Prescribing by Dentists: England 2012

Published 25 April 2013

We are the trusted source of authoritative data and information relating to health and care. www.hscic.gov.uk [email protected]

Author:

Prescribing and Primary Care Services Health and Social Care Information Centre

Responsible statistician:

Oliver Smith, Service Manager

Version:

V1.0

Date of publication

25 April 2013

Prescribing by Dentists England 2012

Contents Executive Summary

4

Key Findings

4

Introduction

5

Overview since 2005

6

British National Formulary (BNF) Chapters

7

British National Formulary (BNF) Sections

12

By Leading Sections

12

Leading BNF Sections by Paragraph

19

BNF Section 5.1 Antibacterial Drugs

19

BNF Section 12.3 Drugs acting on the Oropharynx

22

BNF Section 9.5 Minerals

25

Major Changes in 2012

26

BNF Section 9.5 Minerals

26

BNF Section 5.1 Antibacterial Drugs

27

BNF Section 4.1 Hypnotics and Anxiolytics

28

BNF Section 10.1 Drugs used in Rheumatic Diseases & Gout

29

BNF Section 5.2 Antifungal Drugs

30

BNF Section 21.21 Dry Mouth Products

31

BNF Section 6.1 Corticosteroids (Endocrine)

32

Controlled Drugs Controlled Drugs by Schedule

33 37

Sources and Definitions

39

List of Annexes

42

Other Publications

42

By Other UK countries

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42

3

Prescribing by Dentists England 2012

Executive Summary This bulletin presents a summary of the key findings from the Prescribing by Dentists data collection. The collection records NHS prescriptions by dentists dispensed in the community in England during 2012. The bulletin highlights changes between 2012 and previous years; presenting some of the main trends for leading British National Formulary (BNF) chapters and sections for dental prescribing. The figures shown represent calendar years, 1st January 2012 to 31 December 2012, rather than financial years. This yearly report includes information on the items prescribed by dentists, the Net Ingredient Cost (NIC) and generic prescribing rates. The data is provided by NHS Prescription Services, part of the NHS Business Services Authority (NHSBSA), who process prescriptions in order to reimburse dispensers. The specific source for these statistics is the Prescription Cost Analysis system (PCA).

Key Findings 

5.6 million prescription items at a Net Ingredient Cost (NIC) of £17.7 million were dispensed in 2012. This represents a 4 per cent increase in prescription items from 2011 and a 29.4 per cent rise in NIC.



There were 953 thousand Minerals items (BNF 9.5) representing 17.0 per cent of all items prescribed by dentists. These were prescribed at a NIC of £9.6 million, accounting for 54.5 per cent of NIC prescribed by dentists. This represents a 34.7 per increase in prescription items from 2011 and a 57.9 per cent rise in NIC.



Dental prescription items represent 0.6 per cent of the 1 billion items dispensed overall in 2012. Dental NIC was 0.2 per cent of the overall 2012 total of £8,523 million.



In 2012 prescribing of Controlled Drugs (Schedules 1-5) by dentists represented 0.08 per cent of all Controlled Drug items (the same as 2011) and 0.01 per cent of the total NIC for Controlled Drugs (the same as 2011).

Fluoride is the only paragraph to appear in the Minerals section as prescribed by dentists. The Department of Health’s Delivering Better Oral Health1 toolkit which advocates the use of fluoride to improve dental health, including the provision of high fluoride toothpastes for the prevention and treatment of caries (tooth decay) in adults. Prescriptions dispensed in hospitals, private prescriptions or prescriptions written in England but prescribed outside are not included Better Oral Health – An evidence based toolkit for prevention, second edition published by Department of Health at http://webarchive.nationalarchives.gov.uk/20130107105354/http://www.dh.gov.uk/prod_consum_dh/groups/dh_ digitalassets/documents/digitalasset/dh_102982.pdf 1 Delivering

4

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Prescribing by Dentists England 2012

Introduction 1. This is the sixth annual bulletin published by the NHS Information Centre to focus on prescribing by dentists. Any comments/suggestions for improvements would be welcomed and can be submitted via the ‘Have your say’ link on the publication webpage www.hscic.gov.uk/pubs/prescribingdentists12 or by email to [email protected]. 2. The bulletin presents a summary of NHS prescriptions by dentists dispensed in the community in England during 2012. Figures for 2012 are shown and compared against previous years, with significant changes highlighted. The figures shown represent calendar years (January – December) rather than financial years. 3. Dental prescribing data is only available at a national (England) level as the prescription forms do not identify the Primary Care Trust (PCT) of the prescriber or patient. Neither the number of dentists prescribing nor the number of patients treated is available. 4. Within this bulletin the use of the term ‘items’ refers to prescription items. Each single item written on the form is counted as a prescription item. 5. All costs given in this bulletin are Net Ingredient Cost (NIC). This is the basic price of a drug, i.e. the price listed in the national Drug Tariff or in standard price lists. It standardises cost throughout prescribing nationally, and allows comparisons of data from different sources. 6. This report includes figures on generic prescribing rates in dentistry. Generic prescribing refers to the prescribing of non-proprietary preparations as these are generally less expensive than proprietary brands. Not all preparations have a generic alternative, and it is not always possible or appropriate to prescribe a generic preparation. See Sources and Definitions for further details. 7. For more information on this publication and other dental data published by the NHS Information Centre we recommend our Beginner’s Guide to Dental Data available at http://www.hscic.gov.uk/primary-care.

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5

Prescribing by Dentists England 2012

Overview since 2005 

The number of items increased by 218 thousand (4.0 per cent) in 2012, a rate of increase broadly consistent with those since 2009. Net Ingredient Cost (NIC) increased by £4.0 million (29.4 per cent) in 2012. Having remained relatively stable at over £10 million from 2006 to 2009, successive significant increases since, have raised this to £17.7 million. This is examined in further detail in subsequent chapters.

 Generic prescribing continued the steady increase apparent since 2005. Overview since 2005 Table 1.1: Number of items prescribed by dentists and by all prescribers, 2005 – 2012

Table 1.1: Number of items prescribed by dentists and by all prescribers, 2005-2012 Number (thousands)

Year

Per cent Per cent of change in items items by prescribed dentists on generically by previous year dentists

Change in items by Items by dentists on dentists previous year

Items by all prescribers (includes dentists)

Items prescribed by dentists as a per cent of all prescriber items

2005

4,651

-

-

89.7

720,283

0.6

2006

4,481

-170

-3.7

90.2

751,954

0.6

2007

4,569

87

1.9

90.5

796,298

0.6

2008

4,647

79

1.7

90.6

842,502

0.6

2009

4,909

262

5.6

90.9

885,999

0.6

2010

5,146

237

4.8

91.5

926,658

0.6

2011

5,399

253

4.9

92.0

961,529

0.6

2012

5,617

218

4.0

92.5

1,000,502

0.6

Source: PCA database

Table 1.2: Net Ingredient Cost (NIC) prescribed by dentists and by all prescribers, 2005 – 2012 Table 1.2: NIC prescribed by dentists and by all prescribers, 2005-2012

Pounds (thousands)

Year

Change in Per cent NIC by change in NIC NIC by all NIC by dentists on by dentists on prescribers dentists previous year previous year (includes dentists)

NIC prescribed by dentists as a per cent of all prescriber NIC

2005

9,186

-

-

7,936,564

0.1

2006

10,078

893

9.7

8,196,832

0.1

2007

10,657

578

5.7

8,372,667

0.1

2008

10,304

-353

-3.3

8,325,492

0.1

2009

10,373

69

0.7

8,539,421

0.1

2010

12,416

2,043

19.7

8,834,380

0.1

2011

13,649

1,233

9.9

8,805,067

0.2

2012

17,668

4,019

29.4

8,523,131

0.2

Source: PCA database

6

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Prescribing by Dentists England 2012

British National Formulary (BNF) Chapters 

The same five leading BNF chapters shown in table 2.1 have led in terms of items and NIC since 2006. These chapters have constituted the overwhelming majority (over 99.0 per cent) of items and NIC of NHS dental prescriptions over this period.



Table 2.1 and 2.2 shows that Infections remains the dominant chapter in terms of items dispensed since 2005, accounting for 70.1 per cent of items in 2012. However, Nutrition and Blood remains accountable for the highest percentage of NIC in 2012 (54.5 per cent).



Nutrition and Blood has seen the greatest rise in its share of total dental prescribing items and NIC since 2005 with both measures increasing year on year, as highlighted in figure 2.2. From only twelve thousand items in 2005, Nutrition and Blood is the chapter with the second highest number of items prescribed by dentists in 2012. Items increased by 246 thousand (34.7 per cent) compared with 2011. Figure 2.3 shows how NIC for this chapter has increased its percentage share of all dental NIC at a rate considerably faster than number of items prescribed.



