This element has comprised the bulk of the workstream since the launch of MedSIP in autumn 2019. Research evidence suggests that an estimated 92 million medication errors occur each year in care homes. In collaboration with our colleagues in the other 14 PSCs in England we undertook a rapid diagnostic phase with homes in our region and other key stakeholders to understand what was known in the system about the problem and what improvements had been successfully introduced. This suggested a number of change ideas that required further testing. Although the workstream was paused during the pandemic we are again working with homes in our region as their recovery progresses and they have capacity to do so.