Seb Bacon

Background: The Secondary Care Medicines Data (SCMD) makes detailed data on medicines issued by National Health Service (NHS) hospital trusts in England openly available for the first time. These data provide an opportunity to understand medicine use patterns, highlight variation, and drive improvements in evidence-based practice, prescribing safety, and cost-effectiveness. However, this dataset requires extensive domain and technical knowledge to access, clean, transform, and link to other external sources before it can be used effectively. Objective: This study aimed to describe the development, implementation, and functionality of OpenPrescribing Hospitals and showcases example use cases. OpenPrescribing Hospitals is an open-access platform for analyzing hospital medicines use in England using the SCMD. Methods: We developed a data pipeline that imports the SCMD and links further medicinal product information from the dictionary of medicines and devices, organization information from the Organisation Reference Data, and medicines classifications and measurement information from the Anatomical Therapeutic Chemical and Defined Daily Dose index. Using these linked data, we calculated alternative measures of quantity to support appropriate comparison across the products reported. These data are presented through an open-access web platform with 3 main features: Submission History, Measures, and Analyse. We describe these features through illustrative use cases. We also summarize the web analytics collected between the platform launch in February 2025 and September 2026. Results: The platform supports open, accessible use of preprocessed hospital medicines data and supports analysis and comparisons across NHS trusts, Integrated Care Boards, NHS regions, ingredients, and therapeutic groups. The Submission History feature displays patterns that can indicate changes in the completeness and consistency of data submissions by NHS trusts. The Measures feature presents predefined measures and benchmarking based on national medicines recommendations. The Analyse feature supports detailed user-defined analyses. Illustrative examples show how incomplete submissions can affect apparent medicines use and how the platform can surface trends and variation in the issuing of selected medicines. As of September 2026, the platform attracts approximately 1000 unique visitors monthly and has been used to run more than 20,000 custom analyses. Conclusions: OpenPrescribing Hospitals reduces the technical barriers to analyzing hospital medicines data in England. The platform is openly accessible and accompanied by extensive documentation to support transparent and reproducible analyses. We encourage adoption of the platform by clinicians, academics, and policy advisors to support rapid local feedback against national medicines standards and to monitor the extent of and variation in the uptake of new medicines. This early report does not assess usability, clinical outcomes, prescribing changes, or cost savings. Further research is needed to evaluate data validity, user experience, and effects on medicine optimization.

COVID-19 is associated with higher rates of gastrointestinal diseases, although the duration of this effect and the roles of vaccination and COVID-19 severity remain uncertain. To investigate the relationship between COVID-19 and gastrointestinal diseases by vaccination status in hospitalised and non-hospitalised patients. With NHS England approval, OpenSAFELY-TPP was used to access linked data from 24 million English adults. We defined three cohorts: 'prevaccination' (January 2020-June 2021), 'vaccinated' and 'unvaccinated' (June-December 2021). We estimated adjusted HRs (aHRs) comparing the incidence of 10 gastrointestinal diseases, including upper and lower gastrointestinal bleeding, after vs before or without a COVID-19 diagnosis overall and by COVID-19 severity. COVID-19 diagnosis was associated with elevated incidence of gastrointestinal diseases, particularly after hospitalised disease. In the prevaccination cohort (n=18 422 781), the aHRs for upper gastrointestinal bleeding after hospitalised COVID-19 were 20.1 (95% CI 18.4 to 22.1) in weeks 1-4 and 1.90 (1.63 to 2.22) in weeks 53-102. The corresponding aHRs after non-hospitalised COVID-19 were 1.92 (1.74 to 2.11) and 1.34 (1.23 to 1.45), respectively. Across time periods, aHRs for gastrointestinal diseases were lower in vaccinated (n=14 948 727) than in unvaccinated (n=3 479 043) individuals. These patterns were similar across gastrointestinal diseases. The incidence of gastrointestinal disease is elevated for up to 2 years among individuals hospitalised following a COVID-19 diagnosis, especially in the first few weeks after diagnosis. Increases in incidence are attenuated among vaccinated individuals. Monitoring for gastrointestinal diseases after severe COVID-19 and promotion of vaccination in vulnerable groups are key to reducing long-term burden.

