PINCER national rollout

In 2017, PRIMIS was funded by the Health Foundation to work with Spring Impact to design a replication model for the scale and spread of PINCER using a social franchising approach. As a result of this work, in 2018 PINCER was selected by the AHSN Network for national adoption whereby PRIMIS acted as “Franchisor” and the 15 AHSNs in England acted as “Franchisees”.  

Since 2018, PRIMIS has worked with all 15 AHSNs in England to roll PINCER out to GP practices in England.

• Creating the PINCER specification, business rules and clinical system searches for identifying patients at risk of medication error using 13 evidence-based prescribing safety indicators 

• Developing a PINCER national comparative analysis service (CHART Online) which not only gave an accurate picture of the scale of medication error in primary care, but also provided the opportunity to measure impact – something that is rarely possible when implementing interventions of this scale 

• Developing and delivering a comprehensive PINCER training programme to enable pharmacists and pharmacy technicians to deliver the intervention 

• Working with other IT system providers to embed the national PINCER indicators in their computer software for greater scale, spread and impact 

• Providing a PRIMIS technical helpdesk, designed to support pharmacists and practices with the technological aspects of implementing PINCER 

PINCER has been rolled out to over 2,800 (41%) GP practices in England, with more than 2,350 health care professionals (including 1,785 primary care pharmacists) trained to deliver the PINCER intervention. During this time, just over 27 million patient records have been searched to identify instances of potentially hazardous prescribing and 220,981 patients have been identified as being at risk in at least one indicator at baseline. This is equivalent to a rate of 8.2 per 1,000 patients.  

Analysis of follow-up data from 1,677 practices has shown reductions in numbers of patients at risk of medication error for a range of indicators, particularly for those indicators associated with gastrointestinal bleeding, a common cause of medication-related hospital admissions (18,935 fewer patients at risk; 32.7% reduction).  

The findings from the national rollout of PINCER show comparable reductions in medication errors to the original research study, which the team have managed to replicate at scale and pace. Given that PINCER focuses on ameliorating some of the most common and important prescribing errors in primary care, it is likely that the intervention will have reduced medication-related hospital admissions and patient harm. This is currently being evaluated as part of a large NIHR Programme Grant for Applied Research (PRoTeCT), led by the Universities of Nottingham and Manchester.