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Historically the origins of PACT can be traced back to 1976. Provision of regular prescribing information to General Practitioners (GPs) was the main reason that the PPA went through a seven year computerisation programme. The first computerised information system was based on the manual PD2 / PDS system which few GPs used. This led to the development of PACT, a more informative information system.
PACT provides all GPs with reliable and regular information on their prescribing habits and costs. The PACT system was initially implemented in August 1988. In August 1994 the new PACT standard report was launched.
To ensure that new PACT met the needs of GPs a user group was set up with representatives from the following bodies including:
- the Department of Health
- the General Medical Services Committee of British Medical Association
- the Royal College of General Practitioners
- the Pharmaceutical Society of Great Britain
- research bodies
- the Prescription Pricing Authority (PPA)
- Medical and Pharmaceutical Advisers.
The decision was taken to produce a system that would provide GPs with well presented, timely and more frequent information. To ensure that GPs are not swamped with information, the system is designed to present prescribing information at two different levels depending upon the GPs requirements.
PACT information is provided to enable GPs to:
- review their prescribing habits and costs
- improve their service to patients
- develop and monitor prescribing policies within the practice
- compare themselves with colleagues in the same HA area
- nationally improve the cost effectiveness of prescribing within the practice.
Standard PACT report information is sent to each GP every quarter.
Information is represented in a compact twelve page document. The outer pages show practice or GP level details of the cost of all prescriptions for that quarter. Also shown is the number of prescriptions, the twenty leading cost drugs, the top forty BNF sections and the average cost per prescription. The centre pages discuss a different drug related issue each quarter. These reports are also available at HA, Regional Office and National level. It is important to note that these reports cover three months prescribing; monthly information is available on the electronic PACT systems.
PACT prescribing catalogue reports are issued only at the request of the individual prescriber concerned. They contain a full inventory of the prescriptions issued during the relevant period. Catalogues are available for anything from one to twenty four months depending on the request. It is a detailed list of all prescriptions for GPs who are seriously interested in self-audit of their prescribing. Prescriptions are grouped by product within each BNF therapeutic group. This uses the therapeutic code developed by the PPA. These reports are available at GP, practice Health Authority, Regional Office and National level. One use of these reports is in the production of prescribing formularies by GPs, Practices or HAs.
Prescribing information for GPs
All medical and pharmaceutical advisors will be familiar with the existing PACTLINE, HAEPACT and EXEPACT systems supplied by the PPA. These products satisfy similar information requirements at various levels of organisation and BNF. However, the method of retrieving and analysing data and the user interface differs depending on which system is being used. This has sometimes resulted in inconsistencies and additional work to end users when analysing prescribing information.
The PPA has developed a new generic system to supersede all of the existing systems. This product is known as Electronic PACT (ePACT) and will provide a variety of information to the Department of Health; Regional Offices; Health Authorities and General Practitioners.
The new ePACT system provides the user with all of the functionality currently supported in the existing PACTLINE, HAEPACT and EXEPACT information systems. The level of data available to each user will be restricted to existing NHS access rights.
Many new features are provided by ePACT. These include the ability to compare practice data to aggregated Health Authority data if matched, for example by prescribing unit (PU). Comparisons can also be made between distinct practice types, for example, prescribing, dispensing, fundholding and indicative with data aggregated at Health Authority level. Regular access to current Health Authority and practice level data will be provided. This allows for aggregation at any BNF level with data down to script quantities and items prescribed.
Cost information is provided. The information shows potential savings if all or a given percentage of proprietary drug prescribing was substituted with generic drugs. The system also has the ability to substitute alternative drugs and identify the effect on prescribing cost.
The new ePACT system has several additional tools. The request generator allows the user to formulate requests based on one or more periods, organisations and BNF selections. A Tagging mechanism is included which allows the user to create a group of period, organisation or BNF records. System defined tags are also provided which allow specific types of organisation or BNF to be grouped together. This could include, for example, inner city practices, blacklisted drugs or new drugs.
An analysis tool is provided which consists of a number of facilities which allow the data extracted from the PPA mainframe to be interpreted. Data can be displayed in a number of formats including total prescribing, total fund holding and by fund holding wave.
The analysis tool supports Query by example (QBE), top drugs sorts and drill down sorts. These are enhanced versions of the same facilities available in the PACTLINE system. The information can be displayed in user defined graphs and reports. These can be viewed on screen, saved to disk, or printed.
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