Introduction: Primary care electronic health records (EHRs) are an important resource for health research, but death recording in primary care EHRs may be incomplete or differ from Office for National Statistics (ONS) death registrations. We used OpenSAFELY-TPP to assess the completeness and concordance of death recording and provide recommendations for using date-of-death information. Methods: Using linked primary care EHRs and ONS death registrations, we assessed whether ONS-registered deaths from 2020–2025 had a primary care date of death and, where present, calculated the difference between dates. Where a primary care date was absent, we assessed death-related SNOMED CT codes. Analyses were conducted overall and by year, population subgroup, and general practice. We also examined GP registration end dates and primary-care-recorded deaths without a corresponding ONS record, including monthly patterns near the data extraction date. Results: Among 1,409,275 ONS-registered deaths, 88% had the same date recorded in primary care and 8% had no corresponding primary care date. Among 1,324,995 deaths recorded in primary care, <2% had no corresponding ONS record. Deaths recorded in only one source were more frequent among people aged <45 years and those from Mixed, Asian or Asian British, Black or Black British, and Chinese or Other ethnic groups. ONS-only dates were also more frequent in London and the West Midlands. Primary-care-only deaths increased close to date of data extraction, reaching 7% in February 2026. Same-day GP deregistration increased from 9% in 2020 to 85% in 2025. Conclusions: Death recording in primary care EHRs showed high completeness and concordance with ONS registrations, but discrepancies remained for recent deaths and some population groups. Data recency and population-specific completeness should therefore be considered when using linked mortality data for research.

Background: The long-term effects of a COVID-19 diagnosis on respiratory outcomes by vaccination status, severity of COVID-19, and pre-existing conditions remain unclear. This study investigated the association between COVID-19 and respiratory conditions, considering these factors. Methods: OpenSAFELY-TPP was used to access linked data from 18 million people registered with GPs in England. Three cohorts were defined: pre-vaccination (wild-type/Alpha era), vaccinated and unvaccinated (Delta era). Adjusted hazard ratios (aHRs) compared the incidence of respiratory conditions after COVID-19 with that before or without COVID-19 for pneumonia, asthma, chronic obstructive pulmonary disease (COPD), and interstitial lung disease (ILD). Findings: Incidence of all outcomes was elevated during weeks 1-4 after COVID-19, compared with before or without COVID-19. Although attenuated beyond four weeks, incidence remained elevated for up to 5·5 years after COVID-19 for some outcomes, particularly following hospitalised COVID-19, e.g., COPD: pre-vaccination aHR 1·49[95% CI, 1·24-1·80], vaccinated 1·66[1·25-2·20], unvaccinated 2·15[1·41-3·28]. In most cases, aHRs were lower in vaccinated than unvaccinated people. Absolute incidence of pneumonia and ILD was higher among those with than without pre-existing respiratory conditions. Interpretation: Incidence of respiratory disease remains elevated particularly in the first month, irrespective of vaccination status and pre-existing conditions and for up to five years following hospitalised COVID-19. These findings have important implications for post-COVID clinical care, highlighting the need for long-term respiratory follow-up and healthcare service planning. Funding: UKRI Medical Research Council and UK National Institute for Health and Care Research.

Lithium has been the gold standard for the treatment and prevention of relapse in bipolar disorder for over 60 years. Guidance from the National Institute for Health and Clinical Excellence states explicitly to “offer lithium as a first-line, long-term pharmacological treatment for bipolar disorder”. Yet, in the last two decades its use has been in decline with clinicians favouring anticonvulsants or antipsychotics when treating this condition. In this study, we have used three openly available datasets containing prescribing data from primary and secondary care to explore trends in the use of lithium in England, showing both regional and temporal variance between 2015-2024. We have shown that lithium use declined in primary care by 20.9% in the last ten years (2015-2024) and 10.9% overall in the last five years (2019 to 2025). We have also shown how there is some regional variation in the source of lithium for patients, although the vast majority is prescribed in primary care. Further research into clinical behaviour is needed to understand what is driving the decrease in lithium usage, and what barriers and enablers may influence its use across the country.

We discovered that the official list of clinical codes for pregnancy during the COVID-19 pandemic identified some unlikely pregnancies (for example, in older men), principally due to a code describing a specific fetal position (“knee presentation”), which notably lacks “fetal” in the code description. This is an informative example of commonly overlooked problems in creating and using clinical data.

