Greater Manchester has reduced hazardous prescribing through a collaboration between the NHS, academic teams and Graphnet. An early evaluation in Salford found a 40% reduction within 12 months.
The programme has been rolled out across more than 400 GP practices for 500 users in the region, covering about 3 million people through the Greater Manchester Care Record. It is delivered by Greater Manchester Integrated Care Partnership, the University of Manchester, Health Innovation Manchester and Graphnet, with support from the National Institute for Health and Care Research Greater Manchester Patient Safety Research Collaboration.
At the centre of the work is the Safety Medication Dashboard, known as SMASH. Using real-time patient data and prescribing safety indicators agreed by clinical experts, the dashboard flags patients who may be at risk from potentially hazardous prescribing.
Clinicians can review those patients in their own systems and decide whether medicines need to be changed or monitoring is required. The aim is to intervene earlier and reduce avoidable harm linked to prescribing errors or gaps in follow-up checks.
Medication safety remains a persistent issue in primary care in England. More than 1 billion prescriptions are issued each year, while about 5% of general practice patients are exposed to potentially hazardous prescribing and around 12% do not receive appropriate monitoring.
The Salford evaluation covered more than 235,000 patients across 43 GP practices. That local pilot has since developed into a region-wide service embedded in the shared care record used across Greater Manchester.
The initiative won the HSJ Patient Safety Award for Improving Medicines Safety for its use of digital tools and population health data. Regional officials said it had moved from a local pilot to implementation at scale through joint work between NHS bodies, researchers and an industry partner.
How it works
SMASH was developed by the Greater Manchester Patient Safety Research Collaboration and digitised within the Greater Manchester Care Record with Graphnet. It brings together clinical data to identify patients who match evidence-based safety indicators linked to higher-risk prescribing.
Oversight sits with a dedicated SMASH User Group, chaired by the Digital Transformation Lead in the NHS Greater Manchester Medicines Optimisation Team. The group includes representatives from the University of Manchester, Health Innovation Manchester, Graphnet and users from across the region.
The group is responsible for refining indicators and developing new measures as prescribing risks change. Recent additions include checks for patients on disease-modifying antirheumatic drugs who have not had recent blood monitoring, patients on direct oral anticoagulants without a recorded creatinine clearance measurement, and patients newly prescribed opioids more than 30 days after discharge from hospital who were not opioid dependent on admission.
User response
User feedback has been positive, according to a 2024 survey of prescribers. In that survey, 65% of respondents agreed or strongly agreed that patients are at lower risk of admission from unsafe prescribing when using SMASH.
The research collaboration said its role included providing research capacity and evaluation through its Improving Medication Safety theme. This was intended to ensure the intervention was evidence-based and assessed in practice rather than adopted without formal review.
Health Innovation Manchester has supported adoption across the region, while the University of Manchester is also involved in further work through the MedSID project. The project focuses on helping local and national decision-makers use economic evaluation when assessing medication safety initiatives.
The programme reflects a wider move in the NHS towards using shared records and data tools to identify risks before harm occurs. In this case, the regional care record has allowed the prescribing dashboard to be used across a large network of practices rather than in isolated local systems.
For technology suppliers, the project shows how data integration tools are increasingly being used in routine clinical work to track safety risks across large patient populations. For the NHS, it offers an example of how a local pilot can expand into a region-wide service when backed by evaluation, operational support and a common digital platform.
