [1 paragraph unchanged] By highlighting to medicines optimisation teams any potential relationship between prescribing patterns [12 words unchanged] enabling the most cost effective use of medicines across the health economy. Delivering of the NHS England medicines optimisation agenda: NHS England https://www.england.nhs.uk/medicines-2/medicines-optimisation/ Medicines optimisation requires aligned measurement and monitoring of medicines optimisation across the integrated care system, in order to support these systems in planning for and delivering intended benefits within the prescribing budget. To enable medicines to be considered as an investment rather than solely as a cost, systems need to be able to see primary care spend and choice (NSA data) against outcomes delivered as measured through secondary care (HES data). Identifying better outcomes to the patient population by a change in prescribing [13 words unchanged] (ICS) does not result in increased hospital admissions for an exacerbation of COPD Chronic Obstructive Pulmonary Disease (COPD) , may support prescribers to reduce high dose ICS prescribing which is of health benefit to the patient. High dose ICS are associated with an increased risk of systemic side effects, including adrenal suppression and growth retardation in children (NICE Academic detailing aid, July 2012). [3 paragraphs unchanged] • Variation between CCGs SICBLs in admission rates and spend on respiratory drugs [4 paragraphs unchanged] Using the RDTC respiratory report the group are able to watch for [24 words unchanged] team can investigate further using their local data. The benefit of using CCG SICBL reports enables the stakeholder to benchmark their progress against other CCGs, SICBLs, where the health economy is working on one footprint such as in [9 words unchanged] consider the whole health economy whilst being able to instigate variation at CCG SICBL level within that health economy. CCG's SICBL's can use this information in the reports to investigate discrepancies further, consider practice in other CCGs, SICBLs, and make changes accordingly, with a view to being more cost effective.

Benefits reported

[2 paragraphs unchanged] NHS Digital England data is used to support stakeholder organisations to reduce avoidable hospital admissions through medicines optimisation and improved pathway development in primary care. The presentation of primary care prescribing data against hospital admissions data at CCG SICBL level enables opportunities for improvement to be identified. Area prescribing committees use this data to set workplans for the coming year and to monitor against them, for example, GMMMG the Greater Manchester Medicines Management Group (GMMMG) workplan and the identification of the need to redefine diabetes pathway to reduce unnecessary hospital admissions whilst maintaining use of those agents which are most cost effective. Stakeholders have redefined their COPD and asthma pathways and use our reports to monitor implementation of these new pathways, for example, reduced use of high dose inhaled corticosteroids, but without increased admissions to secondary care for exacerbations of condition. The vast majority of this research is about improving population health through the optimised use of treatments. In order to demonstrate how this is happening RDTC look at prescribed/dispensed data against outcome measures such as hospital admissions for condition X. The research team plot as scatters and this enables NHS organisations to compare themselves in terms of spend on drug X vs admissions to hospital for reason Y, which enables NHS organisations to identify efficiencies and improvements in treatment efficacy. No additional benefits have been yielded yet through the use of GDPPR data as DAE access was delayed for a significant period, which in turn delayed the production of outputs and the resulting benefits. Stakeholders have redefined their COPD and asthma pathways and use RDTC reports to monitor implementation of these new pathways, for example, reduced use of high dose inhaled corticosteroids, but without increased admissions to secondary care for exacerbations of condition. These reports support medicines committees in the development and implementation of ICB system wide pathways. They are again utilised to estimate the impact of the intervention and provide system assurance.

Text removed is struck through; text added is underlined. Unchanged paragraphs are summarised rather than repeated.

