Improving prescribing safety in general practices in the East Midlands through the PINCER intervention


PRIMIS is proud to play a role in the PINCER Health Foundation Scaling Up Improvement Project.

PRIMIS already provides a PINCER quality improvement tool which is available for practices, but the work with the project goes beyond this tool and involves project management of the roll-out of the intervention project within the East Midlands, as well as the quality improvement tools practices need to take part.

Background to the Project

Prescribing errors in general practice are an important and expensive preventable cause of safety incidents, illness, hospitalisation and even deaths. The rate of errors is estimated to be 5%, with serious errors affecting around 1 in 500 of all prescription items.

These errors can stem from clinical, human and social factors, including knowledge gaps about contraindications, failure to heed computerised warnings, failure to arrange appropriate monitoring and failure of current safety systems to prevent these errors from reaching the patient.

The original pharmacist-led information technology intervention for reducing clinically important errors in medication management (PINCER) was  developed to identify and correct prescribing errors in general practices. A cluster randomised trial published in The Lancet showed that PINCER reduced rates of specific prescribing errors by up to 50%. An economic analysis showed PINCER to be cost effective.

The PINCER intervention comprises: practice staff using specific software to identify patients at risk of common prescribing and drug monitoring errors; pharmacists meeting with GPs and nurse prescribers to discuss the results and agree an action plan; and pharmacists working with GP staff to put the plan into action, using approaches such as inviting patients into the surgery and improving prescribing safety systems.

It is anticipated that the intervention will result in clinically important reductions in prescribing errors, reductions in medication-related hospital admissions and deaths, and net cost savings to the NHS.

PRIMIS involvement

PRIMIS has worked closely with Prof Tony Avery, Dr Sarah Rodgers and colleagues within the University of Nottingham's Medical School from the beginnings of the first PINCER trial, to develop tools for practices to check their data for areas of interest and further investigation and to identify patients at risk of common prescribing errors.

PRIMIS has developed additional PINCER quality improvement tools to ensure that the needs of the roll-out project are met and pharmacists (or pharmacy technicians) and practices can participate effectively and accurately.

PRIMIS also project manages the PINCER intervention roll-out.

PINCER Project resources

The University of Lincoln - Understanding statistical process control

Despina Laparidou (Scaling Up PINCER Implementation Fellow at the Community and Health Research Unit, University of Lincoln) You Tube webinar February 2017




Please note

This is an ongoing project with its own specific quality improvement tools and only East Midlands-based pharmacists and practices are involved. It is not a downloadable quality improvement tool. If you are interested in improving your prescribing safety, the original PINCER quality improvement tool is available:

PINCER quality improvement tool

Guides and documents

PINCER Intervention leaflet


Project Partners




Making clinical data work


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