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

Newcastle Upon Tyne Hospitals NHS Foundation Trust requires access to NHS England data for the purpose of the following research project:

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

The following is a summary of the aims of the research project provided by Newcastle Upon Tyne Hospitals NHS Foundation Trust

The Regional Drug and Therapeutics Centre (RDTC) hosted by the Newcastle Upon Tyne Hospitals Foundation Trust has a long-standing role in supporting NHS organisations with evidence-based guidance and analysis related to medicines use. As part of its remit, RDTC provides strategic support to Integrated Care Systems (ICSs) and Sub ICB Locations (SICBLs) across England, helping them optimise prescribing practices and improve patient outcomes.

To fulfil this role, RDTC requires access to comprehensive healthcare datasets, including Hospital Episode Statistics (HES), Emergency Care Data Set (ECDS), and information on medicines dispensed in primary care from the NHS Business Services Authority (NHSBSA). These datasets are accessed via NHS England’s Secure Data Environment (SDE), ensuring that all data is pseudonymised and handled in compliance with data protection regulations.

The research programme builds on previous work conducted by RDTC, which has demonstrated the value of linking prescribing data with hospital activity to identify trends, variations, and opportunities for improvement. By continuing access to these datasets, RDTC aims to provide actionable insights that support medicines optimisation, reduce unwarranted variation, and inform the development of clinical pathways. The project is not only analytical but also collaborative, with outputs shared across NHS networks to inform decision-making and promote best practice.

The following are aims of the project:

- Enable ICSs and SICBLs to make informed decisions about prescribing practices and identifying opportunities for safer, more effective, and cost-efficient use of medicines.

- Use data to compare prescribing patterns across regions as well as highlighting variations and trends that may indicate areas for improvement or best practice.

- Inform the development of clinical pathways, particularly in areas like respiratory and diabetes care.

- Assess the impact of prescribing decisions on hospital admissions and patient outcomes.

- Provide actionable insights to NHS stakeholders through visualisations (e.g., scatter charts) and reports.

The following NHS England Data will be accessed:

- Hospital Episode Statistics (HES)

- Outpatients

- Admitted Patient Care (APC)

- Critical Care

- Accident & Emergency (A&E)

Hospital Episode Statistics – Admitted Patient Care, Critical Care, Accident & Emergency, and Outpatients – necessary because they enable the calculation of hospital utilisation patterns linked to prescribing behaviours. Specifically, these datasets allow the RDTC to assess how prescribing decisions may influence rates of hospital admissions, emergency attendances, and outpatient visits. This analysis supports medicines optimisation by identifying correlations between medication use and healthcare outcomes, helping to inform clinical pathway development and reduce avoidable hospital activity.

- Emergency Care Data Set (ECDS) - Necessary because the dataset provides detailed information on emergency department attendances, which is crucial for understanding how prescribing practices may influence urgent care demand.

- Medicines Dispensed in Primary Care (NHSBSA data) - Necessary because the Medicines Dispensed in Primary Care dataset provides critical insight into prescribing patterns across community settings. It enables analysis to determine which medicines are being prescribed, where, and in what quantities. When linked with hospital activity data, this information helps assess the impact of prescribing decisions on patient outcomes, supports benchmarking across regions, and informs medicines optimisation strategies aimed at improving care quality and reducing avoidable hospital admissions.

The level of the Data will be:

- Pseudonymised

The Data will be minimised as follows:

- Limited to a study cohort identified by the Newcastle Upon Tyne Hospitals Foundation Trust– The Trust will apply data minimisation by aggregating data at SICBL level or for defined practice groups of similar size, ensuring geographic relevance. Data will be filtered by specific fields of interest, such as diagnosis codes (e.g. ICD-10 for diabetes), medications, or reasons for hospital admission. For example, in the diabetes report, only hospital admissions with relevant ICD-10 codes at SICBL level are considered.

Newcastle Upon Tyne Hospitals NHS Foundation Trust is the research sponsor and the controller as the organisation responsible for ensuring that the Data will only be processed for the purpose described above.

The lawful basis for processing personal data under the UK GDPR is:

Article 6(1)(e) - processing is necessary for the performance of a task carried out in the public interest or in the exercise of official authority vested in the controller;

The lawful basis for processing special category data under the UK GDPR is:

Article 9 (2)(h) - 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.

The funding is provided by NHS bodies, including:

- Integrated Care Boards (ICBs)

- NHS Foundation Trusts

- NHS England

The funding is specifically for the project described.