Objective for processing

v4 AMENDMENT REQUEST: The Regional Drug and Therapeutics Centre at Newcastle (RDTC) hosted by the Newcastle Upon Tyne Hospitals Foundation Trust require continued access to the NHS Digital Portal (Data Access Environment; DAE) to access pseudonymised, non-sensitive Hospital Episode Statistics (HES) and GPES Data for Pandemic Planning and Research (GDPPR) data. The NHS Digital Portal (also referred to as DAE), provides secure access to the health and care data held by NHS Digital and it reduces the need for it to leave NHS Digital. Users can access the data within the NHS Digital Portal remotely and it ensures that the correct person, with the correct permissions accesses this data. The NHS Digital Portal caters for standard users with access to standard data sets. Prescribing is the most common patient-level intervention in the NHS, and covers all sectors of care: primary, hospital, public and community health. It is the second highest area of spending in the NHS, after staffing costs (NHS Digital). The Regional Drug and Therapeutics Centre at Newcastle (RDTC) hosted by the Newcastle Upon Tyne Hospitals Foundation Trust (the trust) extracts and analyses prescribing data to identify trends and variation, and to support medicines optimisation. These are presented in reports at regional (Sustainable Transformation Partnerships [STP]/ Integrated Care Systems [ICS]) and Clinical Commissioning Group (CCG) level in relation to particular conditions, such as diabetes. The Regional Drug and Therapeutics Centre (RDTC) (Newcastle-upon-Tyne Hospitals NHS Foundation Trust) require access to the GDPPR data. Access to HES data is required to aid with report writing and project work as described in this Agreement. The DAE provides secure access to the health and care data held by NHS Digital and it reduces the need for it to leave NHS Digital. Users can access the data within the NHS Digital Portal remotely and it ensures that the correct person, with the correct permissions accesses this data. The NHS Digital Portal caters for standard users with access to standard data sets. This is broadly to enable continued provision of accurate prescribing information which is needed to support the NHS at a primary care/ICS level to fulfil their statutory duties. There is significant increased pressure caused by the lack of knowledge of the impact of COVID-19 on both the short-term and long-term prescribing costs. The specific costs presented for prescribing are also used by the CCGs to inform their budget discussions, planning and finance arrangements. The use of GDPPR data is broadly to enable continued provision of accurate prescribing information which is needed to support the NHS at a primary care / Integrated Care Systems (ICS) level to fulfil their statutory duties. RDTC will be required to process and provide the data previously provided on a CCG footprint to whatever structures becomes the Integrated Care Systems. It is not known what these ICS will be yet. CCG footprints are expected to be followed until the ICS are well established. Any changes to data processing that need to be brought about due to this new structure will be reported to NHS Digital via an amendment to the Data Sharing Agreement before they are implemented. All GP and PCN colleagues within those CCGs that have an SLA with the RDTC are able to receive RDTC reports. The researchers are actively seeking better ways to engage and work collaboratively with colleagues across the Northern region, in particular PCNs as their structures develop. There is significant increased pressure caused by the lack of knowledge of the impact of COVID-19 on both the short-term and long-term prescribing costs. The specific costs presented for prescribing are also used by the Clinical Commissioning Groups (CCGs) to inform their budget discussions, planning and finance arrangements. All GP and Primary Care Network (PCN) colleagues within those CCGs that have a Service Level Agreement (SLA) with the RDTC are able to receive RDTC reports. The researchers are actively seeking better ways to engage and work collaboratively with colleagues across the Northern region, in particular PCNs as their structures develop. [1 paragraph unchanged] • The prescribing reports present ePACT2 (an online application which gives authorised users access to prescription data, held by NHS Business Services Authority) data, HES data and relevant QOF Quality and Outcomes Framework (QOF) prevalence, national audit data and public health data in a combined way [165 words unchanged] of the tools for managing and monitoring the safety of prescribing behaviour. [2 paragraphs unchanged] -*-*-*-*-*- Scatter charts incorporating the HES data are included within the reports, and are used to present the outcomes that may be attributed in some part to prescribing patterns within an area. In particular, the reports are useful for CCGs to benchmark against others, identifying where they, for example, have an unusual or high prescribing pattern for a particular condition, which could have a higher-than-average cost. They can then use this information to investigate further, consider practice in other CCGs, and make changes accordingly, with a view to being more cost effective. Previously approved Version 3 of the DSA: The Regional Drug and Therapeutics Centre at Newcastle (RDTC) hosted by the Newcastle Upon Tyne Hospitals Foundation Trust require continued access to the NHS Digital Portal (Data Access Environment) to access pseudonymised, non-sensitive HES data to aid with report writing and project work as described below. Prescribing is the most common patient-level intervention in the NHS, and covers all sectors of care: primary, hospital, public and community health. It is the second highest area of spending in the NHS, after staffing costs (NHS Digital). The Regional Drug and Therapeutics Centre at Newcastle (RDTC) hosted by the Newcastle Upon Tyne Hospitals Foundation Trust (the trust) extracts and analyses prescribing data to identify trends and variation, and to support medicines optimisation. These are presented in reports at regional (Sustainable Transformation Partnerships [STP]/ Integrated Care Systems [ICS]) and Clinical Commissioning Group (CCG) level in relation to particular conditions, such as diabetes. Scatter charts incorporating the HES data are included within these reports, and are used to present the outcomes that may be attributed in some part to prescribing patterns within an area. In particular, the reports are useful for CCGs to benchmark against others, identifying where they, for example, have an unusual or high prescribing pattern for a particular condition, which could have a higher than average cost. They can then use this information to investigate further, consider practice in other CCGs, and make changes accordingly, with a view to being more cost effective. [9 paragraphs unchanged] The RDTC requires HES and GDPPR data from NHS Digital, as it is the only avenue available. [1 paragraph unchanged] The datasets requested are required to cover the diversity of therapeutic areas [21 words unchanged] of data may be required to understand and demonstrate trends in prescribing behavior. behaviour. The geography used is directly related to the CCG stakeholders. However, in [43 words unchanged] enable quantification of the scale of an outcome related to a prescribing behavior. behaviour. [3 paragraphs unchanged] RTDC is hosted by the Newcastle Upon Tyne Hospitals NHS Foundation Trust. The Newcastle Upon Tyne Hospitals NHS Foundation Trust is the sole data controller who also process the data accessed under this Agreement. No other organisations access the record-level data or determine the means for data processing.

