Tackling problematic polypharmacy

Summary 

The Polypharmacy programme addresses the growing challenge of problematic polypharmacy, where patients take multiple medications, increasing their risk of harm and hospital admissions. The programme supports safer prescribing through data-driven insights, workforce training, and public engagement. It has reached over 500 stakeholders and piloted initiatives with seldom-heard communities, resulting in improved Structured Medication Review (SMR) uptake and reduced medication burden. Collaboration with Integrated Care Boards (ICBs) and use of national toolkits have enhanced scalability.  

Challenge 

As people live longer with multiple long-term health conditions, the number of medicines they take often increases. In England, as of September 2023, nearly 1 million people (993,019) were prescribed 10 or more medications (1). This phenomenon, known as polypharmacy, can place a significant burden on patients and increase the risk of harm. Individuals taking 10 or more medicines are three times more likely to experience adverse effects (2). Moreover, polypharmacy is closely linked to health inequalities (3). 

The impact extends beyond individuals. Problematic polypharmacy contributes to 16.5% of unplanned hospital admissions due to Adverse Drug Reactions (ADRs) (4), costing the NHS in England an estimated £2.21 billion annually (5). 

Approach 

The Polypharmacy Programme supports local health systems and primary care to identify patients at risk of harm due to multiple medications and encourages better conversations about medicines. The programme is built on three core pillars: 

1) Data-driven insights: Using NHSBSA (NHS Business Services Authority) Polypharmacy Comparators data to understand risks and identify patients for prioritisation for a Structured Medication Reviews (SMRs) 

2) Education & training: Delivering Polypharmacy Action Learning Sets and Masterclasses to upskill the primary care workforce, building confidence in stopping unnecessary medicines.  

3) Public behaviour change: Offering a suite of public-facing campaigns to challenge the “pill for every ill” mindset and empower patients to engage in conversations about their medicines. 

This work is a strategic priority across all three Integrated Care Boards in Kent and Medway, Surrey, and Sussex. We’ve collaborated closely with Medicines Optimisation teams to mobilize knowledge, engage local pharmacy networks and General Practitioners (GPs), and deliver training, webinars, and shared learning through Communities of Practice. 

Local impact 

• 12 Communities of Practice events attended by 506 stakeholders 

• 104 participants in National Polypharmacy Action Learning Sets (training sessions) 

• 5 Polypharmacy Trainers Accredited  

• 339 attended NHSBSA Polypharmacy Prescribing Comparators Webinars 

• 2 sites funded supporting seldom heard communities to participate in SMRs  

 Statistics for Kent and Medway, Surrey and Sussex for full three-year programme. 

“If you ask patients if they want to take fewer meds, they’ll almost universally say yes. But ironically, clinicians worry it will be a battle. The Action Learning Sets help change this mindset.” – Kim Ridout, pharmacist and newly accredited polypharmacy ALS trainer 

Supporting SMRs in seldom heard community groups 

Two pilot sites in Kent and Medway, Surrey, and Sussex were funded to engage seldom-heard groups and evaluate the impact on SMR uptake and outcomes. 

Southview Practice in Surrey Heartlands focused on patients with Learning Disabilities and saw: 

• A 30% increase in attendance at SMR appointments in the cohort of patients with Learning Disability 
• Clinicians reported that, as a result of the intervention, they were able to stop or reduce a number of medicines during the project period. 
• One carer said the resources helped them to raise concerns about some of the medicines the patient they cared for was prescribed. 

“The resources are simple, easy to understand, and readily available which is great use to our patients….We will most definitely be utilising this for other cohorts e.g. Severe Mental Illness (SMI) and other vulnerable etc.” – Dr Amber Khan, GP Partner at Southview Practice.

Medway Valley Primary Care Network (PCN) in Kent and Medway focused on patients from ethnic minority groups and saw: 

• 17 medicines being changed, reduced or stopped as a results of the intervention. 

• Impacts including reduced anticholinergic burden score, changes to opioids and antidepressants, changes to improve kidney safety and stopping statins. 

Read more about the pilots here. 

Spread and scalability 

Beyond national programme meetings, we engaged with other health innovation networks to share learnings and address barriers. We took a targeted approach, working with the ICB Medicines Optimisation and Safety Teams, mapping successful engagement and also identifying gaps.   

Going forward, we are continuing to work closely with all three ICBs in Kent and Medway, Surrey and Sussex, with a focus on over-supply and over-prescribing. This includes supporting colleagues in primary care with the implementation of the Repeat Prescribing Toolkit endorsed by the Royal Pharmaceutical Society (RPS) and the Royal College of General Practitioners (RCGP), as well as enhancing delivery and uptake of SMRs, supported by the use of the available resources.  

Find out more 

• Practical guide for ICBs, PCNs and GP practices: The mechanics of tackling overprescribing and problematic polypharmacy 
• The first national good practice guidance on repeat prescribing in 20 years: Repeat Prescribing Toolkit  

For more information on the Polypharmacy Programme, contact jo.foulger@nhs.net  

For the Repeat Prescribing Toolkit Programme, contact Lisa.Devine5@nhs.net  

References 

1 BNF Ch 1-4 and 6-10 

2 British Journal of General Practice (2023; 73 (728): e211–e219) by Ann S. Doherty, Fiona Boland, Frank Moriarty, Tom Fahey, and Emma Wallace. 

3 Iqbal A, Richardson C, Iqbal Z, O’Keefe H, Hanratty B, Matthews FE, Todd A. Are there socioeconomic inequalities in polypharmacy among older people? A systematic review and meta-analysis. BMC Geriatr. 2023 Mar 18;23(1):149. doi: 10.1186/s12877-023-03835-z. PMID: 36934249; PMCID: PMC10024437. https://pubmed.ncbi.nlm.nih.gov/36934249/ 

4 BMJ Adverse drug reactions, multimorbidity and polypharmacy 

5 NHS England » Support for prescribers