Integrated Care Boards (ICBs), NHS Foundation Trusts, Grant and research bodies are various stakeholders involved but they do not have access or process the record level data. RDTC works collaboratively with GPs, Primary Care Networks (PCNs), and other regional colleagues to support pathway development and benchmarking.

The research project was initiated in response to stakeholder requests, particularly from Sub ICB Locations (SICBLs) and Integrated Care Systems (ICSs). These stakeholders include GPs, Primary Care Networks (PCNs), and medicines optimisation teams, who represent the interests of their local populations and patient groups. The RDTC team is actively seeking better ways to engage and collaborate with colleagues across the Northern region, especially as PCN structures evolve. Reports produced by RDTC are used by Area Prescribing Committees and Medicines Management Groups (e.g., Greater Manchester Medicines Management Group) to inform pathway development and monitor implementation, indirectly reflecting public health priorities and patient needs.

NHS England will grant access to the Data via the Secure Data Environment (SDE). The SDE is a secure data and research analysis platform. It allows approved researchers with approved projects access to pseudonymised data and industry-leading analytics tools.

NHS England will provide access to the relevant records from the datasets listed in 5a of this DSA to Newcastle Upon Tyne Hospitals NHS Foundation Trust . The Data will contain special categories of personal data but with no direct identifying data items. The Data will be pseudonymised and individuals cannot be reidentified through linkage with other data in the possession of the recipient.

The Data will not be transferred to any other location.

SDE users can request exportation of aggregated analysis results (suppressed and summarised according to the NHS England SDE Disclosure Control rules) subject to review and approval by the NHS England SDE Output Checking team. The SDE Output Checking team will ensure that no output contains information which could be used either on its own or in conjunction with other data to breach an individual's privacy.

Users must identify themselves via a multi-factor authentication mechanism and are only able to access the datasets detailed within this DSA. 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 DSA.

Users are only authorised to access the Data specified in this DSA and can utilise a variety of analytical tools available within the SDE platform. Users are not permitted to export record-level data from the SDE.

The Data will be stored on servers at NHS England.

The Data will be accessed by authorised personnel via remote access.

The Controller(s) must confirm and provide evidence upon audit by NHS England that access via any remote device complies with the data security obligations within this DSA and the Data Sharing Framework Contract.

For remote access:

- Remote access will only be from secure locations situated within the territory of use (as further restricted elsewhere within the DSA if so done) stated within this DSA;

- Access controls granting users the minimum level of access required are in place;

- Remote access is only via secure connections (e.g., VPNs or secure protocols) to protect data;

- Multifactor authentication (MFA) is required for remote access;

- Device security, including up-to-date software and operating systems, antivirus software, and enabled firewalls are utilised for the remote access;

- All remote access is undertaken within the scope of the organisation’s DSPT (or other security arrangements as per this DSA) and complies with the organisation’s remote access policy.

The above applies in addition to any condition set out elsewhere within the DSA (e.g. who may carry out processing, and for what purpose).

Remote processing will be from secure locations within England and Wales.

The data will not leave England & Wales.

Access to the data is restricted to individuals within the prescribing reports team of the prescribing support unit at the RDTC who have authorisation from Newcastle Upon Tyne Hospitals NHS Foundation Trust to access the data for the purpose(s) described, all of whom are substantive employees of the RDTC within the trust.

All personnel accessing the Data have been appropriately trained in data protection and confidentiality.

Data is extracted from NHS England SDE aggregated at SICBL level or cohorts of SICBL magnitude. 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). The data is then linked to a further database which holds all chart data. Data is copied from this database into a spreadsheet for all chart data and finally copied into the prescribing report spreadsheet. The reports are made available to stakeholders via the centres website which is password protected and a summary PDF via email to stakeholders.

Analysts will be able to access only the data they are permitted to see.

There will be no requirement nor attempt to re-identify individuals from the data.

The expected outputs of the processing will be:

- A report of findings to Integrated Care Boards (ICBs), Sub ICB Locations (SICBLs), and NHS Foundation Trusts.

- Submissions to peer-reviewed journals. Findings may be submitted for publication to support wider dissemination and academic validation based on the completion of topic-specific analyses.

- Presentations to NHS stakeholders. RDTC presents findings to Area Prescribing Committees, Medicines Management Groups, and other NHS bodies involved in medicines optimisation.