Processing activities

v4 AMENDMENT REQUEST All organisations party to this Agreement must comply with the Data Sharing Framework Contract requirements, including those regarding the use (and purposes of that use) by “Personnel” (as defined within the Data Sharing Framework Contract i.e.: employees, agents and contractors of the Data Recipient who may have access to that data). The processing activities and conditions as outlined will also apply to the dissemination of the GDPPR data. -*-*-*-*-*- Previously approved Version 3 of the DSA: All organisations party to this agreement must comply with the Data Sharing Framework Contract requirements, including those regarding the use (and purposes of that use) by “Personnel” (as defined within the Data Sharing Framework Contract ie: employees, agents and contractors of the Data Recipient who may have access to that data). [8 paragraphs unchanged] Data is imported into a specific database which only holds hospital data and aggregates the data to LAT, latitude (LAT), Region and North of England level. The data then flows via linked [40 words unchanged] for all chart data and finally copied into the prescribing report spreadsheet. [1 paragraph unchanged] Data will only be accessed by individuals within the prescribing reports team [38 words unchanged] authority and thus the log in details to access NHS Digital Portal system, system and will be the only user. [12 paragraphs unchanged] 6) Where any record level data may have been downloaded previously from NHS Digital Portal, such data must be securely destroyed and a certificate of data destruction provided to NHS Digital within 2 months of this agreement. Agreement. [3 paragraphs unchanged]

Expected output

v4 AMENDMENT REQUEST: Due to the abolishment of CCGs from July 1st 2022, this Agreement needs to reflect the new NHS structures and statutory bodies. The output target audience for RDTC reporting will now include all NHS and associated organisations working within and across integrated care systems and integrated care boards e.g., academic health science networks, public health teams. RDTC will be required to process and provide the data previously provided on a CCG footprint to whatever structures becomes the Integrated Care Systems. It is not known what these ICS will be yet. CCG footprints are expected to be followed until the ICS are well established. Any changes to data processing that need to be brought about due to this new structure will be reported to NHS Digital via an amendment to the Data Sharing Agreement before they are implemented. Prescribing reports containing aggregated HES data will be provided through a combination of the password protected access to the RDTC website, but also distributed via open access as prescribing reports, bulletins and other publications when required. Throughout the report where CCGs are referred to, this will become "sub-ICS" from 1st July 2022. [1 paragraph unchanged] -*-*-*-*-*- The following outputs will be produced: Prescribing reports will be provided to stakeholder organisations across the North of England and other organisations that CCGs were content to share with, via the secure area of the RDTC website which stakeholders can access via password protection. The pdf summary report document is also emailed to stakeholders to alert them to the fact that a new report is available from the website. These outputs have been delayed as DAE access was delayed for some time. Previously approved Version 3 of the DSA: The following outputs will be produced: Prescribing reports will be provided to stakeholder organisations across the North of England and other organisations that CCGs were content to share with, via the secure area of the RDTC website which stakeholders can access via password protection. The pdf summary report document is also emailed to stakeholders to alert them to the fact that a new report is available from the website. [5 paragraphs unchanged]

Expected measurable benefits

v4 AMENDMENT REQUEST [5 paragraphs unchanged] -*-*-*-*-*- Previously approved Version 3 of the DSA: [13 paragraphs unchanged]

Benefits reported

[5 paragraphs unchanged] No additional benefits have been yielded yet through the use of GDPPR data as DAE access was delayed for a significant period, which in turn delayed the production of outputs and the resulting benefits.

Text removed is struck through; text added is underlined. Unchanged paragraphs are summarised rather than repeated.

Datasets: + Emergency Care Data Set (ECDS)

Objective for processing

v4 AMENDMENT REQUEST: [28 paragraphs unchanged]

Processing activities

v4 AMENDMENT REQUEST [31 paragraphs unchanged]

Expected output

v4 AMENDMENT REQUEST: [9 paragraphs unchanged]

Expected measurable benefits

v4 AMENDMENT REQUEST [20 paragraphs unchanged]

Unchanged: Benefits reported.

Text removed is struck through; text added is underlined. Unchanged paragraphs are summarised rather than repeated.