Ear, nose and oropharynx items decreased slightly (0.6 per cent) following a rise in 2011. Musculoskeletal and Joint Diseases and Central Nervous System have continued a downward trajectory, after showing an increase in 2009, as highlighted in table 2.2 and figure 2.1.



Infections items prescribed in 2012 dropped slightly (0.3 per cent) whilst its associated NIC increased 3.9 per cent. Nutrition and Blood and Ear, nose and oropharynx both showed greater rates of increase in NIC compared with items (Tables 2.2 and 2.4).



The generic prescribing rate for Ear, nose and oropharynx was considerably lower than for other leading chapters, as shown in table 2.1. Tables 3.3 and 5.1 provide further detail at section and paragraph levels respectively.

Table 2.1: Number of items dispensed and NIC by leading five BNF chapters, 2012

Table 2.1: Number of items dispensed and NIC by leading five BNF chapters, 2012

BNF Chapter

05 Infections

Items (thousands)

Per cent of items

Per cent of items prescribed generically

NIC (pounds) (thousands)

Per cent of NIC

3,937

70.1

99.7

5,582

31.6

09 Nutrition & blood

953

17.0

80.7

9,625

54.5

12 Ear, nose & oropharynx

517

9.2

56.9

2,208

12.5

10 Musculoskeletal & joint diseases

115

2.1

99.7

106

0.6

04 Central nervous system

76

1.4

99.3

75

0.4

Other

19

0.3

89.1

73

0.4

Total

5,617

100.0

92.5

17,668

100.0

Source: PCA database

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Prescribing by Dentists England 2012

Table 2.2: Number of prescription items by dentists shown by leading five BNF chapters, Table 2.2: Number of prescription items by dentists shown by leading five BNF chapters, 2005 – 2012 2005-2012 Number (thousands) 10 09 Nutrition & 12 Ear, nose & Musculoskeletal 04 Central blood oropharynx & joint diseases nervous system

Year

05 Infections

Other

Total

2005

3,864

12

496

163

2006

3,693

66

478

142

99

18

4,651

87

15

4,481

2007

3,713

154

476

2008

3,678

269

482

126

84

15

4,569

123

81

15

4,647

2009

3,739

426

2010

3,861

546

510

136

81

16

4,909

507

133

79

19

5,146

2011

3,947

2012

3,937

708

520

127

78

19

5,399

953

517

115

76

19

5,617

Change 2011 to 2012

-10

246

-3

-12

-2

0

218

Per cent change 2011 to 2012

-0.3

34.7

-0.6

-9.3

-2.1

-1.5

4.0

Source: PCA database

Figure 2.1: Number of prescriptionof items by dentists shown by leading five chapters, 2005 – 2012 (note in Figure 2.1: Number prescription items byBNF dentists shown bybreak leading five BNF chapters, vertical axis) 2005-2012 (note break in vertical axis)

8

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Prescribing by Dentists England 2012

Table 2.3:2.3: Percentage share of prescription items dentists in leading five BNF chapters, 2005 – 2012 in leading five BNF chapters, Table Percentage share ofby prescription items by dentists 2005-2012

Per cent 10 09 Nutrition & 12 Ear, nose & Musculoskeletal 04 Central blood oropharynx & joint diseases nervous system

Year

05 Infections

Other

Total

2005

83.1

0.3

10.7

3.5

2006

82.4

1.5

10.7

3.2

2.1

0.4

100.0

1.9

0.3

2007

81.3

3.4

10.4

100.0

2.8

1.8

0.3

100.0

2008

79.1

5.8

10.4

2.6

1.7

0.3

100.0

2009

76.2

2010

75.0

8.7

10.4

2.8

1.7

0.3

100.0

10.6

9.9

2.6

1.5

0.4

2011

73.1

100.0

13.1

9.6

2.4

1.4

0.4

100.0

2012

70.1

17.0

9.2

2.1

1.4

0.3

100.0

Per cent point change 2011 to 2012

-3.0

3.9

-0.4

-0.3

-0.1

0.0

0.0

Source: PCA database

Table 2.4: NIC by leading five BNF chapters, 2005 – 2012 Table 2.4: Net Ingredient Cost (NIC) by leading five BNF chapters, 2005-2012

Pounds (thousands) 10 09 Nutrition & 12 Ear, nose & Musculoskeletal 04 Central blood oropharynx & joint diseases nervous system

Year

05 Infections

Other

Total

2005

7,277

23

1,578

167

82

58

9,186

2006

7,867

274

1,614

2007

7,935

815

1,614

182

92

49

10,078

140

105

47

10,657

2008

6,912

1,614

1,563

103

78

35

10,304

2009

5,823

2,716

1,611

111

74

39

10,373

2010 2011

6,052

4,420

1,717

99

78

50

12,416

5,372

6,097

1,955

90

69

66

13,649

2012

5,582

9,625

2,208

106

75

73

17,668

Change 2011 to 2012

209

3,528

253

16

5

7

4,019

Per cent change 2011 to 2012

3.9

57.9

12.9

17.7

7.7

10.6

29.4

Source: PCA database

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9

Prescribing by Dentists England 2012 Table 2.5: Percentage share of NIC by leading five BNF chapters, 2005 – 2012

Table 2.5: Percentage share of NIC by leading five BNF chapters, 2005-2012 Per cent 10 09 Nutrition & 12 Ear, nose & Musculoskeletal 04 Central blood oropharynx & joint diseases nervous system

Year

05 Infections

Other

Total

2005

79.2

0.2

17.2

1.8

0.9

0.6

100.0

2006

78.1

2.7

16.0

2007

74.5

7.6

15.1

1.8

0.9

0.5

100.0

1.3

1.0

0.4

100.0

2008

67.1

15.7

15.2

1.0

0.8

0.3

100.0

2009

56.1

26.2

15.5

1.1

0.7

0.4

100.0

2010 2011

48.7

35.6

13.8

0.8

0.6

0.4

100.0

39.4

44.7

14.3

0.7

0.5

0.5

100.0

2012

31.6

54.5

12.5

0.6

0.4

0.4

100.0

Per cent point change 2011 to 2012

-7.8

9.8

-1.8

-0.1

-0.1

-0.1

0.0

Source: PCA database

Figure 2.2: Growth of items prescribed and NIC for Nutrition and Blood chapter since 2005

Figure 2.2: Growth of Items prescribed and NIC for Nutrition and Blood chapter since 2005

4/23/2013 10:58:49 AM 10

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Prescribing by Dentists England 2012 Figure 2.3 Items prescribed and NIC for Nutrition and Blood chapter as a percentage of all dental prescribing since 2005 Figure 2.3: Items prescribed and NIC for Nutrition and Blood chapter as percentage of all dental prescribing since 2005

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Prescribing by Dentists England 2012

British National Formulary (BNF) Sections By Leading Sections 

In 2012 the items dispensed came from 22 BNF sections. There were no items prescribed from the Vitamins and Skin Fillers and Protectives chapters in 2012. Orabase Paste may be accountable for the Skin Filllers and Protectives chapter, as it was previously classed as a drug and allowed in the Dental Formulary. However, it has been reclassified as an appliance and removed.



In terms of items dispensed, seven of the ten leading sections retained the same order as last year, with no changes occurring within the top five. Antifungal Drugs rose in the number of the items dispensed, whilst Hypnotics and Anxiolytics dropped causing a switch in the order (Table 3.1). Dry Mouth Products now appear within the top ten, replacing Skin Fillers and Protectives which, in 2012, were not prescribed by dentists.



Antibacterial Drugs continues to reduce in terms of its share of all dental items prescribed, with a 3.0 percentage point drop in items from 2011. Minerals continue to rise, as it has since 2007, with an increase of 3.9 percentage points in its share of all dental items prescribed.



Table 3.3 shows that generic prescribing for Drugs acting on the Oropharynx was considerably lower than for other sections. This is discussed at paragraph level in table 5.1.

