New PINCER Partnership Helps GP Practices Avoid Hazardous Prescribing

University of Nottingham team and FDB partner to flag crucial national safety indicators to thousands of primary care professionals through OptimiseRx prescribing software

More than 4,000 GP practices in England are being better empowered to avoid hazardous prescribing, following a key enhancement to a prescribing decision support technology used widely across the country.

Crucial ‘PINCER’ prescribing safety indicators, currently being rolled out nationally to avoid errors and hazardous prescribing, will now be flagged directly to thousands of GPs and other primary care prescribers when relevant prescribing decisions are made in the practice for patients.

In practice, FDB’s (First Databank) OptimiseRx technology, a medicines management system currently used across two thirds of clinical commissioning groups, will now alert GPs and other primary care prescribers, either at point of prescription or reauthorising of medications, when PINCER safety indicators are relevant for specific patients.

The development complements a national drive for the use of the indicators by specially-trained pharmacists in primary care, which is a key part of the NHS England’s strategy for reducing harm from medications in the NHS. In addition, practices in England will be uploading their PINCER results to a national database for analysis purposes.

Research suggests that serious errors are believed to affect one in 550 prescription items, while hazardous prescribing in general practice has been said to contribute to around 1 in 25 hospital admissions.

For the national roll-out, a combination of earlier sets of PINCER indicators in the original research trial, and subsequent programmes of work, are being used which are focused on both prescribing and monitoring aspects of medication safety.

The PINCER intervention helps identify patients at risk of hazardous prescribing. Using the principles of root cause analysis, a pharmacist then works with the practice to draw up action plans to address any immediate risk, and changes to systems and processes required to prevent any error from recurring.

To further mitigate the potential for hazardous prescribing, the indicators are now being made visible to GPs and other primary care prescribers in OptimiseRx. This is through a national partnership between FDB, the leading provider of drug knowledge for healthcare professionals, and the University of Nottingham’s PRIMIS team, who are leading on the national roll-out of the PINCER intervention in partnership with the national network of Academic Health Science Networks. FDB is one of the first delivery partners to implement the PINCER Prescribing Safety Indicators through a software solution.

The OptimiseRx technology’s overall focus is helping GPs and other prescribers make decisions that comply with local and national prescribing priorities. This includes alerting them when more cost-effective alternatives are available, and by providing patient-specific prescribing recommendations based on the patient’s record to ensure safe and effective prescribing.

Kerry Oliver, managing director of PRIMIS, said: “The agreement to embed the PINCER indicators in OptimiseRx provides enormous reach for what will be of vital benefit to key prescribing decisions within thousands of practices throughout England.

“Including them in such a widely used medicines management system will be an important factor for the sustainability of the PINCER indicators, emphasising their role in evolving knowledge and processes that help to prevent medication errors from recurring.”

Darren Nichols, UK managing director at FDB, said: “Our national partnership with PRIMIS is a crucial development in our providing GP practices with the necessary guidance and support to ensure they are alerted to potentially hazardous prescribing.

“We have listened to clinical commissioners and prescribers across the country who see the inclusion of the latest PINCER indicators within OptimiseRx as an important component of their adoption of national policies for helping to safeguard patients.

“Every day thousands of GP practices already draw on alerts within the technology to help them make the best prescribing decisions for patients, with primary care professionals prompted when best practice might indicate there could be better alternatives for patients. This important upgrade to the system with additional indicators will make those prompts even more comprehensive.”

Statistics cited on hospital admissions and serious errors associated with prescribing

Please see:

  1. Avery AJ, Ghaleb M, Barber N, Franklin BD, Armstrong SJ, Serumaga B. et al. The prevalence and nature of prescribing and monitoring errors in English general practice: a retrospective case note review. British Journal of General Practice 2013; 63(11): 543-553.
  2. Howard RL, Avery AJ, Slavenburg S, Royal S, Pipe G, Lucassen P, et al. Which drugs cause preventable admissions to hospital? A systematic review. British Journal of Clinical Pharmacology 2007; 63(2):136-147.

About FDB
FDB (First Databank), part of the Hearst Health network, is the leading provider of drug knowledge that helps healthcare professionals make precise decisions. With thousands of customers worldwide, FDB enables our information system developer partners to deliver valuable, useful, and differentiated solutions. We offer four decades of experience in transforming medical knowledge into actionable, targeted, and effective solutions that help improve patient safety, operational efficiency, and healthcare outcomes.

About FDB OptimiseRx
FDB OptimiseRx® is the leading medicines optimisation solution for primary care in the UK. OptimiseRx combines evidence-based best practice, safety and cost-effective prescribing messages, and delivers them in real time at the point of care during the prescribing workflow.

Used across more than 60% of NHS Clinical Commissioning Groups (CCGs) and Health Boards and thousands of GP practices, OptimiseRx is trusted and valued by prescribers. OptimiseRx is the only solution that delivers patient-specific prescribing guidance, integrated with prescribing workflows, supporting medicines optimisation at the point of care in EMIS Web, TPP SystmOne and Microtest Evolution. Tailored to the patient medical record, OptimiseRx takes into consideration current and previous medications, morbidities, observations and measurements to support prescribers to make the safest, most clinically appropriate prescribing decision.


PINCER (Pharmacist-led Information technology iNtervention for the reduction of Clinically important ERrors in medicines management) comprises three core elements:

  1. searching GP computer systems to identify patients at risk of potentially hazardous prescribing using a set of prescribing safety indicators
  2. pharmacists, specifically trained to deliver the intervention, providing an educational outreach intervention where they meet with GPs and other practice staff to:
    1. discuss the search results and highlight the importance of the hazardous prescribing identified using brief educational materials
    2. agree an action plan for reviewing patients identified as high risk and improving prescribing and medication monitoring systems using root cause analysis (RCA) to minimise future risk
  3. pharmacists (and pharmacy technicians) working with, and supporting, general practice staff to implement the agreed action plan.

The PRIMIS team at the University of Nottingham has been working in partnership with the medicines optimisation leads from all 15 Academic Health Science Networks to roll the PINCER intervention out to all GP practices in England using a social franchise approach. During 2020, the focus will be on the sustainability of PINCER and adaptation of the delivery model for greater involvement with Primary Care Networks.


PRIMIS is the leading organisation in extracting knowledge and value from primary care data, helping to achieve better health outcomes across the UK.
We produce highly effective and practical solutions to help people access, understand and use patient data held on GP IT systems.
We achieve this through our unrivalled understanding of health informatics, our clinical expertise and our trusted and established products, services, consultancy and training.
PRIMIS was formed in 2000 and part of the School of Medicine at the University of Nottingham.