Datasets: + COVID-19 General Practice Extraction Service (GPES) Data for Pandemic Planning and Research (GDPPR)

Objective for processing

AMENDMENT REQUEST: The NHS Digital Portal (also referred to as DAE), provides secure access to the health and care data held by NHS Digital and it reduces the need for it to leave NHS Digital. Users can access the data within the NHS Digital Portal remotely and it ensures that the correct person, with the correct permissions accesses this data. The NHS Digital Portal caters for standard users with access to standard data sets. The Regional Drug and Therapeutics Centre (RDTC) (Newcastle-upon-Tyne Hospitals NHS Foundation Trust) require access to the GDPPR data. This is broadly to enable continued provision of accurate prescribing information which is needed to support the NHS at a primary care/ICS level to fulfil their statutory duties. There is significant increased pressure caused by the lack of knowledge of the impact of COVID-19 on both the short-term and long-term prescribing costs. The specific costs presented for prescribing are also used by the CCGs to inform their budget discussions, planning and finance arrangements. All GP and PCN colleagues within those CCGs that have an SLA with the RDTC are able to receive RDTC reports. The researchers are actively seeking better ways to engage and work collaboratively with colleagues across the Northern region, in particular PCNs as their structures develop. Below are outlined some examples of how GDPPR data may be used to support the CCG stakeholders. • The prescribing reports present ePACT2 data, HES data and relevant QOF prevalence, national audit data and public health data in a combined way that enables CCGs to understand their specific prescribing behaviour over time, the impact of prescribing on outcomes (such as hospital admissions) and the impact of external factors (such as price changes and supply issues). Throughout the prescribing reports that RDTC produce, the researchers use weightings in many charts, to enable more specific interpretation of prescribing. For instance, antipsychotics weighted for the number of dementia patients. With the exception of dementia list size, most weightings (COPD/asthma patients, diabetes prevalence data etc.) are through QOF or national audit and available annually at best. It has been noted that the large number of COVID-19 deaths will impact directly on practice list sizes for specific conditions. The researchers will be unable to correct the weightings in most of the charts to account for decreases in list size (due to COVID-19 deaths) for at least 12 months, when the next QOF data is released. This will make the charts potentially very inaccurate and meaningless for the CCGs, thus removing one of the tools for managing and monitoring the safety of prescribing behaviour. • With respect to the COVID-19 pandemic, CCG stakeholders are currently without sufficient information to make informed decisions around both the short-term cost impact of changes in prescribing over the last few months and additionally the impact of changes in prescribing throughout the COVID-19 pandemic and for the foreseeable future, as the Mid to long term effects of post COVID-19 recovery health needs are seen. In accessing the GDPPR data, it is hoped that analysis of the medication prescribed both at the time of diagnosis and over time following a diagnosis could be used to understand and assist with forecasting CCG spend and cost growth. These areas are usually determined through analysis of ePACT2 data, however, ePACT2 data is only available with a 3 month delay (the CCGs need the information now) and does not provide the level of differentiation needed to understand costs due to COVID-19 infection and short term costs due to changes in prescribing behaviour (e.g. stocking up on medicines). • RDTC also undertake deep dive research for stakeholders, to understand specific therapeutic area prescribing in greater detail where there is concern or a change in behaviour detected. Currently, the COVID-19 impact is a great unknown. Being able to differentiate the data to understand which type of patients, e.g. age group, co-morbidities etc. will help to direct research and be used in conjunction with the ePACT2 prescribing data (released 3 months later) to support the CCGs with specific actions to manage the impact of COVID-19 on prescribing and future strategic planning that may be required to meet the post-COVID-19 infection long term needs. -*-*-*-*-*- Previously approved Version 3 of the DSA: [3 paragraphs unchanged] Reducing unwarranted variation and increasing value through medicines optimisation is a crucial [64 words unchanged] CCGs to investigate the causes of variation locally. They can then identify the better performing CCGs (those with lower prescribing costs and fewer hospital admissions) and make contact with them to share best practice, which can be implemented locally with an aim to improve prescribing and outcomes in the CCGs area. [1 paragraph unchanged] The RDTC have found some CCGs demonstrate lower prescribing costs in diabetes [26 words unchanged] admissions with higher prescribing costs to communicate with those better performing CCGs (or those CCGs demonstrating lower prescribing costs and lower hospital admissions) to understand steps that can be taken to improve the CCGs prescribing and outcome position. Prescribing reports created by the RDTC will allow better communication between the CCGs. [12 paragraphs unchanged]

Processing activities

AMENDMENT REQUEST The processing activities and conditions as outlined will also apply to the dissemination of the GDPPR data. -*-*-*-*-*- Previously approved Version 3 of the DSA: [16 paragraphs unchanged] Access is being requested to HES data, as this will provide the [11 words unchanged] above. Data is only required for the last 5 years, national data (via the NHS Digital Portal) is required in order that The Trust will filter this to only [34 words unchanged] any of the applicant's stakeholders so the data could be filtered out. [11 paragraphs unchanged]

Expected output

The following outputs will be produced: Prescribing reports will be provided to stakeholder CCGs via the secure area of the RDTC website which stakeholders can access via password protection. The pdf summary report document is also emailed to stakeholders to alert them to the fact that a new report is available from the website. AMENDMENT REQUEST: The output for the addition of the GDPPR data will be through the current therapeutic and financial reports, COVID-19 specific reports and response to CCG's. -*-*-*-*-*- Previously approved Version 3 of the DSA: The following outputs will be produced: Prescribing reports will be provided to stakeholder organisations across the North of England and other organisations that CCGs were content to share with, via the secure area of the RDTC website which stakeholders can access via password protection. The pdf summary report document is also emailed to stakeholders to alert them to the fact that a new report is available from the website. [5 paragraphs unchanged]