Table 3.1: Number of items by leading ten BNF sections, 2012

Table 3.1: Number of Items by leading ten BNF Sections, 2012

BNF Section Name 5. 1 Antibacterial Drugs 9. 5 Minerals

Per cent of Total items Per cent of dental items (thousands) dental items in 2011 3,924.4

69.9

72.9

953.3

17.0

13.1

12. 3 Drugs Acting On The Oropharynx

516.0

9.2

9.6

10. 1 Drugs Used In Rheumatic Diseases & Gout

115.2

2.1

2.4

4. 7 Analgesics

66.4

1.2

1.2

5. 2 Antifungal Drugs

10.4

0.2

0.2

9.3

0.2

0.2

13.10 Anti-Infective Skin Preparations

6.1

0.1

0.1

13.11 Skin Cleansers,Antiseptics & Desloughing

3.6

0.1

0.1

21.21 Dry Mouth Products

3.0

0.1

0.0

4. 1 Hypnotics And Anxiolytics

Source: PCA database

12

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Prescribing by Dentists England 2012 Table 3.2: Number of items by remaining BNF sections, 2012

Table 3.2: Number of Items by remaining ten BNF Sections, 2012 BNF Section Name

Total items

6. 3 Corticosteroids (Endocrine)

2,854

5. 3 Antiviral Drugs

1,895

15. 2 Local Anaesthesia

1,562

12. 2 Drugs Acting On The Nose

916

13. 4 Topical Corticosteroids

794

1. 3 Antisecretory Drugs+Mucosal Protectants

638

4. 8 Antiepileptics

363

3. 4 Antihist, Hyposensit & Allergic Emergen

306

2. 9 Antiplatelet Drugs

124

3. 8 Aromatic Inhalations

116

3. 2 Corticosteroids (Respiratory) 19. 2 Selective Preparations

58 8

Source: PCA database

 The use of antiepileptics in dental practice may seem surprising but all of these prescriptions were for carbamazepine and may well have been to treat trigeminal neuralgia.  Table 3.3 shows the number of dentists’ prescription items as percentages of all prescriber items. The 5.6 million items prescribed by dentists represented 0.6 per cent of the total number of items prescribed by all prescribers (1 billion) in all BNF sections. This percentage is unchanged since 2007.  Minerals continued as the section where the percentage of items prescribed by dentists is greatest. The percentage in 2012 at 48.4 per cent is almost triple the 2007 value of 16.7 per cent, and represents a rise of 9.8 percentage points since 2011. This increase in percentage indicates dentists have increased their prescribing of Minerals items at a faster rate than all prescribers, though the rate of increase in this measure had appeared to be slowing. Minerals items have increased from 0.71 million in 2011 to 0.95 million in 2012.

4/23/2013 10:58:49 AM

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13

Prescribing by Dentists England 2012 Table 3.3: Number of dentists' prescription items as a percentage of all prescriber items, 2012

Table 3.3: Number of dentist’ prescription items as percentage of all prescriber items, 2012 Number (thousands) Items prescribed by dentists as a per cent of all prescriber items

Per cent of items prescribed generically by dentists

BNF Section Name

Items by dentists

Items by all prescribers (includes dentists)

5. 1 Antibacterial Drugs

3,924.4

43,274

9.1

99.7

953.3

1,969

48.4

80.7

12. 3 Drugs Acting On The Oropharynx

9. 5 Minerals

516.0

2,176

23.7

56.8

10. 1 Drugs Used In Rheumatic Diseases & Gout

115.2

24,229

0.5

99.7

4. 7 Analgesics

66.4

64,957

0.1

99.2

5. 2 Antifungal Drugs

10.4

2,150

0.5

96.8

9.3

16,766

0.1

100.0

13.10 Anti-Infective Skin Preparations

6.1

4,434

0.1

92.2

13.11 Skin Cleansers,Antiseptics & Desloughing

3.6

239

1.5

100.0

21.21 Dry Mouth Products

3.0

85

3.5

n/a

n/a Other

9.6

840,223

0.0

n/a

Total

5,617.4

1,000,502

0.6

92.5

4. 1 Hypnotics And Anxiolytics

Source: PCA database

 Table 3.4 shows that Minerals accounted for the largest percentage NIC at 54.5 per cent (£9.6 million) of dental prescribing Table 3.4: NIC by leading BNF sections, 2012

Table 3.4: NIC by leading BNF sections, 2012 Pounds (thousands)

BNF Section Name

NIC

Per cent of Per cent of dental NIC in dental NIC 2011

9. 5 Minerals

9,625

54.5

44.7

5. 1 Antibacterial Drugs

5,351

30.3

38.1

2,206

12.5

14.3

213

1.2

1.1

106

0.6

0.7

67

0.4

0.5

21.21 Dry Mouth Products

21

0.1

0.1

13.10 Anti-Infective Skin Preparations

19

0.1

0.1

5. 3 Antiviral Drugs

17

0.1

0.1

6. 3 Corticosteroids (Endocrine)

17

12. 3 Drugs Acting On The Oropharynx 5. 2 Antifungal Drugs 10. 1 Drugs Used In Rheumatic Diseases & Gout 4. 7 Analgesics

0.1 0.1 4/23/2013 10:58:49 AM

Source: PCA database

14

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Prescribing by Dentists England 2012

 NIC of prescribing by dentists accounted for 0.2 per cent of the total NIC of prescribing by all prescribers, as seen in Table 3.5.  Minerals now accounts for the greatest percentage of NIC in relation to the NIC of all prescribers at 26.5 per cent in 2012, overtaking Drugs Acting on the Oropharynx. This is a substantial increase from 2007, where NIC accounted for 4.9 per cent.

Table 3.5: NIC of prescriptions by dentists as a percentage of all prescriber NIC, 2012

Table 3.5: NIC of prescriptions by dentists as a percentage of all prescribers NIC, 2012 Pounds (thousands)

BNF Section Name

NIC by dentists

NIC by all prescribers (inc dentists)

NIC prescribed by dentists as a per cent of all prescriber NIC

9. 5 Minerals

9,625

36,261

26.5

5. 1 Antibacterial Drugs

5,351

195,352

2.7

2,206

10,706

20.6

213

25,622

0.8

106

153,985

0.1

67

492,493

0.0

21.21 Dry Mouth Products

21

606

3.5

13.10 Anti-Infective Skin Preparations

12. 3 Drugs Acting On The Oropharynx 5. 2 Antifungal Drugs 10. 1 Drugs Used In Rheumatic Diseases & Gout 4. 7 Analgesics

19

24,172

0.1

5. 3 Antiviral Drugs

17

15,062

0.1

6. 3 Corticosteroids (Endocrine)

17

69,197

0.0

n/a Other

25

7,499,674

0.0

Total

17,668

8,523,131

0.2

Source: PCA database

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15

Prescribing by Dentists England 2012

 Figure 3.1 demonstrates higher percentages of NIC attributed to Minerals and Drugs acting on the Oropharynx, compared with their respective percentages of items, reflecting their higher overall cost per item. Figure 3.1: Percentage of Items and NIC prescribed by dentists, by leading BNF sections, Figure 3.1 Percentage of items and NIC of items prescribed by dentists, by leading BNF sections, 2012 2012

16

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Prescribing by Dentists England 2012

 Tables 3.6 and 3.7 demonstrate notable year on year percentage increases in terms of items and NIC for Minerals and Antifungal Drugs. Table 3.6: Number of prescription items by dentists shown by leading ten BNF sections (in terms of items), 2005 – Table 3.6: Number of prescription items by dentists shown by leading ten BNF sections (in 2012 terms of items), 2005-2012 Number (thousands) Drugs Used Drugs Acting In Rheumatic On The Diseases & Minerals Oropharynx Gout

Year

Antibacterial Drugs

2005

3,857.8

11.5

495.2

2006

3,687.3

66.1

2007

3,706.0

2008

3,669.9

2009 2010

Skin Hypnotics Anti-Infective Cleansers,Ant And Skin iseptics & Anxiolytics Preparations Desloughing

Analgesics

Antifungal Drugs

Dry Mouth Products

162.6

84.1

4.0

14.4

11.5

3.8

-

477.2

142.0

73.5

4.2

12.5

9.0

4.0

-

154.1

475.4

126.1

71.4

5.6

12.1

7.8

4.3

-

268.3

481.1

122.9

69.3

6.1

11.1

7.1

4.3

0.1

3,731.1

426.1

509.5

136.4

70.1

6.1

10.7

6.2

4.3

0.2

3,850.8

546.3

506.6

133.5

68.8

8.0

10.1

6.1

4.0

0.7

2011

3,935.7

707.7

519.1

127.0

67.4

9.5

10.0

6.1

3.4

2.2

2012

3,924.4

953.3

516.0

115.2

66.4

10.4

9.3

6.1

3.6

3.0

Change 2011 to 2012

-11.3

245.6

-3.1

-11.8

-1.0

0.9

-0.6

0.0

0.2

0.8

Per cent change 2011 to 2012

-0.3

34.7

-0.6

-9.3

-1.5

9.4

-6.5

-0.3

5.6

34.3

Source: PCA database Table 3.7: NIC by dentists shown by leading ten BNF sections (in terms of NIC), 2005 – 2012

Table 3.7: NIC by dentists shown by leading ten BNF sections (in terms of NIC), 2005-2012 Pounds (thousands) Drugs Acting Antibacterial On The Drugs Oropharynx

