Hazardous prescribing has been significantly reduced across Greater Manchester following a pioneering collaboration between the NHS, academia and industry, supported by the National Institute for Health and Care Research (NIHR) Greater Manchester Patient Safety Research Collaboration (GM PSRC).
Early evaluation in Salford, for example, covering more than 235,000 patients across 43 GP practices, showed a 40% reduction in hazardous prescribing within 12 months.
The award-winning programme has now been implemented across more than 400 GP practices and 500 users across Greater Manchester, supporting a population of around 3 million people through the Greater Manchester Care Record (GMCR).
Delivered by Greater Manchester Integrated Care Partnership, The University of Manchester, Health Innovation Manchester and Graphnet, the initiative won the 2024 HSJ Patient Safety Award for Improving Medicines Safety for its innovative use of digital technology and population health data to identify and reduce high-risk prescribing.
At the centre of the programme is the Safety Medication Dashboard (SMASH), developed by the NIHR Greater Manchester Patient Safety Research Collaboration and digitised within the GMCR in partnership with Graphnet.
The tool uses real-time patient data and a set of evidence-based prescribing safety indicators, agreed by clinical experts, to identify patients who may be at risk from potentially hazardous prescribing. Once identified, clinicians can access the patient’s record within their own systems to review medications and take appropriate action, enabling earlier intervention and reducing avoidable harm.
Preventing medication errors remains a major patient safety challenge in primary care. More than one billion prescriptions are issued annually in England, with errors contributing to significant levels of avoidable harm. Around 5% of general practice patients are exposed to potentially hazardous prescribing, while approximately 12% do not receive appropriate monitoring.
The collaboration was supported and funded by the NIHR Greater Manchester Patient Safety Research Collaboration (GM PSRC), whose input was critical to the programme’s development and evaluation. The GM PSRC provided research capacity and expertise through its Improving Medication Safety theme, ensuring the intervention was grounded in robust evidence and evaluated effectively.
Health Innovation Manchester has also played a key role in supporting the adoption and spread of the intervention across the region, helping to maximise the impact of the GMCR as a shared care record platform. By bringing together NHS organisations, industry partners and academic teams, the programme has moved from local pilot to large-scale implementation across Greater Manchester.
User feedback has been positive. In a 2024 survey, 65% of prescribers agreed or strongly agreed that patients are at lower risk of admission from unsafe prescribing when using SMASH.
Dashboard oversight and ongoing development is led through a dedicated SMASH User Group, bringing together system partners from across Greater Manchester to ensure the programme continues to evolve in response to medication-related patient safety challenges.
The group is chaired by the NHS Greater Manchester Medicines Optimisation Team Digital Transformation Lead and includes representatives from The University of Manchester, Health Innovation Manchester, Graphnet and expert users from across the region.