Expected measurable benefits

AMENDMENT REQUEST The short-term cost impact of changes in prescribing over the last few months and additionally the impact of changes in prescribing throughout the pandemic and for the foreseeable future, as the Mid to long term effects of post COVID-19 recovery health needs are seen. In accessing the GPES data, it is hoped that analysis of the medication prescribed both at the time of diagnosis and over time following a diagnosis could be used to understand and assist with forecasting CCG spend and cost growth to support the CCG in meeting their statutory functions during the pandemic. The provision of accurate prescribing data appropriately contextualised, is needed at a CCG level to improve prescribing in line with guidance, detect trends and feed into strategic work plans. Using the GPES information in conjunction with other data sources may enable statisticians to calculate a COVID-19 adjustment to the weightings. This is essential and will support the NHS CCG stakeholders to be able to continue to monitor and change their prescribing behaviour to meet the targets set out in the NHS long term plan. It will also support identification of potential mis-management of prescribing in COVID-19 infection and subsequent management, which is needed to ensure optimum patient care. The GPES data will help to fight against the pandemic by predicting increased usage of different medicines groups due to COVID-19 in the long term and by attributing usage to COVID-19 impact in the short-term. This will help to manage the impact of the virus and thus ease pressures in the NHS system. Part of supporting the CCGs with specific actions to help manage the impact of COVID-19 on prescribing and future strategic planning includes noting where CCGs are prescribing in a manner different to their peers. This helps to identify areas where the quality of prescribing may be improved and similarly potential unsafe practice. One of the particular areas that the researchers are interested in looking at further is the use of antipsychotics during the COVID-19 pandemic. Preliminary data highlighted this as an area of potential concern as it appeared that there was increased prescribing. It is likely that this is a mis-representation of the data due to a significant change in the dementia patient list size. However, without the GPES data, the researchers are unable to confirm this and clarify what is happening in a timescale that is going to assist with patient care and safety. -*-*-*-*-*- Previously approved Version 3 of the DSA: [13 paragraphs unchanged]

Unchanged: Benefits reported.

Text removed is struck through; text added is underlined. Unchanged paragraphs are summarised rather than repeated.