Drugs Used In Rheumatic Antifungal Diseases & Drugs Gout

Analgesics

Dry Mouth Products

Anti-Infective Skin Preparations

Antiviral Corticosteroid Drugs s (Endocrine)

Year

Minerals

2005

21.2

7,231.8

1,577.4

22.8

166.9

75.7

-

50.6

22.5

-

2006

272.6

7,829.4

1,613.1

18.4

181.5

85.5

-

37.3

19.4

-

2007

813.6

7,896.6

1,612.5

18.7

140.2

97.7

-

33.4

19.9

-

2008

1,611.6

6,876.0

1,562.0

18.0

102.7

71.4

0.5

22.7

17.5

1.7

2009

2,714.8

5,786.8

1,609.4

17.3

110.7

66.0

1.2

21.8

18.5

4.4

2010

4,419.8

5,964.7

1,715.8

64.9

99.0

69.6

4.7

21.9

22.4

7.7

2011

6,097.1

5,204.9

1,953.6

147.3

89.9

62.6

16.9

19.9

19.9

11.9

2012

9,625.4

5,351.0

2,206.2

213.1

105.8

66.7

21.1

19.5

17.5

17.3

Change 2011 to 2012

3,528.3

146.1

252.6

65.8

15.9

4.1

4.2

-0.4

-2.4

5.4

Per cent change 2011 to 2012

57.9

2.8

12.9

44.7

17.7

6.6

24.6

-2.2

-12.2

45.0

Source: PCA database

4/23/2013 10:58:49 AM Copyright © 2013, Health and Social Care Information Centre. All rights reserved.

17

Prescribing by Dentists England 2012

 Figure 3.2 highlights the relative changes in items and NIC from 2011 to 2012 for the leading sections. The sections with the most notable changes are: Minerals, Antifungal Drugs and Drugs Used in Rheumatic Disease & Gout. Figure 3.2: Leading BNF Sections in terms dispensed 2012; percentage change in items and NIC from 2011.

Figure 3.2: Leading BNF Sections in terms of items dispensed 2012; percentage change in items and NIC from 2011

Source: PCA database

18

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Prescribing by Dentists England 2012

Leading BNF Sections by Paragraph  The following section examines the three leading BNF sections – Antibacterial Drugs, Minerals and Drugs acting on the Oropharynx– at paragraph level. Dental prescribing is also compared to overall national prescribing figures.

BNF Section 5.1 Antibacterial Drugs  Penicillins had both the highest number of items and NIC, 2.6 million and £3.2 million respectively, within the Antibacterial Drugs section. Table 4.2 and 4.3 indicates that Antibacterial Drugs have remained relatively stable from 2011 to 2012, with items falling by just 0.3 per cent and NIC rising by 2.8 per cent.  Clindamycin items made up 0.6 per cent of total prescription items within this section but

accounted for 3.7 per cent of the total net ingredient costs. Clindamycin items prescribed have reduced by 10.5 per cent; with NIC reducing by 12.5 per cent since 2011.  Generic prescribing rates were shown to be high across all paragraphs in this section.

Table 4.1: Antibacterial Drugs; items and NIC as prescribed by dentists, 2012

Table 4.1: Antibacterial Drugs; items and NIC as prescribed by dentists, 2012 Items (thousands)

Per cent of Antibacterial Drug items

Per cent of items prescribed generically

NIC (pounds) (thousands)

Per cent of Antibacterial Drug NIC

Penicillins

2,586

65.9

99.8

3,157

59.0

Metronidazole and Tinidazole

1,097

27.9

99.9

1,391

26.0

186

4.7

99.0

498

9.3

Clindamycin

24

0.6

98.5

201

3.7

Cephalosporins and other Betalactams

20

0.5

97.1

47

0.9

Tetracyclines

12

0.3

99.6

57

1.1

3,924

100.0

99.7

5,351

100.0

Paragraph name

Macrolides

Total

Source: PCA database

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19

Prescribing by Dentists England 2012 Table 4.2: Antibacterial Drugs; items as prescribed by dentists, 2005 – 2012

Table 4.2: Antibacterial Drugs; items as prescribed by dentists, 2005-2012 Number (thousands)

Year

Metronidazole Penicillins and Tinidazole

Macrolides

Cephalosporin s and other Clindamycin Betalactams

Tetracyclines

Others

Total

2005

2,582.1

950.1

199.8

65.1

37.5

23.3

-

3,857.8

2006

2,454.9

927.2

183.7

66.9

33.4

21.1

-

3,687.3

2007

2,458.5

952.0

178.8

67.4

29.8

19.6

0.0

3,706.0

2008

2,419.9

976.9

176.3

52.6

27.0

17.2

-

3,669.9

2009

2,448.9

1,026.9

179.5

35.3

24.9

15.4

-

3,731.1

2010

2,537.1

1,059.5

184.8

31.4

23.5

14.6

-

3,850.8

2011

2,595.8

1,089.4

187.2

26.9

22.6

13.8

-

3,935.7

2012

2,585.7

1,096.7

185.7

24.1

19.7

12.5

-

3,924.4

-10.1

7.3

-1.5

-2.8

-2.9

-1.3

-

-11.3

-0.4

0.7

-0.8

-10.5

-12.9

-9.3

n/a

-0.3

Change 2011 to 2012 Per cent change 2011 to 2012

Source: PCA database Table 4.3: Antibacterial Drugs; NIC as prescribed by dentists, 2005 – 2012

Table 4.3: Antibacterial Drugs; NIC as prescribed by dentists, 2005-2012 Pounds (thousands)

Year

Metronidazole Penicillins and Tinidazole

Macrolides

Cephalosporin s and other Clindamycin Betalactams

Tetracyclines

Others

Total

2005

4,720.2

1,222.9

555.6

536.1

139.5

57.5

-

7,231.8

2006

4,877.5

1,391.5

532.4

806.8

150.8

70.4

-

7,829.4

2007

4,442.7

1,404.8

551.1

1,283.0

133.1

81.7

0.0

7,896.6

2008

3,400.1

923.7

590.9

1,779.4

97.8

84.2

-

6,876.0

2009

3,303.5

1,074.1

464.8

809.6

68.7

66.1

-

5,786.8

2010

3,555.3

1,255.5

492.8

519.7

60.3

81.1

-

5,964.7

2011

3,043.5

1,342.3

465.2

229.3

50.1

74.6

-

5,204.9

2012

3,157.3

1,391.4

497.9

200.6

46.9

56.9

-

5,351.0

Change 2011to 2012

113.9

49.0

32.7

-28.7

-3.1

-17.7

-

146.1

Per cent change 2011 to 2012

3.7

3.7

7.0

-12.5

-6.3

-23.7

n/a

2.8

Source: PCA database

4/23/2013 10:58:49 AM

20

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Prescribing by Dentists England 2012

These changes are examined in further detail in ‘Major Changes in 2012’ of this bulletin.  While taken as whole, overall dentists’ prescribing accounts for only a small percentage of items prescribed, figure 4.1 shows that dental prescribing of Metronidazole and Tinidazole and Clindamycin account for substantial percentages of both items and cost of prescriptions of these items by all prescribers. Figure 4.1: Percentage of Antibacterial Drug items and NIC prescribed byand dentists as a Figure 4.1: Percentage of Antibacterial Drug items and NIC prescribed by dentists as a percentage of items NIC by all prescribers at paragraph level, 2012 percentage of items and NIC by all prescribers at paragraph level, 2012

Source: PCA database

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Prescribing by Dentists England 2012

BNF Section 12.3 Drugs acting on the Oropharynx  Generic prescribing for this section was particularly low. Table 5.1 shows that Mouthwashes,

gargles and dentifrices continues as the main contributor to total items and NIC within this section. More than half (53.0 per cent) the Mouthwashes, gargles and dentifrices items dispensed within this paragraph were for Corsodyl products, a significant majority (80.3 per cent) of which were not prescribed generically.  After rising in 2011, Drugs Acting on the Oropharynx items slightly dropped in 2012, by 0.6 per cent. NIC continued to rise in 2012, by £253 thousand (12.9 per cent), to £2.2 million. Table 5.1: Drugs acting on the Oropharynx; as prescribed by dentists, 2012

Table 5.1: Drugs acting on the Oropharynx; as prescribed by dentists, 2012

Items (thousands)

Per cent of drugs acting on the Oropharynx Items

Per of items prescribed generically

NIC (pounds) (thousands)

