PRIMIS is proud to play an integral role in the national roll out of PINCER, in partnership with the AHSN Network, and is part of the PINCER Team at the University of Nottingham.
The PINCER team is comprised of the original research fellows for developing the intervention and PRIMIS in the School of Medicine at the University of Nottingham.
PRIMIS involvement in PINCER includes:
PINCER is a proven pharmacist-led IT-based intervention to reduce clinically important medication errors in primary care. The intervention comprises three core elements:
With funding obtained from the Health Foundation (through their Scaling Up Improvement Programme) and East Midlands Academic Health Science Network, PINCER has been rolled out to 370 general practices across 12 East Midlands CCGs between September 2015 and April 2017. Over 22,000 instances of hazardous prescribing were identified in a patient population of over 2.9 million people. Findings from the evaluation of this rollout have demonstrated statistically significant reductions in numbers of at risk patients, particularly in relation to prescribing safety indicators associated with risk of gastrointestinal bleeding, where the overall reduction was around 31% (14% after taking account of secular trends). Extrapolating figures provided by two CCGs, it is estimated that over 10,500 patients received an active intervention resulting in safer care as a direct benefit of implementing the intervention.In terms of impact, the PINCER intervention has been incorporated into national guidelines to support medicines optimisation by National Institute for Health Care Excellence ‘Medicines Optimisation Clinical Guideline’ published 04/03/15 and available at: http://www.nice.org.uk/guidance/ng5/evidence. This means that general practices throughout the country are encouraged to use the intervention.
In response to the WHO Global Patient Safety Challenge, NHS Business Services Authority have recently produced a Medication Safety Dashboard drawing on the PINCER indicators for GI bleed and Acute Kidney Injury:
Medication Safety Dashboard
The system links prescribing data in primary care to hospital admissions to help the NHS monitor and prevent errors.In addition to the East Midlands rollout, since 2013 the PINCER Quality Improvement Tool has:
In 2017, a Short Life Working Group was commissioned by the Secretary of State for Health to respond to the World Health Organisation challenge to reduce serious harm from medication errors. One of the main recommendations from this Group is for a national roll-out of PINCER.6
Having successfully obtained further funding from the Health Foundation to work with Spring Impact, a not-for profit social enterprise, the University of Nottingham PINCER Team and PRIMIS have designed a replication model for PINCER for further scale up. As a result of this work, PINCER has been identified as one of seven programmes for national rollout during 2018-2020 via the AHSN network and rollout has already commenced in two early adopter AHSN regions:
AHSN Networks national programmes priorities
Funding has been allocated to all 15 AHSNs nationally to facilitate the roll out of PINCER via the AHSN network.
If you are interested in PINCER please speak to the relevant AHSN in your locality.
In January 2019, NHS England published “Investment and evolution: A five-year framework for GP Contract Reform to implement the NHS Long Term Plan”. Prescribing safety is now a new quality improvement domain in the contract, with the average size practice potentially earning £8.5k if they achieve this domain. The Framework states (section 3.16, page 22) “the nationally-backed rollout of the pharmacist-led information technology intervention for medical errors (PINCER or equivalent) by the AHSNs” as one of four key areas for Quality Improvement. PINCER provides a mechanism for practices to achieve this, as well as providing CCGs with a process for verifying GP practice achievement.
Over the period 2018-2020, the PINCER Team will be working with Medicines Optimisation Leads from all 15 AHSNs to roll the PINCER intervention out to all GP practices in England using a social franchise approach. To date, PINCER has been rolled out in two early adopter AHSNs:
1. Oxford 2. Yorkshire and Humber
Rollout has also commenced in the following AHSNs (in no particular order):
To date [July 2019], key milestones and activities are:
If you are using PINCER as part of the national scaling up programme, you can obtain download files, find links for CHART Online, download PINCER-branded templates and images and view instructional videos. You will need to log in using your PINCER username and password:
PINCER resource area
PRIMIS + PINCER / PRoTeCT case studies
The AHSN Network's new 'The Innovators' pdf magazine [June 2019] features PINCER, Sr Sarah Rodgers from the PINCER Team, PRIMIS and West Hampshire CCG in an article on the spread of healthcare innovation:
The Innovators (online)
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