Mapping English GP prescribing data: a tool for monitoring health-service inequalities

OBJECTIVE: The aim of this paper was to show that easily interpretable maps of local and national prescribing data, available from open sources, can be used to demonstrate meaningful variations in prescribing performance. DESIGN: The prescription dispensing data from the National Health Service (NHS) Information Centre for the medications metformin hydrochloride and methylphenidate were compared with reported incidence data for the conditions, diabetes and attention deficit hyperactivity disorder, respectively. The incidence data were obtained from the open source general practitioner (GP) Quality and Outcomes Framework. These data were mapped using the Ordnance Survey CodePoint Open data and the data tables stored in a PostGIS spatial database. Continuous maps of spending per person in England were then computed by using a smoothing algorithm and areas whose local spending is substantially (at least fourfold) and significantly (p<0.05) higher than the national average are then highlighted on the maps. SETTING: NHS data with analysis of primary care prescribing. POPULATION: England, UK. RESULTS: The spatial mapping demonstrates that several areas in England have substantially and significantly higher spending per person on metformin and methyphenidate. North Kent and the Wirral have substantially and significantly higher spending per child on methyphenidate. CONCLUSIONS: It is possible, using open source data, to use statistical methods to distinguish chance fluctuations in prescribing from genuine differences in prescribing rates. The results can be interactively mapped at a fine spatial resolution down to individual GP practices in England. This process could be automated and reported in real time. This can inform decision-making and could enable earlier detection of emergent phenomena.