Per cent of Drugs acting on the Oropharynx NIC

423.1

82.0

56.6

1,521

68.9

Drugs For Oral Ulceration & Inflammation

68.6

13.3

57.1

560

25.4

Oropharyngeal Anti-Infective Drugs

16.1

3.1

84.2

62

2.8

8.2

1.6

8.7

64

2.9

516.0

100.0

56.8

2,206

100.0

Paragraph Name

Mouth-Washes, Gargles, And Dentifrices

Treatment Of Dry Mouth Total

Source: PCA database

22

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Prescribing by Dentists England 2012

Table 5.2: acting on items the asOropharynx; items as prescribed by dentists, 2005-2012 Table 5.2: DrugsDrugs acting on the Oropharynx; prescribed by dentists, 2005 – 2012 Number (thousands)

Year

Mouth-Washes, Drugs For Oral Oropharyngeal Gargles, And Ulceration & Anti-Infective Dentifrices Inflammation Drugs

Treatment Of Dry Mouth

Total

2005

376.0

90.9

24.5

3.7

495.2

2006

364.6

87.1

21.6

3.9

477.2

2007

365.0

87.4

18.5

4.4

475.4

2008

375.2

83.1

17.6

5.2

481.1

2009

409.9

74.0

18.9

6.7

509.5

2010

419.1

63.8

16.4

7.2

506.6

2011

430.6

66.3

15.7

6.5

519.1

2012

423.1

68.6

16.1

8.2

516.0

Change 2011 to 2012

-7.5

2.3

0.4

1.6

-3.1

Per cent change 2011 to 2012

-1.7

3.5

2.9

24.8

-0.6

Source: PCA database

Table 5.3: Drugs acting on the Oropharynx; NIC as prescribed by dentists, 2005 – 2012

Table 5.3: Drugs acting on the Oropharynx; NIC as prescribed by dentists, 2005-2012 Pounds (thousands)

Year

Mouth-Washes, Drugs For Oral Oropharyngeal Gargles, And Ulceration & Anti-Infective Dentifrices Inflammation Drugs

Treatment Of Dry Mouth

Total

2005

931.2

529.6

92.2

24.3

1,577.4

2006

920.3

589.0

78.4

25.3

1,613.1

2007

914.8

604.9

64.6

28.2

1,612.5

2008

933.3

533.8

60.7

34.2

1,562.0

2009

1,013.7

477.6

68.8

49.3

1,609.4

2010

1,163.7

437.3

59.9

54.9

1,715.8

2011

1,366.5

480.9

58.2

48.1

1,953.6

2012

1,520.5

560.2

61.6

63.9

2,206.2

154.0

79.4

3.4

15.8

252.6

11.3

16.5

5.9

32.9

12.9

Change 2011 to 2012 Per cent change 2011 to 2012

Source: PCA database

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23

Prescribing by Dentists England 2012

Figure 5.1: Percentage of Drugs acting on the Oropharynx items prescribed by dentists compared with Drugs acting on the Oropharynx items by all prescribers at paragraph level, 2012 Figure 5.1: Percentage of Drugs acting on the Oropharynx items prescribed by dentists compared with Drugs acting on the Oropharynx items by all prescribers at paragraph level, 2012

Source: PCA database

Figure 5.2: Percentage of Drugs acting on the Oropharynx NIC of items prescribed by dentists compared with Drugs acting on the Oropharynx NIC of items by all prescribers at paragraph level, 2012 Figure 5.2: Percentage ofDrugs acting on the Oropharynx NIC of items prescribed by dentists compared with Drugs acting on the Oropharynx NIC of items by all prescribers at paragraph level, 2012

24

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4/23/2013 10:58:49 AM

Prescribing by Dentists England 2012

BNF Section 9.5 Minerals  Fluoride was the only paragraph to appear in the Minerals section as prescribed by dentists.  Fluoride prescription items and NIC have risen continuously since 2005, though Table 6.2 shows that NIC continues to increase at a significantly faster rate than items. Table 6.1: Minerals; as prescribed by dentists, 2012

Table 6.1: Minerals; as prescribed by dentists, 2012

Items (thousands)

Per cent of Mineral items

Per cent of items prescribed generically

Fluoride

953

100.0

80.7

9,625

100.0

Total

953

100.0

80.7

9,625

100.0

Paragraph Name

NIC (thousands)

Per cent of Mineral NIC

Source: PCA database Table 6.2: Minerals; items and NIC of as prescribed by dentists, 2005 – 2012

Table 6.2: Minerals; items and NIC as prescribed by dentists, 2005-2012 Number & Pounds (thousands) Fluoride Year

Items

NIC

2005

12

21

2006

66

273

2007

154

814

2008

268

1,612

2009

426

2,715

2010

546

4,420

2011

708

6,097

2012

953

9,625

Change 2011 to 2012

246

3,528

Per cent change 2011 to 2012

34.7

57.9

Source: PCA database

These changes are examined in further detail in ‘Major Changes in 2012’ of this bulletin.

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Prescribing by Dentists England 2012

Major Changes in 2012  This section examines changes between 2011 and 2012 within seven leading BNF sections at presentation level.

BNF Section 9.5 Minerals  Duraphat fluoride toothpaste (5000ppm) was the most commonly prescribed item from the Minerals section, and also accounted for the highest cost. While the number of items rose by 62.7 per cent to 419 thousand, the associated NIC increased by 82.0 per cent to £6.4 million.  Duraphat fluoride toothpaste 2800ppm and 5000ppm continued to be the main drivers of growth, as they have been since these items were first introduced into the market in 2006. The items prescribed figures for both these presentations have grown each year since their introduction. Table x.x: Leading M inerals presentations w ith largest changes in item s, 2011 - 2012

Table 7.1: Leading Minerals presentations with largest changes in items, 2011-2012 2011 Items

2012 Items

Change in items

Per cent change in items

Duraphat_Fluoride Toothpaste (5000ppm)

257,838

419,491

161,653

62.7

Duraphat_Fluoride Toothpaste (2800ppm)

307,684

369,243

61,559

20.0

Fluorigard Daily_Dental Rinse 0.05%

61,671

72,573

10,902

17.7

En-De-Kay_Daily Fluoride Mouthrinse

28,130

38,860

10,730

38.1

8,845

1,772

-7,073

-80.0

Drug Name

Duraphat_Rinse 0.2%

Source: PCA database

Table x.x: Leading M inerals presentations w ith largest changes in NIC, 2011 - 2012

Table 7.2: Leading Minerals presentations with the largest changes in NIC 2011-2012 2011 NIC

2012 NIC

Change in NIC

Per cent change in NIC

Duraphat_Fluoride Toothpaste (5000ppm)

3,516,065

6,400,649

2,884,584

82.0

Duraphat_Fluoride Toothpaste (2800ppm)

1,947,415

2,508,083

560,669

28.8

197,701

244,980

47,278

23.9

En-De-Kay_Daily Fluoride Mouthrinse

84,934

130,075

45,141

53.1

Duraphat_Rinse 0.2%

27,646

6,104

-21,542

-77.9

Drug Name

Fluorigard Daily_Dental Rinse 0.05% A/F

Source: PCA database

26

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Prescribing by Dentists England 2012

BNF Section 5.1 Antibacterial Drugs  Amoxicillin 500mg capsules continued to be the most commonly prescribed item within the Antibacterial Drugs section, and also accounted for the highest cost in this section. Tables 8.1 and 8.2 show that while number of items increased by 48.1 thousand (3.5 per cent), the associated NIC increased by 10.9 per cent to £1.5 million, largely due to fluctuations in the unit price of 21 tablet packs.  Metronidazole_Tab 200mg capsules experienced the greatest fall in absolute NIC within this section. As items fell in 2012 by 2.4 per cent, NIC declined by 7.9 per cent, mostly due to its unit price peaking in early 2012, and then falling by 19.0 per cent by December 2012.  All the items listed in tables 8.1 and 8.2 below are included in the Category M scheme, which aims to reduce the NIC of generic formulations. See Sources and Definitions for further information. Table x.x: Leading Antibacterial Drugs presentations w ith largest changes in item s, 2011 - 2012

Table 8.1: Antibacterial Drugs presentations with the largest changes in items, 2011-2012 2011 Items

2012 Items

Change in items

Per cent change in items

1,365,093

1,413,181

48,088

3.5

463,862

486,516

22,654

4.9

Amoxicillin_Oral Susp 250mg/5ml S/F

19,288

22,832

3,544

18.4

Co-Amoxiclav_Tab 250mg/125mg

12,998

16,345

3,347

25.8

Amoxicillin_Oral Susp 250mg/5ml

38,373

41,505

3,132

8.2

Metronidazole_Tab 200mg

610,667

595,769

-14,898

-2.4

Amoxicillin_Cap 250mg

890,425

854,014

-36,411

-4.1

Drug Name Amoxicillin_Cap 500mg Metronidazole_Tab 400mg

Source: PCA database Table x.x: Leading Antibacterial Drugs presentations w ith largest changes in NIC, 2011 - 2012