Objective for processing

Prescribing is the most common patient-level intervention in the NHS, and covers all sectors of care: primary, hospital, public and community health. It is the second highest area of spending in the NHS, after staffing costs (NHS Digital). The Regional Drug and Therapeutics Centre at Newcastle (RDTC) hosted by the Newcastle Upon Tyne Foundation Trust (NUTH) extracts and analyses prescribing data to identify trends and variation, and to support medicines optimization. These are presented in reports at regional and CCG level in relation to particular conditions, such as diabetes. Scatter charts incorporating the HES data are included within these reports, and are used to present the outcomes that may be attributed in some part to prescribing patterns within an area. In particular, the reports are useful for CCGs to benchmark against others, identifying where they, for example, have an unusual or high prescribing pattern for a particular condition, which could have a higher than average cost. They can then use this information to investigate further, consider practice in other CCGs, and make changes accordingly, with a view to being more cost effective. The Regional Drug and Therapeutics Centre at Newcastle (RDTC) hosted by the Newcastle Upon Tyne Hospitals Foundation Trust require continued access to the NHS Digital Portal (Data Access Environment) to access pseudonymised, non-sensitive HES data to aid with report writing and project work as described below. Reducing unwarranted variation and increasing value through medicines optimisation is a crucial element of NHS RightCare’s innovation work (further information can be found on the NHS RightCare website). RDTC prescribing reports were developed in response to requests from CCGs (and this work is funded by the CCGs) so that variation in prescribing between CCGs could be illustrated, so that they can benchmark their performance against their peers regionally and nationally. Identifying variation at this level prompts CCGs to investigate the causes of variation locally. They can then identify better performing CCGs and make contact with them to share best practice, which can be implemented locally with an aim to improve prescribing and outcomes in their area. Prescribing is the most common patient-level intervention in the NHS, and covers all sectors of care: primary, hospital, public and community health. It is the second highest area of spending in the NHS, after staffing costs (NHS Digital). The Regional Drug and Therapeutics Centre at Newcastle (RDTC) hosted by the Newcastle Upon Tyne Hospitals Foundation Trust (the trust) extracts and analyses prescribing data to identify trends and variation, and to support medicines optimisation. These are presented in reports at regional (Sustainable Transformation Partnerships [STP]/ Integrated Care Systems [ICS]) and Clinical Commissioning Group (CCG) level in relation to particular conditions, such as diabetes. The RDTC produces a series of reports and publications for their stakeholders across the North of England, utilizing EPACT data, Quality Outcomes Framework (QOF) data and for a small number of their charts Hospital Episodes Statistics (HES) data. The RDTC requires HES data for use in the therapeutic prescribing reports, in the attached example the scatter chart illustrates that the CCGs sitting in the bottom left quadrat are demonstrating lower prescribing costs in diabetes realising lower hospital admissions whereas the CCGs sitting in the top right quadrat are demonstrating higher admissions with higher prescribing costs. It would be of benefit for the latter CCGs to communicate with those better performing CCGs to understand steps that can be taken to improve their prescribing and outcome position. Scatter charts incorporating the HES data are included within these reports, and are used to present the outcomes that may be attributed in some part to prescribing patterns within an area. In particular, the reports are useful for CCGs to benchmark against others, identifying where they, for example, have an unusual or high prescribing pattern for a particular condition, which could have a higher than average cost. They can then use this information to investigate further, consider practice in other CCGs, and make changes accordingly, with a view to being more cost effective. The RDTC is hosted by the Newcastle Upon Tyne Foundation Trust (the data controller), however data processing is undertaken by the prescribing reports team within the RDTC. The reports are produced only for RDTC stakeholders. Reducing unwarranted variation and increasing value through medicines optimisation is a crucial element of NHS RightCare’s innovation work (further information can be found on the NHS RightCare website). RDTC prescribing reports were developed in response to requests from CCGs (and this work is funded by the CCGs) so that variation in prescribing between CCGs could be illustrated, so CCGs can benchmark their performance against other CCGs both regionally and nationally. Identifying variation at this level prompts CCGs to investigate the causes of variation locally. They can then identify better performing CCGs and make contact with them to share best practice, which can be implemented locally with an aim to improve prescribing and outcomes in the CCGs area. HES data is currently only supplied to these users within the form of scatter charts presented at either an area team level or CCG level. This work was instigated in response to stakeholder requests that it would be of value to include information highlighting whether prescribing patterns could influence episodes of hospital admissions. This data is only presented at CCG level, and is only extracted for processing at CCG level. The RDTC produces a series of reports and publications for RDTC stakeholders across the North of England, primarily utilising EPACT2 data, Quality Outcomes Framework (QOF) and Hospital Episodes Statistics (HES) data (from NHS Digital), but also incorporating relevant data sets including public health, ONS and national audit data. The aim of this work is to highlight variation in prescribing between CCGs, more specifically the use of HES data within these reports aims to highlight possible variation in hospitals admissions due to prescribing practice. It maybe that the data suggests that higher prescribing costs within a therapeutic area by CCG A do not lead to reduced hospital admissions compared to CCG B who is prescribing at a lower cost. National data is specifically required in order to enable benchmarking of CCGs. The RDTC have found some CCGs demonstrate lower prescribing costs in diabetes realising lower hospital admissions whereas other CCGs are demonstrating higher admissions with higher prescribing costs. RDTC believe it would be of benefit for CCGs demonstrating higher admissions with higher prescribing costs to communicate with those better performing CCGs to understand steps that can be taken to improve the CCGs prescribing and outcome position. Prescribing reports created by the RDTC will allow better communication between the CCGs. The RDTC is hosted by the Trust (the data controller), however data processing is undertaken by the prescribing reports team within the RDTC. The reports are produced only for RDTC stakeholders. There are no other funders or commissioners involved in this work that are not mentioned in this agreement. HES data is supplied to stakeholders within the form of charts presented as a minimum at CCG level. This work was instigated in response to stakeholder requests that it would be of value to include information highlighting whether prescribing patterns could influence episodes of hospital admissions. This data is presented at a minimum of CCG level, and is only extracted for processing at CCG level. The aim of this work is to highlight variation in prescribing between CCGs. More specifically the use of HES data within these reports aims to highlight possible variation in hospitals admissions due to prescribing practice. It is possible that the data suggests that higher prescribing costs within a therapeutic area by CCG A do not lead to reduced hospital admissions compared to CCG B who is prescribing at a lower cost. National data is specifically required in order to enable benchmarking of CCGs. [1 paragraph unchanged] The reports will be updated quarterly as necessary with access required to the Hospital Episode Statistics data covering various therapeutic areas. The applicant RDTC requires this HES data from NHS Digital, as it is the only avenue available to them. available. Data minimisation The datasets requested are required to cover the diversity of therapeutic areas and the breadth of work across an integrated care system to meet the specific prescribing analysis needs. Up to 5 years of data may be required to understand and demonstrate trends in prescribing behavior. The geography used is directly related to the CCG stakeholders. However, in order to benchmark prescribing, access to the 10 most similar CCGs nationally (for each CCG) and a national benchmark, is required. Different therapeutic areas and prescribing analysis may necessitate access to different age and clinical factors. Similarly, all patient episodes are required to enable quantification of the scale of an outcome related to a prescribing behavior. The RDTC rely on the following Legal basis under GDPR for processing HES data: The data requested is necessary for the performance of a task carried out in the public interest; monitoring outcomes and patterns of prescribing services in local areas (covered by Article 6 (1)(e) of GDPR)). The Trust is a public body and can rely on this legal basis. Processing is necessary for the purposes of preventive or occupational medicine, for the assessment of the working capacity of the employee, medical diagnosis, the provision of health or social care or treatment or the management of health or social care systems and services on the basis of Union or Member State law or pursuant to contract with a health professional and subject to the conditions and safeguards referred to in paragraph 3, covered by Article 9 (2)(h) of the GDPR, as the analysis of prescribing services looks to see if differences in patterns have an impact on hospital admissions. This data is only extracted as aggregated data at CCG level. The RDTC does not extract record level data.

