Influence of population and general practice characteristics on prescribing of minor tranquilisers in primary care

  • Andrew C. Wagner
  • Mark Hann
  • Darren M. Ashcroft
Keywords: Tranquilizing Agents, Drug Prescriptions, Drug Utilization, Healthcare Disparities, United Kingdom


Prevalence of generalised anxiety disorders is widespread in Great Britain. Previous small-scale research has shown variations in minor tranquiliser prescribing, identifying several potential predictors of prescribing volume.

Objective: This study aimed to investigate the relationship between general practice minor tranquiliser prescribing rates and practice population and general practice characteristics for all general practices in England.

Methods: Multiple regression analysis of minor tranquiliser prescribing volumes during 2004/2005 for 8,291 English general practices with general practice and population variables obtained from the General Medical Services (GMS) statistics, Quality and Outcomes Framework (QOF), 2001 Census and 2004 Index of Multiple Deprivation (IMD).

Results: The highest rates of minor tranquiliser prescribing were in areas with the greatest local deprivation while general practices situated in areas with larger proportions of residents of black ethnic origin had lower rates of prescribing. Other predictors of increased prescribing were general practices with older general practitioners and general practices with older registered practice populations.

Conclusion: Our findings show that there is wide variation of minor tranquilisers prescribing across England which has implications regarding access to treatment and inequity of service provision. Future research should determine the barriers to equitable prescribing amongst general practices serving larger populations of black ethnic origin.


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1. Psychiatric morbidity among adults living in private households. (2001) London: Office of National Statistics.

2. Weich S, Lewis G. Material standard of living, social class, and the prevalence of the common mental disorders in Great Britain. J Epidemiol Community Health. 1998;52(1):8-14.

3. Ostler K, Thompson C, Kinmonth AL, Peveler RC, Stevens L, Stevens A. Influence of socio-economic deprivation on the prevalence and outcome of depression in primary care: the Hampshire Depression Project. Br J Psychiatry. 2001;178(1):12-17.

4. Key health statistics from general practice 1998. (2000) London: Office of National Statistics. Report No.: 2.

5. Hull SA, Aquino P, Cotter S. Explaining variation in antidepressant prescribing rates in east London: a cross sectional study. Fam Pract. 2005;22(1):37-42.

6. Hull SA, Cornwell J, Harvey C, Eldridge S, Bare PO. Prescribing rates for psychotropic medication amongst east London general practices: low rates where Asian populations are greatest. Fam Pract. 2001;18(2):167-173.

7. Ashworth M, Lloyd D, Smith RS, Wagner A, Rowlands G. Social deprivation and statin prescribing: a cross-sectional analysis using data from the new UK general practitioner 'Quality and Outcomes Framework'. J Public Health (Oxf). 2007 Mar;29(1):40-47.

8. Hann M, Cantrill J, Baker D, Gill P. Prescribing patterns in high-need Health Authority populations: how does an ethnically mixed composition affect volume and cost? J Clin Pharm Ther. 2004;29(6):537-546.

9. Ward PR, Noyce PR, St Leger AS. Are GP practice prescribing rates for coronary heart disease drugs equitable? A cross sectional analysis in four primary care trusts in England. J Epidemiol Community Health. 2004 Feb;58(2):89-96.

10. Packham C, Robinson J, Morris J, Richards C, Marks P, Gray D. Statin prescribing in Nottingham general practices: a cross-sectional study. J Public Health Med. 1999;21(1):60-64.

11. Commission for Health Improvement. Commission for Health Improvement website. Available at:, accessed on 21 February 2008.

12. Department of Health Website. Available at:, accessed on 10 January 2008.

13. Pharoah PD, Melzer D. Variation in prescribing of hypnotics, anxiolytics and antidepressants between 61 general practices. Br J Gen Pract. 1995;45(400):595-599.

14. Wilson RP, Hatcher J, Barton S, Walley T. The influence of practice characteristics on the prescribing of benzodiazepines and appetite suppressant drugs. Pharmacoepidemiol Drug Saf. 1998;7(4):243-251.

15. Mackenzie IF, Buckingham K, Wankowski JM, Wilcock M. Morbidity, deprivation, and antidepressant prescribing in general practice. Br J Gen Pract. 1999;49(448):884-886.