Table 8.2: Antibacterial Drugs presentations with the largest changes in NIC 2011-2012 Drug Name Amoxicillin_Cap 500mg

2011 NIC

2012 NIC

Change in NIC

Per cent change in NIC

1,394,888

1,547,188

152,299

10.9

Metronidazole_Tab 400mg

546,488

641,375

94,887

17.4

Clindamycin HCl_Cap 150mg

220,854

193,793

-27,061

-12.3

Amoxicillin_Oral Pdr Sach 3g S/F

306,772

276,683

-30,089

-9.8

Metronidazole_Tab 200mg

624,660

575,049

-49,610

-7.9

Source: PCA database

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27

Prescribing by Dentists England 2012

BNF Section 4.1 Hypnotics and Anxiolytics  Whilst Hypnotics and Anxiolytics showed a 6.5 per cent decrease to 9.3 thousand (Table 3.6) in the number of items prescribed, the associated NIC rose by 8.5 per cent to £5.5 thousand, from 2011 to 2012.  Diazepam_Tab 5mg is the most commonly prescribed item within this section, accounting for 3,542, up 1.6 per cent from 2011. However, its associated NIC is £637, a decrease of 11.0 per cent on the previous year, due to a fall of over 20 per cent in its unit cost between January 2012 and December 2012. Table 9.1: Hypnotics and Anxiolytics presentations with the largest changes in items, 2011Table x.x: Leading Hypnotics And Anxiolytics presentations w ith largest changes in item s, 2011 - 2012 2012 Drug Name

Per cent change in items

2011 Items

2012 Items

Change in items

3,486

3,542

56

1.6

2

10

8

400.0

Diazepam_Oral Soln 2mg/5ml

105

83

-22

-21.0

Temazepam_Oral Soln 10mg/5ml S/F

268

213

-55

-20.5

Temazepam_Tab 20mg

699

633

-66

-9.4

Diazepam_Tab 2mg

1,641

1,506

-135

-8.2

Temazepam_Tab 10mg

2,022

1,876

-146

-7.2

Diazepam_Tab 10mg

1,700

1,454

-246

-14.5

Diazepam_Tab 5mg Diazepam_Oral Soln 2mg/5ml S/F

Source: PCA database

Table 9.2: Hypnotics and Anxiolytics presentations with the largest changes in NIC 2011Table x.x: Leading Hypnotics And Anxiolytics presentations w ith largest changes in NIC, 2011 - 2012 2012 2011 NIC

2012 NIC

Change in NIC

Per cent change in NIC

724

932

208

28.8

Temazepam_Oral Soln 10mg/5ml S/F

1,345

1,542

197

14.6

Temazepam_Tab 10mg

1,269

1,400

131

10.3

5

81

76

1,604.0

Temazepam_Tab 20mg

213

237

24

11.2

Diazepam_Tab 2mg

539

487

-51

-9.6

Diazepam_Tab 10mg

306

234

-72

-23.5

Diazepam_Tab 5mg

716

637

-79

-11.0

Drug Name Diazepam_Oral Soln 2mg/5ml

Diazepam_Oral Soln 2mg/5ml S/F

Source: PCA database

28

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Prescribing by Dentists England 2012

BNF Section 10.1 Drugs used in Rheumatic Diseases & Gout  Whilst the Drugs used in Rheumatic Diseases & Gout section experienced an 11,800 (9.3 per cent) drop in items, the corresponding NIC displayed a £15,900 rise.  The unit price of the ibuprofen items (pack size 84), prescribed and listed in the tables below, increased between January 2012 and December 2012: 200mg by 73.2 per cent; 400mg by 42.8 per cent, and 600mg by 8.1 per cent. The 200mg and 400mg are included in the Category M scheme, but the 600mg is not included. Pack size 24 unit prices only became available mid-way through the reporting year.  Ibuprofen 400mg tablets was the most commonly prescribed item within the Drugs used in Rheumatic Diseases & Gout section. After showing a rise in items in 2009, these items have resumed the decline in prescriptions apparent since 2006, falling 9.9 per cent (7,037) in 2012. In contrast, the NIC for this item rose by 20.8 per cent.  Diclofenac Sodium 50mg E/C tablets has risen considerably from 1 item in 2007 to 10,169 in 2012, representing a 12.2 per cent increase in items since 2011 and a 58.3 per cent increase in NIC since 2011. Table x.x: Leading Drugs Used In Rheumatic Diseases & Gout presentations w ith largest changes in item s, 2011 2012 Table 10.1: Drugs used in Rheumatic Diseases & Gout presentations with the largest

changes in items, 2011-2012 2011 Items

2012 Items

Change in items

Per cent change in items

9,061

10,169

1,108

12.2

Ibuprofen_Tab 200mg

13,705

11,611

-2,094

-15.3

Ibuprofen_Tab 600mg

25,203

22,227

-2,976

-11.8

Ibuprofen_Tab 400mg

70,808

63,771

-7,037

-9.9

Drug Name Diclofenac Sod_Tab E/C 50mg

Source: PCA database

Table x.x: Leading Drugs Used In Rheumatic Diseases & Gout presentations w ith largest changes in NIC, 2011 Table 10.2: Drugs used in Rheumatic Diseases & Gout presentations with the largest 2012 changes in NIC, 2011-2012 2011 NIC

2012 NIC

Change in NIC

Per cent change in NIC

Ibuprofen_Tab 400mg

37,323

45,103

7,780

20.8

Ibuprofen_Tab 600mg

29,399

34,682

5,283

18.0

Ibuprofen_Tab 200mg

6,701

8,895

2,194

32.7

Diclofenac Sod_Tab E/C 50mg

3,418

5,411

1,993

58.3

526

422

-104

-19.7

9,616

9,366

-250

-2.6

Drug Name

Nurofen For Child_Susp 100mg/5mlS/F(Orng Ibuprofen_Oral Susp 100mg/5ml S/F

Source: PCA database

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Prescribing by Dentists England 2012

BNF Section 5.2 Antifungal Drugs  The Antifungal Drugs section experienced a 900 (9.4 per cent) increase in items and a more noticeable increase of £65,800 (44.7 per cent) in NIC.  Nystatin Oral Suspension 100,000u/ml was the most commonly prescribed item within the Antifungal Drugs section. Items for this presentation rose by 15.0 per cent (1,082) compared with 2011, but more substantial was the 46.6 per cent (£63,766) increase in NIC. This is explained in part by a unit price increase of 10.8 per cent between January 2012 and December 2012. Table x.x: Leading Antifungal Drugs presentations w ith largest changes in item s, 2011 - 2012

Table 11.1: Antifungal Drugs presentations, changes in items, 2011-2012 2011 Items

2012 Items

Change in items

Per cent change in items

7,201

8,283

1,082

15.0

-

265

265

n/a

1,521

1,560

39

2.6

9

5

-4

-44.4

Nystan_Susp (Ready Mixed)

522

300

-222

-42.5

Diflucan_Pdr For Susp 50mg/5ml

283

32

-251

-88.7

Drug Name Nystatin_Oral Susp 100,000u/ml Fluconazole_Oral Susp 50mg/5ml Fluconazole_Cap 50mg Diflucan_Cap 50mg

Source: PCA database Table x.x: Leading Antifungal Drugs presentations w ith largest changes in NIC, 2011 - 2012

Table 11.2: Antifungal Drugs presentations, changes in NIC, 2011-2012 2011 NIC

2012 NIC

Change in NIC

Per cent change in NIC

136,981

200,757

63,776

46.6

-

8,272

8,272

n/a

2,596

2,594

-2

-0.1

297

202

-95

-32.0

Nystan_Susp (Ready Mixed)

1,080

603

-477

-44.2

Diflucan_Pdr For Susp 50mg/5ml

6,312

664

-5,647

-89.5

Drug Name Nystatin_Oral Susp 100,000u/ml Fluconazole_Oral Susp 50mg/5ml Fluconazole_Cap 50mg Diflucan_Cap 50mg

Source: PCA database

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Prescribing by Dentists England 2012

BNF Section 21.21 Dry Mouth Products  Although a relatively small component of dental prescribing, Dry Mouth Products has gradually increased in terms of the number of items prescribed and NIC over recent years. The chapter now accounts for three thousand items, and a NIC of £21 thousand.  Biotene Oralbalance Gel is the most commonly prescribed item with 2,217 prescriptions in 2012, an increase of 32.8 per cent on the previous year. Table x.x: Leading Dry M outh Products presentations w ith largest changes in item s, 2011 - 2012

Table 12.1: Dry Mouth Products presentations, changes in items, 2011-2012 2011 Items