Processing activities

All organisations party to this agreement must comply with the Data Sharing Framework Contract requirements, including those regarding the use (and purposes of that use) by “Personnel” (as defined within the Data Sharing Framework Contract ie: employees, agents and contractors of the Data Recipient who may have access to that data). [1 paragraph unchanged] Data is extracted from NHS Digital Portal aggregated at CCG level. Record-level data cannot be downloaded and, in line with the HES Analysis Guide suppression rules, small numbers will be suppressed at the point of extraction from NHS Digital Portal and will not include any description of a cell size below 6. Data is saved within a restricted drive as per the Protocol - RDTC Management of Hospital Episode Statistics (HES) data. The original downloads are password protected. All downloads are recorded in the extraction log including: Data is only handled as per the agreed processes set out in the protocol and data flow map provided to NHS Digital. Details of the data flow map are included below. Any changes to protocol deemed significant by the Trust Information Governance team that changes the processing activities or purposes of this agreement will be communicated to NHS Digital and subsequent amendments will be made to the agreement. Data is extracted from NHS Digital Portal aggregated at CCG level. The extraction and processing of data is carried out by a substantive employee appropriately trained in data protection as required by the Trust. The data is processed by the RDTC at within a secure environment and stored at the approved trust premises. (Newcastle-upon-Tyne). Record-level data cannot be downloaded and, in line with the HES Analysis Guide suppression rules, small numbers will be suppressed at the point of extraction from NHS Digital Portal and will not include any description of a cell size between 1 and 7. If national total is greater than or equal to 8, then all other counts will be rounded to the nearest 5. Data is saved within a restricted access folder within a restricted drive as per the Protocol - RDTC Management of Hospital Episode Statistics (HES) data. The original downloads are password protected. All downloads are recorded in the extraction log including: [4 paragraphs unchanged] Data is imported into a specific database which only holds hospital data and aggregates the data to LAT, Region and North of England level. The data then flows via linked tables into databases for each therapeutic area and after processing for weighting is then weighted with the data’s denominator. The data is then linked to a further database which holds all scatter plot chart data. Data is copied from this database into a spreadsheet for all scatterplot chart data and finally copied into the therapeutic prescribing report spreadsheet. The reports are made available to stakeholders via the centres website which is password protected. A protected and a summary PDF of the reports dashboard summary is emailed via email to all stakeholders. Data is only handled as per the protocol and data flow maps. [1 paragraph unchanged] HES data will be primarily plotted against EPACT EPACT2 prescribing data and data, quality and outcomes framework (QOF) data. data and other applicable data sets. The plotted data is displayed as scatter charts. It will only be presented at CCG and Area Team level. level as a minimum but in some instances up to National level depending on the report format. [1 paragraph unchanged] There will be no requirement nor attempt to reidentify re-identify individuals from the data. [1 paragraph unchanged] Access is being requested to HES data, as this will provide the Trust with the data required to produce the scatter charts detailed above. They Data is only require data required for the current financial year, last 5 years, national data is required in order that The Trust will filter this [36 words unchanged] any of the applicant's stakeholders so the data could be filtered out. [1 paragraph unchanged] All organisations party to this agreement must comply with the Data Sharing Framework Contract requirements, including those regarding the use (and purposes of that use) by “Personnel” (as defined within the Data Sharing Framework Contract i.e.: employees, agents and contractors of the Data Recipient who may have access to that data). [1 paragraph unchanged] 1) Access to NHS Digital Portal will be restricted to approved users [5 words unchanged] in a controlled manner. Only users who have undergone Information Governance training as required by IG Toolkit v14.1 may be permitted to access NHS Digital Portal. [2 paragraphs unchanged] 4) The NHS Digital will monitor use of the NHS Digital Portal system as [12 words unchanged] access could be withdrawn with data destruction notices issued if that occurs. [5 paragraphs unchanged]

