Script headache

The great NHS prescribing lottery. Imagine a patient in Manchester receiving a cutting-edge medication, while another in Cornwall waits endlessly for the same treatment. Welcome to the NHS prescribing landscape, where geography can influence therapy as much as pathology.

Here at HSJ Information, we’ve delved into this conundrum using our exclusive specialist share data, which looks at actual patient numbers on a specified medicine by Trust, cancer alliance, ICB or other footprint, rather than script numbers.

The findings? A tapestry of inconsistencies that raise eyebrows and questions in equal measure. In this article, I will first show how those variations play out in the figures, then explore why, and finally discuss what can be done about it: with the right data; the right analysis; the right strategy; the right engagement and the help of advanced segmentation tools.

Our data reveals startling disparities. Taking oncology as a sample therapy area, one thing you learn quite quickly using SSD is that proximity does not lead to conformity.

Looking at variation between cancer alliances in Yorkshire in endometrial cancer, in the second half of 2024, we saw that Humber and North Yorkshire Cancer Alliance was treating a much higher than average share of its patients with hormone therapy (around half) for recurrent endometrial cancer.

However, for patients receiving treatment within South Yorkshire and Bassetlaw Cancer Alliance for recurrent endometrial cancer, 90% of those patients are receiving a form of immunotherapy, usually a novel biologic.

In urothelial cell carcinoma (UCC), we see a lot of variation at Trust level. Milton Keynes is only treating patients for urothelial cell carcinoma with chemotherapy – that is, 100%.

But NHS Grampian, NHS Dumfries and Galloway and NHS Tayside all treat 75% of their UCC patients with chemotherapy, whilst East Suffolk is treating over 70% of patients with immunotherapy, as is Walsall and NHS Forth Valley.

We can take any Trust, ICB or cancer alliance and any drug being prescribed within them, and we will always find some kind of variation in uptake and patient numbers. Sometimes, strongly launching drugs get near universal prescribing coverage quickly. Sometimes, they’re strong in some areas but don’t cut through at all in others. Sometimes, we see new drugs launched and then fail to be prescribed at all.

These aren’t mere statistical anomalies: they represent real-world impacts on patient care and outcomes.

Several factors contribute to this uneven landscape.

Local formularies are a big one. Each Trust’s unique formulary decisions – driven by consultants, pharmacists and managers that each have their own approach to risk, change and continuity – can lead to significant differences in drug availability.

Budget constraints are another. Financial pressures, from ICB to ICB and Trust to Trust, often dictate prescribing habits, sometimes at the expense of optimal patient care.

Something that has emerged in our work with clients as a driver of variation is clinical leadership. The presence (or absence) of clinical champions can sway the adoption of new therapies.

But a more amorphous factor, if no less frustrating than all of these, is simply habit. Sometimes a Trust just prescribes what it prescribes and there is no process or no person to shift the dial.

Some of our pharma clients have complained about those habits: drugs are given a TA by NICE, are green on formulary and have demonstrable benefits for specific patient groups, but Trusts do not want to change what seems to be working already.

That’s when data visibility becomes key. Without clear insights, Trusts may remain unaware of their prescribing gaps compared to peers.

For pharma, these variations present both challenges and opportunities.

For a start, let’s state the obvious. If your product use is variable around the country, your use of staff and resources is going to need to be as well. Understanding where particular discrepancies lie allows for targeted engagement. Understanding where your product is underutilised allows for focused outreach and education.

High-variance areas can be allocated marketing and support resources more efficiently.

Once you’ve established where the variance is, it’s a talking point with the local NHS – both to provide a torch to see what the gap is and a spanner to adjust prescribing habits to deliver better outcomes.

It’s also a way in to talking about collaborative solutions: partnering with Trusts to address barriers, be it through training, patient support programmes or data sharing.

So you’ve got to the point where you know where the variance is. What next? Extremely detailed segmentation, to truly understand the factors that make for variation.

Another HSJ Information solution is our recently relaunched HSJi Cancer Alliances Tool. It gathers data on several metrics about your customers – through a vast research exercise – to present a fuller picture of their potential. This is important because variation does not exist in a vacuum.

Many factors can affect variance, including overall population of your target area, disease incidence (in this case cancer), the overall performance of the organisation, performance within cancer, the number of patients on treatment, how innovative the organisation is, its propensity to work with industry to iron out these discrepancies, its level of focus on cancer, its strategy, the complexity of the alliance in terms of its personnel and governance, and the number of disease treaters within each one.

By harnessing the power of these two different types of insight – precision prescribing data and advanced segmentation tools – it’s possible for industry to really get to grips with variation and demonstrate massive untapped potential for companies, the NHS and patients.

Prescribing variation isn’t just an NHS issue: it’s a call to action for the pharmaceutical industry. Now, companies can not only identify and address disparities but also play a pivotal role in ensuring equitable patient access to therapies.

Oli Hudson is content director at HSJ Information. Go to hsjinformation.co.uk