2012 Items

Change in items

Per cent change in items

1,670

2,217

547

32.8

Xerotin Saliva Rep P/Spy 100ml

244

434

190

77.9

SST Saliva Stimulating Tab

331

364

33

10.0

Drug Name Biotene Oralbalance Gel

Source: PCA database

Table x.x: Leading Dry M outh Products presentations w ith largest changes in NIC, 2011 - 2012

Table 12.2: Dry Mouth Products presentations, changes in NIC, 2011-2012 Drug Name Biotene Oralbalance Gel

2011 NIC

2012 NIC

Change in NIC

Per cent change in NIC

12,996

15,262

2,266

17.4

Xerotin Saliva Rep P/Spy 100ml

1,996

3,698

1,701

85.2

SST Saliva Stimulating Tab

1,904

2,091

187

9.8

Source: PCA database

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Prescribing by Dentists England 2012

BNF Section 6.1 Corticosteroids (Endocrine)  The number of items for Betnesol_Tab 500mcg dropped slightly (0.2 per cent) from 2011 to 2012 with 2,206 prescribed, its associated NIC displayed a 1.7 per cent decrease (£200) during the same time period.  Betameth Sod Phos_Tab Solb 500mcg was not prescribed by dentists in 2011, which would explain the Corticosteroids chapter displaying a 45.0 per cent increase in items for 2012, despite the highest volume item falling. Although there are no data to compare with 2011, it is worth noting that the unit price of Betameth Sod Phos_Tab Solb 500mcg has almost doubled during the twelve months January to December 2012, increasing by 99.3 per cent. Table x.x: Leading Corticosteroids (Endocrine) presentations with largest changes in items, 2011 - 2012

Table 13.1: Corticosteroids (Endocrine) presentations, changes in items, 2011-2012

Drug Name Betameth Sod Phos_Tab Solb 500mcg Betnesol_Tab 500mcg

Change in Per cent change items in items

2011 Items

2012 Items

-

648

648

n/a

2,210

2,206

-4

-0.2

Source: PCA database

Table x.x: Leading Corticosteroids (Endocrine) presentations w ith largest changes in NIC, 2011 - 2012

Table 13.2: Corticosteroids (Endocrine) presentations, changes in NIC, 2011-2012 Drug Name Betameth Sod Phos_Tab Solb 500mcg Betnesol_Tab 500mcg

2011 NIC

2012 NIC

Change in NIC

Per cent change in NIC

-

5,583

5,583

n/a

11,949

11,749

-200

-1.7

Source: PCA database

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Prescribing by Dentists England 2012

Controlled Drugs All Primary Care Trusts have a responsibility to monitor their use of Controlled Drugs. For most prescribers this information is available from ePACT, the information system provided by NHS Prescription Services. However these figures do not include prescribing by dentists because the dental prescription forms do not uniquely identify them.

The following Controlled Drug Schedule definitions are taken from the British National Formulary 63 (March 2012). The Misuse of Drugs Regulations 2001 define the classes of person who are authorised to supply and possess controlled drugs while acting in their professional capacities and lay down the conditions under which these activities may be carried out. In the regulations drugs are divided into five schedules each specifying the requirements governing such activities as import, export, production, supply, possession, prescribing, and record keeping which apply to them.

Schedule 1 includes drugs such as cannabis and lysergide which are not used medicinally. Possession and supply are prohibited except in accordance with Home Office authority.

Schedule 2 includes drugs such as diamorphine (heroin), morphine, nabilone, remifentanil, pethidine, secobarbital, glutethimide, amfetamine, and cocaine and are subject to the full controlled drug requirements relating to prescriptions, safe custody (except for secobarbital), the need to keep registers, etc. (unless exempted in Schedule 5).

Schedule 3 includes the barbiturates (except secobarbital, now Schedule 2), buprenorphine, diethylpropion, mazindol, meprobamate, midazolam, pentazocine, phentermine, and temazepam. They are subject to the special prescription requirements (except for temazepam) and to the safe custody requirements (except for any 5,5 disubstituted barbituric acid (e.g. phenobarbital), mazindol, meprobamate, midazolam, pentazocine, phentermine, or any stereoisomeric form or salts of the above). Records in registers do not need to be kept (although there are requirements for the retention of invoices for 2 years).

Schedule 4 includes in Part I benzodiazepines (except temazepam and midazolam, which are in Schedule 3) and zolpidem, which are subject to minimal control. Part II includes androgenic and anabolic steroids, clenbuterol, chorionic gonadotrophin (HCG), non-human chorionic gonadotrophin, somatotropin, somatrem, and somatropin. Controlled drug prescription requirements do not apply and Schedule 4 Controlled Drugs are not subject to safe custody requirements.

Schedule 5 includes those preparations which, because of their strength, are exempt from virtually all Controlled Drug requirements other than retention of invoices for two years.

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Prescribing by Dentists England 2012

 Table 14.1 shows the number of Controlled Drugs items prescribed by dentists has steadily reduced since 2005, NIC peaked in 2007 before reducing steadily.  In 2012 40,649 Controlled Drugs items were prescribed by dentists. This figure represented 0.7 per cent of the 5.6 million total items prescribed by dentists. Controlled Drugs NIC of £38,036 represented 0.2 per cent of dentists total NIC of £17.7 million.  Controlled Drugs prescribing by all prescribers in 2012 totalled 48.4 million items with a NIC of £511 million. Controlled Drugs prescribed by dentists accounted for 0.08 per cent of items and 0.01 per cent of NIC of all Controlled Drugs prescribed in 2012. Table 14.1: Controlled Drugs; items and NIC of as prescribed by dentists, 2005 – 2012

Table 14.1: Controlled Drugs; items and NIC prescribed, 2005-2012 Number

Pounds

Items prescibed by Items by all dentists as a prescribers per cent of all (includes prescriber dentists) items

NIC of items NIC of items by all prescribed by prescribers dentists as a per (includes cent of all dentist) prescriber NIC

Year

Items by Dentists

NIC of items by Dentists

2005

56,548

43,294,481

0.13

55,383

310,420,172

0.02

2006

46,766

42,985,721

0.11

60,934

378,933,163

0.02

2007

45,297

44,470,790

0.10

68,819

435,982,804

0.02

2008

43,077

45,469,078

0.09

49,824

449,492,917

0.01

2009

41,834

46,566,491

0.09

39,362

475,296,647

0.01

2010

40,687

47,637,220

0.09

40,756

514,926,068

0.01

2011

40,232

48,102,480

0.08

36,840

501,481,826

0.01

2012

40,649

48,448,956

0.08

38,036

510,563,321

0.01

Change 2011 to 2012

417

346,476

0.00

1,196

9,081,495

0.00

Per cent change 2011 to 2012

1.0

0.7

n/a

3.2

1.8

n/a

Source: PCA database

 The number of items within each Controlled Drug Schedule has steadily reduced over the last three years, although there was a slight increase in Schedule 5 drugs in 2012 compared to 2011.  Schedule 2 drugs had no items prescribed in 2012, for the third year in succession following a gradual decline prior to 2010.  Figures 15.1 and 15.2 show that in each year since 2005 Schedule 5 drugs have accounted for the majority of Controlled Drugs items and NIC. The 31,312 Schedule 5 items and £32,417 Schedule 5 NIC in 2012, shown in Figures 14.1 and 14.2, can be attributed to one drug, Dihydrocodeine Tartrate Tablets 30mg.

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Prescribing by Dentists England 2012

 In 2012 Diazepam preparations account for over 97.0 per cent of the Schedule 4 items and NIC. Diazepam 5mg tablets remained the most commonly prescribed Schedule 4 item with 3542 items at a NIC of £636.69.  Schedule 3 Controlled Drugs as prescribed by dentists from 2005 to date has comprised of three Temazepam presentations. These are Temazepam 10mg/5ml sugar-free oral solution, Temazepam 10mg tablets and Temazepam 20mg tablets. Temazepam 10mg tablets has consistently been the most commonly prescribed, accounting for 69 per cent of Schedule 3 items in 2012.

