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Medicines Safety Assurance Tool

The Challenge

There is considerable scope in primary care and across the interface with secondary care, for consistent and assured implementation of safety alerts. National organisations such as NHS England, NICE and the MHRA frequently share safely alerts and good practice guides to minimise harm from medication errors. Commissioners and clinical leads need a systematic way of assessing these medicines safety alerts and engaging with providers across their populations.

MLCSU Medicines Management and Optimisation (MMO) team working in GP Practice identified the burden on clerical and clinical staff to identify, share, action, and follow-up on medicines safety alerts. As a consequence the MLCSU MMO team developed a tool that could support local Birmingham and Black Country CCGs. The Medicines Safety Assurance Tool or MSAT™ could systematically horizon scan medicines safety information, provide a means for commissioners and practices alike to record actions, monitor implementation and ultimately provide assurance of compliance. 

It became clear to that an at-scale solution was needed that could be shared across the MLCSU footprint.  Over the last seven years, MLCSU has developed and evolved the MSAT™ into an at scale innovative solution, that supports both GP practices and CCG commissioners alike with the assurance framework needed. The MSAT™ is currently utilised by 25 Clinical Commissioning Groups in the Midlands, Cheshire, Merseyside and Lancashire.

Our Solution

With an emphasis on ease of use, the MSATTM allows at a glance visibility of progress against actions required to ensure patient safety. Central to the MSAT™ is its innovativeness and uniqueness. Its adaptability allows the tool to easily be tailored to local needs. The MSAT™ is designed to meet the needs of individual GP Practices and providing effective governance and oversight to a larger network and organisation.

Unique to the MSATTM  is the tools functionality. Each alert is listed with a recommended action and priority level via RAG status. The tool allows free text notes to be added and amended, for recording of progress and for communication to be shared.

The completed document is a permanent record that demonstrates compliance and gives assurance to patients, commissioners and regulators; that care providers are meeting their NHS obligation to patient safety.

CCGs, GP Practices & Federations and PCNs all benefit from the at scale solution that is the MSAT™.


The primary purpose of the MSATTM is to reduce patient harm due to medicines. The data below shows by CCG the impact the MSAT had over a year:

  • 51 safety alerts were identified.
  • 100% of the alerts were communicated in a prescribing newsletter to GPs, the CCG and community pharmacies.
  • 75% of the safety alerts were implemented through decision support software.
  • 70% of the alerts prompted a recommendation to complete a search of practice clinical systems.

There are no perceived barriers to other organisations adopting the MSAT™. As an innovative way to capture, record, and act upon safety alerts associated with medicines and medical devices, it can easily be shared at scale.

"The MSAT is a highly valued resource for Wolverhampton CCG. MLCSU have worked to improve and develop this tool over a period of time to meet the CCG needs. The tool has proven to be an excellent checklist that helps the CCG take appropriate actions around patient safety. The tool is also used regularly to inform the content of our internal assurance committee report."
David Birch, Former Head of Medicines Optimisation, Wolverhampton CCG