Building a replication model for the national rollout of PINCER using a social franchising approach.

Conference:

SAPC ASM 2020 - cancelled due to pandemic

Talk Code:

U.21

Presenter:

Dr Sarah Rodgers

Twitter:

@sarahrodgers24

Co-authors:

Tony Avery, Hannah Barker, James Barrett, Lauren Fensome, Jennie Johnson, Kerry Oliver, Tony Panayiotidis, Martha Paren, Oli Smithson.

Author institutions:

PRIMIS University of Nottingham, Division of Primary Care University of Nottingham, Spring Impact, Health Foundation.

Problem

PINCER is a proven pharmacist-led IT-based intervention to reduce clinically important medication errors in primary care. Having demonstrated its effectiveness in a randomised controlled trial, we then assessed whether PINCER could be ‘scaled up’ with the same effect. Findings from this further project showed that large scale rollout to 370 general practices was effective and demonstrated statistically significant reductions in hazardous prescribing (particularly for preventing gastrointestinal (GI) bleed). Our objective was to develop a replication model for the further scale and spread of PINCER using a social franchising approach and to use this model to roll PINCER out to at least 60% of GP practices in England over a five year period to make primary care prescribing even safer for patients.

Approach

Social franchising involves enabling another team or organisation to deliver a proven intervention to agreed standards under a franchise agreement, with the primary aim of maximising social benefit. Over the last two years, we have been funded by the Health Foundation to work with Spring Impact, a non-profit global leader in social replication, to implement their systematic five-stage process to design a replication model for the scale and spread of PINCER.

Findings

We have designed a replication model for the national rollout of PINCER using a social franchise approach, and are working with Medicines Optimisation Leads from all 15 Academic Health Science Networks to roll PINCER out to GP practices across England. As of February 2020, 4,318 (62%) GP practices in England across 126 (66%) Clinical Commissioning Groups have engaged in the PINCER rollout. Of these, 2,264 (55%) practices have uploaded baseline data to the national PINCER comparative analysis service showing that a minimum of 21.9 million patient records have been searched to identify instances of potentially hazardous prescribing using 13 evidence-based prescribing safety indicators. Almost 176,000 at-risk patients have been identified in at least one prescribing safety indicator at baseline. Early findings from analysis of follow-up data from 816 practices show overall reductions in numbers of at-risk patients (12.3%) with greatest reductions for those indicators associated with GI bleed (23.1%). Over 1,100 pharmacists (of a total 1,579 individuals) have been trained to deliver the PINCER intervention and further training sessions are planned as the rollout progresses.

Consequences

We have used the concept of social franchising to develop a replication model for the national rollout of PINCER. Early findings have demonstrated that this approach has been successful in terms of both reach and impact. There is potential for this approach to be used for the scale and spread of other proven interventions in healthcare.

Submitted by:

Sarah Rodgers

Funding acknowledgement:

We would like to the thank the Health Foundation, NHS England and the Academic Health Science Network for funding this work.