Reducing harm to patients taking high risk drugs in Salford

Practices Improving the Safety of Medicines in Salford, otherwise known as PrISMS, was a Breakthrough Series Collaborative designed to improve medication safety in 8 Salford GP practices with a view to scale up across all GP practices in Salford.

Commissioned by Salford Clinical Commissioning Group (CCG) and delivered jointly by the CCG and Haelo, the programme included eight GP practices within Salford and ran for 12 months from September 2015.

Why Medicines Safety?

According to NHS England[1], primary care accounts for 85 to 90% of patient contact with the NHS, with the majority of medicines prescribed and monitored also within primary care.

As we know, medicines are central to healthcare and save lives. However, ensuring medicines are delivered safely and without error is complex. 59% of drug-related hospital admissions are preventable, this equates to 4% of all hospital admissions.

Within Salford alone there were approximately 16,000 reported incidents related to medication errors in 2014. [2]

About the programme

In September 2015, Salford CCG commissioned Haelo to run a Breakthrough Series (BTS) Collaborative with eight GP practices focusing on improving the prescribing, monitoring and reconciliation of a discrete group of high risk medications, specifically Non-Steroidal Anti Inflammatory Drugs (NSAIDS), Methotrexate and Amiodarone.

The eight practices included:

  • Clarendon Medical Practice
  • Langworthy Medical Centre
  • Blackfriars Medical Practice
  • Mosslands Medical Practice
  • Pendleton Medical Centre
  • Salford Health Matters
  • St Andrews Medical Practice 2
  • St Andrews Medical Practice 3

Based on the PINCER audit tool [4], Haelo along with the innovation team at Salford CCG and the expert faculty developed a suite of measures, a shared measurement strategy and data collection processes for the collaborative to answer the question “how do we know that change is an improvement?”

Aim: 95% of patients on high risk medicines (NSAIDS, Methotrexate and Amiodarone) will have optimised medicines care by October 2016.

The below driver diagram was developed for the programme and articulates the collaborative theory for change and how the collaborative practices will achieve the aim

prisms driver diagram


The structure of this collaborative was based upon the Institute for Healthcare Improvement’s Breakthrough Series (BTS) collaborative framework [3]. During the course of the collaborative the GP practice teams were invited to attend a series of learning sessions, interspersed with three ‘action periods’.

Within the learning sessions participating teams received training in improvement science methodologies. Using the Model for Improvement, the practices worked together following a shared theory of change to support Plan, Do, Study, Act cycles to test their change ideas on how to improve the current system.

Teams also attended talks by expert clinical faculty including Dr Neil Houston, GP and National Clinical Lead, Safety Improvement in Primary Care, Healthcare Improvement Scotland and had the opportunity to learn and share experiences from each other. In the action periods Haelo provided measurement support and bespoke coaching sessions via practice visits.

“With all agencies working together in a collaborative the patients are going to receive the benefits of that thinking…”

David Backhouse, PrISMS Patient Representative reviews the success of working collaboratively


All of the eight outcome measures showed statistically significant change. This means that 6.1% more patients across the eight practices received optimised medicines care by the end of the collaborative.

prisms graphs

As a result of the collaborative, we learnt:

  • Collaboration between practices has the potential to deliver system-wide engagement and accelerate the pace of change. Once identified, simple changes to GP practice systems can result in significant improvements in medicines safety and optimising care as demonstrated by the rapid improvement shown in the data. It appears that the changes are transferable from practice to practice. Cross-pollination which occurred at learning sessions resulted in further improvement in the data. The methodology is not exclusive to medicines optimisation and can be applied to a variety of healthcare challenges.
  • A good knowledge of the data available is absolutely critical for improvement projects especially within primary care. Due to the nature of the systems in primary care, accessing relevant baseline data was a major challenge, consequently the time period from the start of the programme to the second learning session was determined as the baseline period. More robust baseline data would be advisable in future programmes as once data analysis began it was noted that three of the measures that were chosen using the PINCER audit tool were already significantly above the set target; more meaningful measures could have been chosen with adequate baseline data.

What’s next for PrISMS?

At the summit event in October 2016, the eight GP practice teams came together to showcase results and reflections from their projects with the aim to learn from each other. The programme has celebrated positive results and feedback from all programme stakeholders and the completion of the PrISMS Collaborative Intervention Bundle.

The PRISMS Collaborative Intervention Bundle contains refined change ideas that when implemented at scale we believe will make real difference to medicines safety in primary care. An intervention bundle is a group of interventions which, when adopted and applied will address a particular problem. Many of these interventions interlink and will be most effective when they are combined together as a bundle rather than when they are used individually.


A PrISMS poster, on improving medicines safety in general practice, was showcased at The International Forum on Quality and Safety in Healthcare, one of the world’s largest conferences for healthcare professionals committed to improving patient care and their safety, in April 2017 when the International Forum returned to London.

Whilst the one year programme has now drawn to a close, work continues to improve the safety of medicines within primary care in Salford as part of the Safer Salford programme. We hope to have more information to share soon.

Find out more on the PrISMS programme page.


[1] NHS England

[2] Medicines Safety Thermometer, 2015:

[3] The Breakthrough Series: IHI’s Collaborative Model for Achieving Breakthrough Improvement. IHI Innovation Series white paper. Boston: Institute for Healthcare Improvement, 2003. (Available on

[4] Pincer audit tool, July 2015. The University of Nottingham