In January 2016, the MSOs ran an anonymous survey on safety culture and incident reporting. Respondents to the survey felt their company procedures for reporting incidents were generally clear, but said there were still a number of barriers that prevented them from reporting patient safety incidents. 

The two most significant barriers highlighted were time constraints and fear of criminal prosecution. Around half of the respondents said simpler reporting tools and systems would encourage them to report more patient safety incidents, and 42 per cent felt a more open culture would help. 

Based on the findings of their survey, the MSOs have developed a set of patient safety incident reporting principles, which are presented in the 'Report, Learn, Share, Act, Review' (RLSAR) wheel (see Figure 1). This provides a simple framework that pharmacy teams can use to structure their actions when identifying and reporting patient safety incidents. 

The wheel is now used in the professional standards for pharmacists, pharmacy technicians and the wider pharmacy team, as well as in NHS England's recommended templates for monthly and annual patient safety incident logs, in line with quality payment criteria.