Preventing prescribing errors in south London with PINCER

Over the past fortnight, almost 90 GP pharmacists have taken part in training on software that aims to reduce prescribing errors. PINCER searches GP clinical systems using computerised prescribing safety indicators to identify patients at risk from complications that arise owing to being prescribed multiple medicines that don’t always work together and then acting to correct the problem. The training sessions mean that GP Pharmacists in eight south London CCGs can now use the software in their practises.

“I can’t wait to use the PINCER too, to help reduce errors and adverse reactions. This will help complement our role as clinical pharmacists.”Reena Rabheru-Dodhy, Senior Primary Care Pharmacist

Prescribing errors in general practice are an expensive, preventable cause of safety incidents, illness, hospitalisations and even deaths. Serious errors affect one in 550 prescription items, while hazardous prescribing in general practice contributes to around 1 in 25 hospital admissions.

Outcomes of a trial published in the Lancet showed a reduction in error rates of up to 50% following adoption of PINCER – a pharmacist led system which acts as a risk assessment tool to identify and flag errors in general practice prescribing.

These original PINCER indicators have been incorporated into National Institute for Health and Care Excellence (NICE) Medicines Optimisation Clinical Guideline (May 2015).

Mandeep Butt, Communities of Practice, who is part of the Health Innovation Network team coordinating the training was delighted by the response from the trainees:

“I look forward to working with the amazing practice based pharmacists and technicians we have met over the last 2 weeks. Their enthusiasm was infectious!” The trainees

More about PINCER:

Developed by The University of Nottingham, the PINCER intervention developed as part of PRIMIS audit tools is led by primary care pharmacists and pharmacy technicians.

With funding and support from the Health Foundation and East Midlands AHSN, PINCER was rolled out to more than 360 practices across the East Midlands between September 2015 and April 2017.

This involved:

  • Using software to search clinical systems to identify patients at risk of hazardous prescribing
  • Conducting clinical reviews of patient notes and medication
  • Carrying out root cause analysis and providing feedback to the practice
  • Establishing action planning to improve systems and reduce risk
  • Establish action planning to improve systems and reduce risk
    Scale up PINCER using a large-scale Quality Improvement Collaborative approach
  • More than 2.9 million patient records were searched, and 21,617 cases of potentially hazardous prescribing were identified

The programme is one of the interventions selected for national adoption and spread across the AHSN Network and has so far demonstrated great results in a preliminary study, where there was a significant reduction in hazardous prescribing for indicators associated with gastrointestinal bleeding, heart failure and kidney injury.

Further information

Further training sessions will be happening in May and June. For more information or sign up for the training, please contact us.

Get in touch

We're here to help

If you have any questions or would like more information about PINCER. Please contact us.

Get in touch

Support for the deployment of GP online consultation systems in south London

Support for the deployment of GP online consultation systems in south London

Since its inception, Health Innovation Network’s Technology team has been interested in how new communications technologies offer the opportunity to enhance healthcare interactions. Such interactions could include clinical consultations between a GP or specialist and a patient in general practice or hospital outpatients’ department. They could also include discussions between professionals, for instance:

  • A multi-disciplinary team (MDT) meeting in a hospital/community setting
  • A GP seeking the input of an expert specialist.

In July 2016,we undertook a review of the Hurley Group’s ‘eConsult’ (formerly ‘WebGP’) platform, in which we sought to understand the nature and extent of this particular opportunity to transform access to general practice. More recently, we have undertaken work to promote the spread and adoption, specifically, of video-based remote consultation in hospitals—often generically referred to as ‘Skype clinics’.

Given the announcement in October 2017 of NHS England’s GP Online Consultation Systems Fund, Health Innovation Network’s Technology team is now exploring how it could be of support to CCGs and GPs in south London as they progress plans to introduce or further develop provision for GP online consultation.

We are well-aware that CCGs across south London are by no means lacking in ambition where digital transformation is concerned, and many are already forging ahead with enhancements to primary care provision with online consultation solutions of one form or another at their heart. We watch these developments with great interest and excitement.

We would be interested to hear from colleagues across south London to understand your plans for offering GP online consultation, and to discuss how can best support you in this endeavour. We are in the process of engaging CCGs across the patch, but if you would like to discuss this support opportunity further now, please contact Tim Burdsey, Technology Project Manager at tim.burdsey@nhs.net We look forward to hearing from you—and to working with you, to help realise your digital ambitions for primary care and for your wider local health and care system.