BACKGROUND The Secondary Care Medicines Data (SCMD) makes detailed data on medicines issued by National Health Service (NHS) hospital trusts in England openly available for the first time. These data provide an opportunity to understand medicine use patterns, highlight variation, and drive improvements in evidence-based practice, prescribing safety, and cost-effectiveness. However, this dataset requires extensive domain and technical knowledge to access, clean, transform, and link to other external sources before it can be used effectively. OBJECTIVE This study aimed to describe the development, implementation, and functionality of OpenPrescribing Hospitals and showcases example use cases. OpenPrescribing Hospitals is an open-access platform for analyzing hospital medicines use in England using the SCMD. METHODS We developed a data pipeline that imports the SCMD and links further medicinal product information from the dictionary of medicines and devices, organization information from the Organisation Reference Data, and medicines classifications and measurement information from the Anatomical Therapeutic Chemical and Defined Daily Dose index. Using these linked data, we calculated alternative measures of quantity to support appropriate comparison across the products reported. These data are presented through an open-access web platform with 3 main features: Submission History, Measures, and Analyse. We describe these features through illustrative use cases. We also summarize the web analytics collected between the platform launch in February 2025 and September 2026. RESULTS The platform supports open, accessible use of preprocessed hospital medicines data and supports analysis and comparisons across NHS trusts, Integrated Care Boards, NHS regions, ingredients, and therapeutic groups. The Submission History feature displays patterns that can indicate changes in the completeness and consistency of data submissions by NHS trusts. The Measures feature presents predefined measures and benchmarking based on national medicines recommendations. The Analyse feature supports detailed user-defined analyses. Illustrative examples show how incomplete submissions can affect apparent medicines use and how the platform can surface trends and variation in the issuing of selected medicines. As of September 2026, the platform attracts approximately 1000 unique visitors monthly and has been used to run more than 20,000 custom analyses. CONCLUSIONS OpenPrescribing Hospitals reduces the technical barriers to analyzing hospital medicines data in England. The platform is openly accessible and accompanied by extensive documentation to support transparent and reproducible analyses. We encourage adoption of the platform by clinicians, academics, and policy advisors to support rapid local feedback against national medicines standards and to monitor the extent of and variation in the uptake of new medicines. This early report does not assess usability, clinical outcomes, prescribing changes, or cost savings. Further research is needed to evaluate data validity, user experience, and effects on medicine optimization. CLINICALTRIAL

Aims: Andexanet alfa was recommended by the National Institute for Health and Clinical Excellence (NICE) as an option in the management of life‐threatening gastrointestinal bleeding in patients taking apixaban or rivaroxaban in May 2021. A recent UK‐wide survey of local hospital protocols for the use of andexanet alfa suggested that practice across the United Kingdom is highly variable. In January 2025, NICE was unable to make a recommendation on the use of andexanet alfa for reversing anticoagulation in adults with intracranial haemorrhage. We set out to report trends and variation in the uptake of andexanet alfa across the NHS in England, using the new OpenPrescribing Hospitals platform. Methods: To assess the uptake of andexanet alfa, we analysed pharmacy stock control data from NHS trusts in England using the openly available Secondary Care Medicines Dataset. Analysis was restricted to NHS trusts with 24‐h consultant‐led emergency care activity. Results: Between May 2021 and June 2025, 19 608 vials of andexanet alfa were issued in NHS trusts in England. There was wide variation in the timing and speed of uptake across NHS trusts. Substantial variation was also observed between NHS Regions in England. Conclusions: The use of andexanet alfa varies markedly between NHS regions and between NHS trusts in England. This study is the first analysis of adoption of a new treatment using the OpenPrescribing Hospitals platform, which is expected to provide a generalizable framework for similar analyses in the future.

UNSTRUCTURED We discovered that the official national UK SNOMED CT codelist for identifying pregnant people during the COVID-19 pandemic identified pregnancy in people who were very unlikely to be pregnant (for example, elderly men). Analysing usage patterns of the individual codes identified a principal code describing a specific foetal position in labour (“knee presentation”) incorrectly used to code knee complaints. The absence of “foetal”, or ”pregnancy” in the code description is a likely contributory factor. This is an informative example of commonly overlooked problems in creating and using clinical data.