Medicine Safety and Effective Healthcare Research
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Evaluating the effectiveness of the PINCER prescribing safety intervention when widely implemented in general practices

IRAS Project ID: 243026

Thanks to the efforts of general practices and pharmacists in Nottinghamshire, Leicestershire and Derbyshire, hazardous prescribing has been significantly reduced.

Over 350 practices took part in the PINCER prescribing safety intervention between September 2015 and April 2017. Searches were run on GP computer systems to identify patients at risk of potentially hazardous prescribing, and then pharmacists worked with the practices to tackle the problems identified. 

Data from participating practices showed significant reductions in hazardous prescribing.

  • Over 22,000 instances of potentially hazardous prescribing were identified
  • 17% reduction in exposure to hazardous prescribing at 6 months
  • 24% reduction in hazardous prescribing associated with gastrointestinal bleeding

Analysis has shown clinically significant reductions in hazardous prescribing as a result of the PINCER intervention. Six months after the intervention there was a 17% reduction in hazardous prescribing across all of the prescribing indicators, and a 24% reduction in hazardous prescribing associated with gastrointestinal bleeding. These benefits were sustained at 12 months after the intervention.

This success has led to PINCER currently being rolled-out to all practices across England through the Academic Health Science Network. At the start of 2020, 4,000 practices had signed up, and over 750 pharmacists had been trained.

What is Next?

As a result of this success, the research team from the University of Nottingham has obtained further funding to find out whether the intervention also prevented serious harm to patients, including hospital admissions. This follow-on study (called PRoTeCT) will involve a more detailed analysis of the data. Practices will be funded to provide further data, and we hope that all 350 practices will agree to participate.

This study will evaluate whether PINCER:

  • Reduces the prevalence of patient exposure to hazardous prescribing
  • Reduces the incidence of serious harm in patients at risk of hazardous prescribing
  • Provides value for money for the NHS

Our hypothesis is PINCER reduces exposure to hazardous prescribing, reduces the incidence of serious avoidable harm, and represents value for money for the NHS.

Contact Us

If you have any questions that are not answered on this page, please contact:

Professor Tony Avery

Division of Primary Care,
School of Medicine,
University of Nottingham,
Room 1301, Tower Building,
University Park,
Nottingham, NG7 2RD.

0115 748 7201



Later in 2020 eligible practices within the East Midlands will be invited to take part in the PINCER/PRoTeCT follow-up study.


Medicine Safefy and Effective Healthcare Research

The University of Nottingham
School of Medicine

telephone: +44 (0) 115 823 0209