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ben goldacre @bengoldacre
, 19 tweets, 12 min read Read on Twitter

Today @NHSEngland will announce their new "do not prescribe" list for primary care.

Within an hour we will have graphs and data on showing prescribing levels for these medicines at every individual GP practice in England.

@NHSEngland today announced a new "Do Not Prescribe" list

We've made graphs showing *every* *single* GP practice's prescribing of these items. You can drill down to CCG level, and then practice level.

Took us one hour...…
@NHSEngland Today @NHSEngland asked doctors to stop using Aliskiren, as NICE HT guidance says insufficient evidence of benefit, especially long term.

On our @OpenPrescribing you can see which CCGs are using it the most. Click on a CCG to see individual practices.…
@NHSEngland @openprescribing Today @NHSEngland asked doctors to stop using bath emollients as the BATHE study found no evidence of benefit.

On our @openprescribing you can see which CCGs are using it the most. Click on a CCG to see individual practices.…
@NHSEngland @openprescribing ..We hope that this data will be useful for clinicians and CCG pharmacists to identify where there is most room for improvement, or change. Or, to drive discussion about agreement on the guidance. More examples to follow...
@NHSEngland @openprescribing Today @NHSEngland
asked doctors to stop using the most expensive blood glucose test strips as there's no evidence they're better.

On our @openprescribing you can see which CCGs are least efficient prescribers. Click on a CCG to see individual practices.…
@NHSEngland @openprescribing .. similarly, there is no evidence that the higher cost insulin pen needles are better. Here are the CCGs and practices prescribing at highest cost.

Look. LOVELY DATA. Data to help you. Data to help the NHS. Open, accessible, fast, responsive...…

@NHSEngland @openprescribing ... to remind you, we got all these measures, graphs, and data feeds up live online within ONE HOUR of @NHSEngland announcing their new "Do Not Use" list.

Because computers are fast. And our coders, clinicians and academics work closely and efficiently together...
@NHSEngland @openprescribing ..Another new one from @NHSEngland ...

Silk garments, CLOTHES trial showed they're unlikely to be cost effective for the NHS. You could argue with that. But you'd still want data on who is and isn't using them, across t'NHS.

HERE IT IS. You're welcome.…
@NHSEngland @openprescribing ...Next: Minocycline. I wouldn't. You might. I'd be worried about side FX. There may be reasons occasionally. But LORD look at that variation among CCGs, even bigger among practices.

INTERESTING EH. We think so. Have some data. Free. From us to everyone.…
@NHSEngland @openprescribing Now, lastly, Dronedarone to prevent recurrence of AF. This is likely to be driven, in many cases, as with many things, by secondary care choices. But my god look at the variation. Someone should do a paper on that. WE ARE lol.

Lovely data:…
@NHSEngland @openprescribing NOW.


1. A very small team of clinicians, academics, and software engineers working together, pooling skills and knowledge, can rapidly produce very usable informatics tools for NHS clinicians.

@NHSEngland @openprescribing 2. Clinicians, doctors, pharmacists, are hungry for good tools that give them data they can act on. OpenPrescribing has had 80,000 unique users in the past year. EIGHTY THOUSAND USERS.

@NHSEngland @openprescribing 3. There are NO FUNDING STREAMS for work like ours. I fight + win. But I am UNUSUAL. There are lots of funding streams to turn data and clinical/epidemiology skills into BORING PAPERS read by NOBODY. Want to build a tool for 80,000 users with the same skills and data? NO FUNDING.
Now that is COMPLETELY INSANE. It is 2018. There will be other groups out there who could operate like my @EBMDataLab We should have open competitive funding streams, bottom-up, ideas-driven, where you submit a great idea for a tool or a service and can get resource to build it..
.. This is exactly what we have to fund pure academic research producing academic papers of very low impact (we also produce a ton of those btw). We should have the same for tools and services. Run by clueful people. I have a paper coming on how to run that.
NHS Digital, England, Improvement, BSA, etc, largely *cannot* build slick public facing digital tools like We know that, because, for the most part, they have not. That's not a criticism. Why should they? The state MUST be data manager, data publisher..
... but it absolutely does not need to be the sole software house. There are many situations where it possibly SHOULD be. To disrupt a market, for example. Or to meet one key core need. ...
.. but it's getting late. The wider story of how govt should interact with vendors while also building in-house capacity will have to wait for another day.

I hope you enjoy the data we have shared data, and the tools we have built. May we have many competitors in a fair market.
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