A ground-breaking project to reduce the risk of patients being prescribed the wrong medication is being rolled out across 150 East Midlands general practices - with plans to increase this to 500 by the end of 2016.

National statistics show that 1 in 20 prescriptions contain an error and lead to 1 in 25 of all admissions to hospital. With this in mind ‘PINCER’ is being rolled out across the region to GPs with support from the East Midlands Academic Health Science Network (EMAHSN).

PINCER has already been shown to be effective in reducing prescribing errors in general practices (Lancet 2012) and is supported by the National Institute for Health Care Excellence (NICE) in its ‘Medicines Optimisation Clinical Guideline’.

Now in use at 110 practices across 4 of the East Midland’s CCGs, the initiative is being rolled out to a further 12 CCGs benefiting thousands of people from across the East Midlands – including many elderly and vulnerable patients.

When used by GPs PINCER, reduces the number of medicines-related patient safety incidents by up to 50% and could increase the quality of life for many thousands of patients. PINCER has also been shown to save around £2,500 per practice through reduced hospital admissions for patients.

The PINCER Intervention rollout has been underway since July 2015. The practices are uploading the PINCER software, identifying at-risk patients and meeting with pharmacists specially trained in the PINCER Intervention. PINCER provides each practice with access to a system that automatically reviews existing prescriptions, and also offers expert support from a pharmacist.

Pharmacists work with the practice to review the way drugs are prescribed, reducing the risk that patients, particularly people with a number of conditions who need a combination of different drugs, receive the wrong medication. PINCER enables the active involvement of a multidisciplinary team, including GPs, nurses and support staff; resulting in safety improvements for patients.

The initiative is being led by Lincolnshire Community Health Services NHS Trust, universities of Lincoln and Nottingham, EMAHSN and Clinical Commissioning Groups, with funding from the Health Foundation and EMAHSN.

Sadler Stacey, a Primary Care Pharmacist in Rushcliffe CCG said: “The PINCER intervention provides a great opportunity for primary care pharmacists and GPs to work together. Using the PINCER approach allows all involved in the prescribing process to really understand their particular prescribing systems and processes and gain an insight into why prescribing issues are arising. Discussing ways of overcoming issues identified has been very rewarding and has resulted in many positive changes within GP practices regarding their prescribing and monitoring systems.”

Professor Tony Avery, Director of Research at the University of Nottingham's School of Medicine, said: "Medication errors often lead to considerable risk of harm to patients and increase the number of unnecessary admissions to hospital, placing extra pressure on services.

"So far, rolling out this project across the East Midlands has been going really successfully and we want to thank all partners and the Clinical Commissioning Groups involved.”

Janice Wiseman, Research and Innovation Manager, Lincolnshire Community Health Services NHS Trust stated: “Lincolnshire Community Health Services NHS Trust is delighted to be involved in this project. It offers a wonderful opportunity to contribute to an improvement in healthcare for the people of Lincolnshire, bringing benefits for so many, both now and in the future.”

Professor Niro Siriwardena, Professor of Primary and Prehospital Health Care at the University of Lincoln: “GP and pharmacists are working and learning together across the East Midlands region to make general practice prescribing even safer, providing a model for how pharmacists can successfully contribute to the primary care team.”

Professor Rachel Munton, EMAHSN Managing Director, said: "We are delighted to support this project which is supporting GPs to make prescribing safer. We believe it will make a massive impact and lasting improvements to the way health care is delivered, across our region and beyond.”


NOTES TO EDITORS

1. About PINCER

'PINCER' stands for Pharmacist-led INformation technology intervention for reducing Clinically important ERrors in medication management. The initiative will be rolled out over the next two years to 150 GP practices within the following Clinical Commissioning Group areas:

- Derbyshire (North) - Erewash - Derbyshire (South) - Leicester City - Hardwick - Leicestershire (West) - Leicestershire (East and Rutland) - Lincolnshire (East) - Lincolnshire (South)
- Lincolnshire (South West) - Lincolnshire (West) - Mansfield and Ashfield - Newark and Sherwood - Nottingham City - Nottingham (North and East) - Nottinghamshire (West) - Rushcliffe

Each PINCER intervention will be based on a three stage approach:

1. Searches on the GP practice's computer systems will identify patients at risk from prescribing and drug monitoring errors
2. A pharmacist - trained in the PINCER approach – will work with the practice for up to three months to develop an action plan. For example this could involve inviting patients into the surgery to review their prescription or have a blood test, and working with staff to review and enhance safety systems and plans for prescribing and monitoring medications
3. The pharmacist will continue to work with and support the general practice staff to implement the action plan.

2. About the partners

The East Midlands Academic Health Science Network (EMAHSN) is one of 15 Academic Health Science Networks in England. EMAHSN brings together the NHS, universities, industry and social care to transform the health of the region’s 4.5M residents and stimulate wealth. Current priorities focus on identifying and spreading innovations that address challenges including cancer, obesity, diabetes, mental health, respiratory disease, stroke, liver disease and support for frail older people. 

Lincolnshire Community Health Services NHS Trust delivers care closer to home, providing community healthcare and healthy lifestyle services for the people of Lincolnshire, one of the largest healthcare communities in the country. Their 2,500 staff care for thousands of patients every day in community hospitals, health clinics, schools, children’s centres and also have the privilege of delivering care to patients within their own homes.

The University of Lincoln was named among the UK's best modern universities in the Times and Sunday Times Good University Guide 2016. We have some of the most satisfied students in the UK, rating in the top 25% nationally in a number of subject areas of the National Student Survey 2015 with Psychology ranked number one. We are recognised for our pioneering approach to working with employers, winning a Lord Stafford Award and a Times Higher Education Award. Graduate prospects are strong with nine out of ten of Lincoln’s most recent graduates in work or further study six months after finishing their course.

In the Research Excellence Framework 2014, more than half of our submitted research was judged to be internationally excellent or world leading, with Lincoln ranked in the UK’s top 10 for quality of research outputs in two major subject areas.

The University of Nottingham has 43,000 students and is ‘the nearest Britain has to a truly global university, with a “distinct” approach to internationalisation, which rests on those full-scale campuses in China and Malaysia, as well as a large presence in its home city.’ (Times Good University Guide 2016). It is also one of the most popular universities in the UK among graduate employers and the winner of ‘Research Project of the Year’ at the Times Higher Education Awards 2014. It is ranked in the world’s top 75 by the QS World University Rankings 2015/16, and 8th in the UK by research power according to the Research Excellence Framework 2014. It has been voted the world’s greenest campus for three years running, according to Greenmetrics Ranking of World Universities.

The Health Foundation is an independent charity working to improve the quality of health care in the UK. It supports people working in health care practice and policy to make lasting improvements to health services; carrying out research and in-depth policy analysis, funding improvement programmes to put ideas into practice in the NHS, supporting and developing leaders and sharing evidence to encourage wider change.

Nationally, seven health care projects have been selected by the Health Foundation to be part of its new £3.5 million improvement programme ‘Scaling Up’ Improvement. The programme aims to improve health care delivery and / or the way people manage their own care through the delivery of successful health care improvement interventions at scale. The programme will run for two and a half years and each project will receive funding to support the implementation and evaluation of the work. More information about the programme.

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