- Presentations at appropriate conferences. Outputs are shared at national and regional conferences, including those focused on prescribing, public health, and clinical pathways.

- Aggregated findings are published on the RDTC’s password-protected website, accessible to commissioning organisations.

- Benchmarking tools and visualisations (e.g., scatter charts) are developed to support decision-making. Access to these tools are provided to NHS stakeholders at no cost as part of the commissioning support.

The outputs will not contain NHS England Data and will only contain aggregated information with small numbers suppressed as appropriate in line with the relevant disclosure rules for the dataset(s) from which the information was derived

The outputs will be communicated to relevant recipients through the following dissemination channels:

- Journals

- Social Media

- Public Reports

- Direct Bilateral Engagement with NHS Stakeholders. RDTC engages directly with Area Prescribing Committees, Medicines Management Groups, and ICBs to present findings and support decision-making.

- Briefing Documents Provided to Commissioners and Prescribing Leads. Topic-specific summaries and visualisations are shared via email and secure platforms.

- Presentations at Appropriate Conferences. RDTC presents findings at national and regional conferences focused on prescribing, public health, and clinical pathways.

The target dates for outputs are on a rolling calendar and vary from monthly to annual, including one-off reports as need requires. Outputs are produced and disseminated depending on stakeholder needs and topic-specific requirements.

The findings of this research study are expected to contribute to evidence-based decision-making for policy-makers, local decision-makers such as doctors, and patients to inform best practice to improve the care, treatment and experience of health care users relevant to the subject matter of the study.

The use of the data could:

- Help the system to better understand the health and care needs of populations by analysing prescribing patterns and hospital activity at SICBL level, the research helps identify regional variations and unmet needs in medicines use and outcomes.

- Lead to the identification or improvement of treatments or interventions, or health and care system design to improve health and care outcomes or experience. The findings support the development and evaluation of clinical pathways (e.g. for diabetes, respiratory conditions), guiding safer and more effective prescribing practices.

- Advance understanding of regional and national trends in health and social care needs. Aggregated data across multiple regions enables benchmarking and trend analysis, informing strategic planning and policy development.

- Advance understanding of the need for, or effectiveness of, preventative health and care measures for particular populations or conditions such as obesity and diabetes. The data supports evaluation of interventions aimed at reducing hospital admissions and improving management of long-term conditions.

- Inform planning health services and programmes, for example to improve equity of access, experience and outcomes. Inclusion of ethnicity and geographic data enables analysis aligned with the CORE20+5 agenda, helping to address health inequalities.

- Inform decisions on how to effectively allocate and evaluate funding according to health needs. Insights from the data help commissioners and medicines committees prioritise resources and target interventions where they are most needed.

- Provide a mechanism for checking the quality of care. The outputs help identify areas of good practice and highlight regions where prescribing patterns may be contributing to poorer outcomes, supporting continuous improvement.

- Support knowledge creation or exploratory research. The research contributes to the evidence base for medicines optimisation and service design, with findings shared via reports, journals, and conferences.

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 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. Subject to the findings, the expected benefits to patients include safer and more effective prescribing through improved medicines optimisation, reduced hospital admissions by identifying and addressing adverse drug events, and more equitable care via tailored local insights. The data will support informed clinical decisions and enable cost savings that can be reinvested into frontline services, ultimately enhancing patient outcomes and healthcare efficiency.

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. 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 (NHSBSA data) against outcomes delivered as measured through secondary care (HES data).

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 Chronic Obstructive Pulmonary Disease (COPD) , may support prescribers to reduce high dose ICS prescribing which is of health benefit to the patient.

It is hoped that through publication of findings in appropriate media, the findings of this research will add to the body of evidence that is considered by the bodies, organisations and individual care practitioners charged with making policy decisions for or within the NHS or treatment decisions in relation to specific patients.

To optimise public benefit from the use of the data, the RDTC plans to produce outputs such as reports, scatter charts, and publications that will be shared with stakeholders across Integrated Care Boards (ICBs) and Sub ICB Locations (SICBLs). These outputs are designed to inform medicines optimisation and prescribing intelligence.

By presenting the HES data provided within RDTC reports, stakeholders have been able to identify and prioritise key areas for development. For example, in Greater Manchester the illustration that Cardiovascular outcomes in diabetes population were out with that of the rest of the region has driven the accelerated development of a pathway to tackle this issue, resulting in changes to the agents listed within the formulary to provide those 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.

NHS 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 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, 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.

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 RDTC 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.

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.