EMAHSN PINCER IMPACT REPORT IMAGE 2“PINCER is a really worthwhile intervention. It has led to complex reviews being carried out by GPs facilitated by practice pharmacists, which will ultimately improve
patient safety.”

Medicines Management Team


Prescribing errors in general practices are not common – but when they happen they are an expensive cause of safety incidents, illness, hospitalisation and even deaths.

Errors happen for a number of reasons but main causes include ‘contraindications’ (different drugs used together), failure to take action on computer warnings, lack of appropriate monitoring and breakdown of safety systems. “PINCER” which stands for Pharmacist-led INformation technology intervention for reducing Clinically important Errors helps tackle these issues.

Local teams of primary care pharmacists and pharmacy technicians:

  • Use software to run a search on the GP clinical system to identify patients at risk of potentially hazardous prescribing
  • Review the patient notes using clinical judgement to assess the risk and the appropriate actions needed to address the issues identified
  • Apply root cause analysis to identify the circumstances that led to the potential risk and then feedback findings to the practice
With funding from the Health Foundation and EMAHSN, PINCER has been implemented in over 350 East Midlands GP practices.


General practice prescribing error rates are around 5%, with serious errors affecting 1 in 500 of all prescription items - analysis shows PINCER is cost effective and reduces error rates by up to 50%.

The PINCER scale-up so far has identified an estimated 21,000 instances of potentially hazardous prescribing across 11 prescribing indicators – enabling action to be taken.

What's the impact?

  • Pharmacists and pharmacy technicians have worked with over 350 (approximately 95%) of East Midlands GP practices in 12 Clinical Commissioning Groups (CCGs) to implement PINCER
  • 2.9m patient records have been searched and 21,636 instances of potentially hazardous prescribing rates have been identified across 11 prescribing indicators – half of these needed an intervention to avoid harm, cases that could otherwise have been missed
  • Quarterly analysis of the data indicates that improvements to the safety systems are sustained by the practices, beyond the time of the pharmacy team intervention.

What's next?

  • Participating CCGs will gain extended access to the PINCER toolkit for a further 12 months. Support from the Universities of Lincoln and Nottingham will also continue

  • Exploring different models for further scale and spread we are sharing the East Midlands’ experiences with other AHSNs for example Wessex, ensuring our learning helps speed up national adoption and spread

  • Further grant money from the National Institute for Health Research will allow for a more detailed evaluation of the implementation to see whether PINCER leads to reduced medication related hospital admissions and deaths
PINCER is supported by PRIMIS, for more information about PRIMIS visit their website.

View a summary of PINCER in 30 seconds here: