Scale up, replication and licensing of the PINCER intervention University of Nottingham

Prescribing errors in general practice are a significant preventable cause of patient safety incidents, illness, hospitalisation and death. PINCER is a successful pharmacist-led information technology intervention for reducing important and common medication errors in general practice prescribing. It has been incorporated into national guidelines on medicines optimisation from the National Institute for Health and Care Excellence (NICE) as well as various national policy documents.

PINCER involves clinical pharmacists and pharmacy technicians working with GP practices to identify cases of potentially hazardous prescribing of medicines associated with increased risk of gastrointestinal bleeding, exacerbation of asthma, worsening of heart failure, stroke and acute kidney injury.

The pharmacists feed back to the GP practices using the principles of educational outreach and root cause analysis, and work with them to build and implement an action plan to resolve issues identified and prevent future recurrence.

Through the Exploring Social Franchising programme, the PRIMIS team at the University of Nottingham developed a strategy to scale and spread the PINCER intervention, using a social franchising approach.

As of June 2021, 2,817 (41%) general practices have implemented PINCER and uploaded data to the PINCER comparative analysis service across 98 clinical commissioning groups in England. In total, 2,296 individuals (1,750 pharmacists) have been trained to deliver PINCER, 27.04 million patient records have been searched for prescribing errors, and 220,981 at-risk patients have been identified in at least one prescribing safety indicator.

Analysis of follow-up data from 1,677 practices that implemented PINCER showed sustained reductions (18,935 fewer patients at risk; 32.7%) for those indicators associated with gastrointestinal bleeding, a common cause of medication-related hospital admissions.

The implementation of PINCER continues, with comparable reductions in medication errors to the original research study demonstrated for those indicators associated with gastrointestinal bleeding.

Contact information

For more information about this project, please contact Dr Sarah Rodgers, PINCER National Programme Manager, PRIMIS.