PRIMIS and the AHSN Network, key partners in the national roll out of the PINCER intervention, have released a progress report to give an overview of the first 18 months of the national roll out of the pharmacist-led, IT-based intervention, designed to reduce clinically important medication errors in primary care (PINCER).

The report details the level of spread across England with the involvement of the AHSN Network and some of the impressive impacts of the PINCER intervention during this time.

• 30 (68%) CCGs have engaged in the PINCER roll out as of 3 April 2020. 
• A total of 2,430 general practices have uploaded baseline data to the national PINCER comparative analysis service, showing that a minimum of 35 million patient records have been searched to identify instances of potentially hazardous prescribing using 13 evidence-based prescribing safety indicators.
• Analysis of follow-up data shows a reductionin the absolute number of at-risk patients identified in at least one prescribing safety indicator of 13,387 patients (-14.4%). Greatest reductions can be seen for those indicators associated with GI bleed which showed a decrease of 10,559 at-risk patients (-25.9%).In addition, 1,600+ individuals have been trainedto deliver the PINCER intervention through a combination of eLearning tools, online resources and face-to-face action learning set sessions.

In 2015, East Midlands AHSN were involved in an initial Health Foundation pilot and study of PINCER to formally evaluate the benefits of the intervention. Following this successful project, PINCER was put forward as an AHSN Network adoption and spread programme – meaning all of England’s 15 regional AHSNs were tasked to work with stakeholders in their area to spread the intervention. This report highlights the benefits of this national approach and the impact it can have at pace and scale.

East Midlands progress

• As of September 2020, around 40% of East Midlands practices uploaded PINCER data.
• EMAHSN has facilitated the training of 230 pharmacy staff across the East Midlands.
• 109 practices in the East Midlands have uploaded data more than once and this showed an absolute reduction in the number of at-risk patients by 552

Next steps

PINCER has proved to be an ideal intervention to use in the current climate and can provide many benefits while practices refine their processes:

• As the searches used help to identify patients at high risk of avoidable harm from medicines and reduce unnecessary visits to healthcare providers
• In the initial response to COVID-19, many GP practices reviewed patients and extended the frequency of blood monitoring for medication. As practices revert to standard testing frequencies, PINCER highlights were some of these tests have become overdue
• PINCER can be used as part of the risk stratification process for care home residents – read more on the PRIMIS website
• Practices can use PINCER as a risk stratification tool to prioritise patients for medication reviews – read more in the NHS guidance
• Primary Care Networks (PCN) can use PINCER to reach targets for the PCN Investment and Impact Fund. In the medicines safety section three of the indicators outlined are PINCER indicators aimed to identify patients at risk of gastric bleed due to medication. PINCER can create evidence using the comparative database which provides PCN views – read the Investment and Impact Fund guidance for more information.

Free online PINCER training 

The East Midlands AHSN is currently supporting the provision of free online PINCER training delivered by PRIMIS, in order to further the spread of the intervention in the region. Find out more about free online PINCER training for East Midlands pharmacists and technicians in our latest update.

The PINCER Progress Report and accompanying Extended Executive Summary can be accessed on PRIMIS' website.