Expected output

The following outputs will be produced: Therapeutic prescribing Prescribing reports will be provided to stakeholder CCGs on a quarterly basis via the secure area of the RDTC website which stakeholders can access [10 words unchanged] emailed to stakeholders to alert them to the fact that a new therapeutic report is available from the website. [3 paragraphs unchanged] CCG medicines optimisation teams use the information within the report to benchmark their prescribing against their neighbouring CCGs, comparator CCGs and their comparator CCGs. regionally and nationally. The hospital admissions data enable CCGs to identify whether their prescribing practice [27 words unchanged] there appear to be "better" outcomes and seek to replicate this success. For example identifying that lower prescribing rates of high dose inhaled corticosteroids (ICS) does not result in increased hospital admissions for an exacerbation of COPD, may support prescribers to reduce high dose ICS prescribing which is of health benefit to the patient. High dose ICS are associated with an increased risk of systemic side effects, including adrenal suppression and growth retardation in children (NICE Academic detailing aid, July 2012). The target dates for outputs are on a rolling calendar and vary from monthly to annual, including one-off reports as need requires. Reports are realised as stated in the text above. CCGs across Greater Manchester has implemented a new treatment pathway across its health economy to address the following issues: • Multitude of different inhalers and inhaler types • Probable overprescribing of inhaled corticosteroids • Variation between CCGs in admission rates and spend on respiratory drugs. The outputs being measured are: • Any change in corticosteroid prescribing • Any change in exacerbations of COPD • Any change in COPD referral or admission rates. Using the RDTC respiratory report the group are able to watch for any change in trends of ICS prescribing and also any change in hospital admissions for Chronic Obstructive Pulmonary Disesease (COPD) exacerbations. If a correlation is identified, then the team can investigate further using their local data. The benefit of using CCG reports enables the stakeholder to benchmark their progress against other CCGs, where the health economy is working on one footprint such as in Greater Manchester this enables the medicines management group to consider the whole health economy whilst being able to instigate variation at CCG level within that health economy.

Expected measurable benefits

By highlighting to medicines optimisation teams any potential relationship between prescribing patterns and hospital admissions organisations can work to identify ways to optimize prescribing, enabling the most cost effective use of medicines across the health economy. The following is expected to be achieved from the use of the HES data: Identifying better outcomes to the patient population by a change in prescribing pattern e.g. identifying that lower prescribing rates of high dose inhaled corticosteroids (ICS) does not result in increased hospital admissions for an exacerbation of COPD , may support prescribers to reduce high dose ICS prescribing which is of health benefit to the patient. High dose ICS are associated with an increased risk of systemic side effects, including adrenal suppression and growth retardation in children (NICE Academic detailing aid, July 2012). By highlighting to medicines optimisation teams any potential relationship between prescribing patterns and hospital admissions organisations can work to identify ways to optimise prescribing, enabling the most cost effective use of medicines across the health economy. One of the applicant's stakeholder regions has implemented a new treatment pathway across its health economy to address the following issues: Identifying better outcomes to the patient population by a change in prescribing pattern. For example. identifying that lower prescribing rates of high dose inhaled corticosteroids (ICS) does not result in increased hospital admissions for an exacerbation of COPD , may support prescribers to reduce high dose ICS prescribing which is of health benefit to the patient. High dose ICS are associated with an increased risk of systemic side effects, including adrenal suppression and growth retardation in children (NICE Academic detailing aid, July 2012). An example of how a respiratory therapeutic report is used to achieve the purpose of data processing is as follows: One of the applicant's stakeholder regions has implemented a new treatment pathway across its health economy to address the following issues [8 paragraphs unchanged] CCG's can use this information in the reports to investigate discrepancies further, consider practice in other CCGs, and make changes accordingly, with a view to being more cost effective.

Benefits reported

By presenting the HES data provided within RDTC therapeutic reports, stakeholders have been able to identify and prioritise key areas for development. For example, in Greater Manchester the illustration that Cardio Vascular Cardiovascular outcomes in diabetes population were out with that of the rest of [27 words unchanged] agents with known cardiovascular benefit to be placed over previously used therapies. Without this data this population may not have been highlighted as needing more appropriate therapy, the provision of this data has directed the necessary resource to support this work ahead of other topics. Without this data this population may not have been highlighted as needing more appropriate therapy, the provision of this data has directed the necessary resource to support this work ahead of other topics. NHS Digital data is used to support stakeholder organisations to reduce avoidable hospital admissions through medicines optimisation and improved pathway development in primary care. The presentation of primary care prescribing data against hospital admissions data at CCG level enables opportunities for improvement to be identified. Area prescribing committees use this data to set workplans for the coming year and to monitor against them, for example, GMMMG workplan and the identification of the need to redefine diabetes pathway to reduce unnecessary hospital admissions whilst maintaining use of those agents which are most cost effective. Stakeholders have redefined their COPD and asthma pathways and use our reports to monitor implementation of these new pathways, for example, reduced use of high dose inhaled corticosteroids, but without increased admissions to secondary care for exacerbations of condition.