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35

Prescribing by Dentists England 2012

Figure 14.1: Percentage of items prescribed dentists for each Drug Schedule 2012 Figure 14.1: Percentage of itemsbyprescribed byControlled dentists for each (3-5), Controlled Drug Schedule 1 (3-5) , 2012

Source: PCA databse No items prescribed for schedule 1 and 2 in 2012

Figure 14.2: Percentage of NIC for each Controlled Drug Schedule (3-5)2 prescribed by Figure 14.2:2012 Percentage of NIC for each Controlled Drug Schedule (3-5) prescribed by dentists, 2012 dentists,

Source: PCA databse No NIC for schedule 1 and 2 in 2012

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Prescribing by Dentists England 2012

Controlled Drugs by Schedule In light of the Shipman Inquiry monitoring of Schedule 2 Controlled Drugs is of particular interest.  In previous years the only Schedule 2 drug prescribed by dentists was Pethidine hydrochloride 50mg tablets. Table 15.1 shows that no Schedule 2 drugs have been prescribed by dentists since 2010. Table 15.1: Controlled Drugs changeDrugs in items bychange schedule, 2005 Table 15.1: Controlled in- 2012 items by Schedule, 2005-2012

Schedule Year

2

3

4

5

2005

448

4,717

9,656

41,727

2006

412

4,026

8,511

33,817

2007

331

3,917

8,182

32,867

2008

316

3,403

7,664

31,694

2009

60

3,397

7,278

31,099

2010

-

2,949

7,125

30,613

2011

-

2,989

6,994

30,249

2012

-

2,722

6,615

31,312

Change 2011 to 2012

-

-267

-379

1,063

n/a

-8.9

-5.4

3.5

Per cent change 2011 to 2012

Source: PCA database Figure 15.1: Controlled Drugs items prescribed by dentists by schedule, 2005 - 2012

Figure 15.1: Controlled Drugs items prescribed by dentists by schedule, 2005-2012

Source: PCA database

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Prescribing by Dentists England 2012 Table 15.2: Controlled Drugs change in NIC by schedule, 2005 - 2012

Table 15.2: Controlled Drugs change in NIC by Schedule, 2005-2012 Pounds Schedule Year

2

3

4

5

2005

942

1,861

2,867

49,713

2006

854

1,846

3,521

54,713

2007

640

2,213

3,450

62,516

2008

668

2,689

2,121

44,346

2009

144

3,492

2,413

33,312

2010

-

3,500

2,462

34,795

2011

-

2,826

2,324

31,691

2012

-

3,178

2,442

32,417

Change 2011 to 2012

-

352

118

726

n/a

12.4

5.1

2.3

Per cent change 2011 to 2012

Source: PCA database

Figure 15.2: Controlled Drugs NIC presrcribed by schedule, 2005 - 2012

Figure 15.2: Controlled Drugs NIC prescribed by dentists by schedule, 2005-2012

Source PCA database

4/23/2013 10:58:49 AM

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Prescribing by Dentists England 2012

Sources and Definitions Sources

8. Statistics in this bulletin are for calendar years. All prescription statistics in this bulletin are based on information systems from NHS Prescription Services at the NHS Business Services Authority (NHSBSA). The system used is the Prescription Cost Analysis (PCA), which was introduced in January 1991. This system is based on an analysis of all prescriptions dispensed in the community, i.e. by community pharmacists and appliance contractors, dispensing doctors, and prescriptions submitted by doctors for items personally administered. 9. The analyses are based on prescriptions written by dentists that were dispensed in the community in England. Also included are prescriptions written by dentists in Wales, Scotland, Northern Ireland and the Isle of Man provided they were dispensed in England. The analyses do not include prescriptions dispensed in hospitals, private prescriptions or prescriptions written in England but dispensed outside England. 10. NHSBSA processes validate preparations prescribed by dentists against a list of substances which form the Dental Practitioner’s Formulary (DPF). The DPF is part of the British National Formulary (http://www.bnf.org/bnf/) and covers all drugs which dentists can prescribe on the NHS. During the validation process for the 2012 publication, three preparations were identified where prescriptions issued by dentists had been paid by NHSBSA, but where the preparation was not listed on the DPF in 2012. In total these preparations accounted for 88 items and £203.88 NIC. This error was attributed to an inconsistency in NHSBSA processing routines, which has since been corrected. These preparations have been included in all relevant totals in this publication. Definitions

11. Prescribers write prescriptions on a prescription form. Each single item written on the form is counted as a prescription item. 12. The net ingredient cost (NIC) refers to the cost (which the dispenser is reimbursed) of the drug before discounts and does not include any dispensing costs or fees. It does not include any adjustment for income obtained where a prescription charge is paid at the time the prescription is dispensed or where the patient has purchased a pre-payment certificate.

13. PCA uses the therapeutic classifications defined in the BNF (September 2010 edition in this bulletin). The NHSBSA (Prescription Services) has created additional pseudo BNF chapters, which do not appear in the BNF, for items not included in BNF chapters 1 to 15. The majority of such items are dressings and appliances, which the (NHSBSA (Prescription Services)) has classified into four pseudo BNF chapters (20 to 23). The NHSBSA (Prescription Services) has produced a booklet on BNF classifications and the pseudo classifications used. This is available on the internet at: Copyright © 2013, Health and Social Care Information Centre. All rights reserved.

39

Prescribing by Dentists England 2012

http://www.nhsbsa.nhs.uk/PrescriptionServices/Documents/PrescriptionServices/BNF_Classificatio n_Booklet-2013.pdf

14. The classification of drugs and appliances used by the NHSBSA (Prescription Services) for PCA does not always equate exactly with the BNF. For example, the NHSBSA (Prescription Services) does not include stoma appliances in BNF section 1.8 but classifies them under a pseudo BNF chapter 23

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Prescribing by Dentists England 2012

Generic Prescribing & Category M Scheme 15. Generic prescribing is encouraged and many drugs are prescribed generically even when they are not available in generic form (principally because the branded product is still in patent). Because of this within the PCA system prescriptions for drugs are classified in four ways: Class 1 - Drugs prescribed and available generically and the dispenser is reimbursed at the Drug Tariff price or the price of the generic. It is possible in such circumstances for a branded drug or a parallel import to be dispensed against the prescription.

Class 2 - Drugs prescribed generically but because a generic is not available (for example the proprietary is still under patent) a proprietary product or a parallel import has been dispensed.

Class 3 - Drugs prescribed and dispensed by proprietary brand name

Class 4 - Dressings and appliances

16. Where a pharmacist has dispensed the generic form of the drug and has been reimbursed at the generic price, the data for the drug dispensed will be recorded against the class 1 (generic) form of the drug in PCA. Where a generic is not available and hence a pharmacist has been reimbursed at proprietary prices for dispensing the proprietary form, the data will be defined as class 2 but recorded in PCA against the class 3 (proprietary) form of the drug. 17. Where a drug is defined as class 2, the prescription items, NIC, etc for it are allocated across the items for all equivalent proprietary brands. This is done pro rata on the basis of the number of proprietary prescription items dispensed. "Of which class 2" (Owc2) gives the number of prescription items resulting from this apportionment. There are a small number of preparations that are not linked to equivalent proprietary brands that appear separately with a class of 2. 18. For the purpose of these statistics generic prescribing is defined as the sum of drugs defined as class 1 and class 2, as a percentage of all drugs of classes 1 to 3. 19. The Category M scheme is an arrangement where the net ingredient cost for selected generic formulations is controlled, with the aim of reducing costs overall. The drugs subject to the new arrangements are classified as Category M in Part VIII of the Drug Tariff. The majority of these formulations have fallen in price, although some formulations have increased in price.

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Prescribing by Dentists England 2012

List of Annexes Annex 1 – Report tables and charts (Excel workbook) All tables and charts presented in this report in Excel format, plus patients seen tables by patient type at SHA level Annex 2 – Source data (csv files)

Other Publications A full list of NHS Information Centre reports produced on dentistry can be found at: http://www.hscic.gov.uk/primary-care For information on other data related to the dental sector, please see our Guide to Dental Data at: https://catalogue.ic.nhs.uk/publications/primary-care/dentistry/nhs-dent-stat-seco-qt-rep-eng-20122013/nhs-dent-stat-eng-2012-13-seco-quar-rep-guid.pdf A full list of NHS Information Centre reports produced on prescribing can be found at: http://www.hscic.gov.uk/searchcatalogue?topics=0%2fPrescribing&sort=Relevance&size=10&page =1#top

By Other UK countries Scotland - http://www.isdscotland.org/Publications/index.asp?ht=Prescribing-and-Medicines Wales - http://wales.gov.uk/topics/statistics/theme/health/primary-care/prescribing/?lang=en Northern Ireland - http://www.hscbusiness.hscni.net/services/1806.htm

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Prescribing by Dentists England 2012

Published by the Health and Social Care Information Centre Part of the Government Statistical Service Responsible Statistician Oliver Smith, Service manager ISBN 978-1-84-636869-1

This publication may be requested in large print or other formats.

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Copyright © 2013 Health and Social Care Information Centre. All rights reserved. This work remains the sole and exclusive property of the Health and Social Care Information Centre and may only be reproduced where there is explicit reference to the ownership of the Health and Social Care Information Centre. This workHealth mayand beSocial re-used by NHSCentre. and government organisations Copyright © 2013, Care Information All rights reserved.

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