16. Goyder E, Dibben C, Grimsley M, Peters J, Blank L, Ellis E. Variation in prescribing for anxiety and depression: a reflection of health inequalities, cultural differences or variations in access to care? Int J Equity Health. 2006;5:4.

17. Joint Formulary Committee. British National Formulary 54. British Medical Association and the Royal Pharmaceutical Society of Great Britain.

18. NHS Prescription Pricing Division website. Available at:, accessed on: 10 November 2007

19. Lloyd DC, Harris CM, Roberts DJ. Specific therapeutic group age-sex related prescribing units (STAR-PUs): weightings for analysing general practices' prescribing in England. BMJ. 1995;311(7011):991-994.

20. Walley T, Roberts D. Average daily quantities: a tool for measuring prescribing volume in England. Pharmacoepidemiol Drug Saf. 2000;9(1):55-58.

21. The English Indices of Deprivation 2004. (2005) London: Office of the Deputy Prime Minister.

22. Strong M, Maheswaran R, Pearson T, Fryers P. A method for modelling GP practice level deprivation scores using GIS. Int J Health Geogr. 2007;6:38.

23. Adams J, White M. Socio-economic deprivation is associated with increased proximity to general practices in England: an ecological analysis. J Public Health (Oxf). 2005;27(1):80-81.

24. Pritchard C, de Verteuil B. Application of health equity audit to health visiting. Community Pract. 2007;80(5):38-41.

25. Macintyre S, Ellaway A, Der G, Ford G, Hunt K. Do housing tenure and car access predict health because they are simply markers of income or self esteem? A Scottish study. J Epidemiol Community Health. 1998;52(10):657-664.

26. Bentham G. Limiting long-term illness and its associations with mortality and indicators of social deprivation. J Epidemiol Community Health. 1995;49(Suppl 2):S57-64.

27. Benzeval M. The self-reported health status of lone parents. Soc Sci Med. 1998;46(10):1337-1353.

28. Drever F, Doran T, Whitehead M. Exploring the relation between class, gender, and self rated general health using the new socioeconomic classification. A study using data from the 2001 census. J Epidemiol Community Health. 2004;58(7):590-596.

29. Chandola T, Jenkinson C. The new UK National Statistics Socio-Economic Classification (NS-SEC); investigating social class differences in self-reported health status. J Public Health Med. 2000;22(2):182-190.

30. National Database for Primary Care Groups and Trust, National Primary Care Research and Development Centre. Available at:, accessed 1 February 2008.

31. Walker A, O’Brien M, Traynor J, Fox K, Goddard E, Foster K. Living in Britain. Results from the 2001 general household survey. London: The Stationary Office; 2002.

32. Lloyd DC. Prescribing at the primary care group level: census data and prescribing indicators. J Clin Pharm Ther. 2001;26(2):93-101.

33. Quality and Outcomes Framework 2004-2005. NHS Information Centre. Available at:, accessed 11 November 2007

34. South East Public Health Observatory. Available at:, accessed 20 January 2008.

35. Pearce N. The ecological fallacy strikes back. J Epidemiol Community Health. 2000;54(5):326-327.

36. Strong M, Maheswaran R, Pearson T. A comparison of methods for calculating general practice level socioeconomic deprivation. Int J Health Geogr. 2006;5:29.

37. Rogers A, Pilgrim D, Brennan S, Sulaiman I, Watson G, Chew-Graham C. Prescribing benzodiazepines in general practice: a new view of an old problem. Health (London). 2007;11(2):181-198.

38. Rothera I, Jones R, Gordon C. An examination of the attitudes and practice of general practitioners in the diagnosis and treatment of depression in older people. Int J Geriatr Psychiatry. 2002;17(4):354-358.

39. Butler R, Collins E, Katona C, Orrell M. How do general practitioners select antidepressants for depressed elderly people? Int J Geriatr Psychiatry. 2000;15(7):610-613.

40. Kirmayer LJ. Cultural variations in the clinical presentation of depression and anxiety: implications for diagnosis and treatment. J Clin Psychiatry. 2001;62(Suppl 13):22-28.

41. Docherty JP. Barriers to the diagnosis of depression in primary care. J Clin Psychiatry. 1997;58(Suppl 1):5-10.

42. Mensah SA, Beavis JM, Thapar AK, Kerr M. The presence and clinical implications of depression in a community population of adults with epilepsy. Epilepsy Behav. 2006;8(1):213-219.
Original Research