Polypharmacy

Overview of the programme

In England, the NHS primary care system dispenses over 1 billion prescription items every year. As more people live longer with multiple long-term health conditions, the number of medicines they take often increases. This can create a significant burden for the person trying to manage multiple medicine regimes, and in some cases it can cause harm.

Problematic polypharmacy adds a cost to the healthcare system and diminishes quality care for the patient – and most of this is entirely preventable.

The AHSN Network national polypharmacy programme is creating clinical, multi-stakeholder communities of practice across England, hosted by regional AHSNs, focusing on problematic polypharmacy within local areas.

Through a series of national webinars, education and training, the programme is also supporting routine use of the NHSBSA Polypharmacy Prescribing Comparators to identify and prioritise patients for shared decision making structured medication reviews.

Training through evidence-based polypharmacy Action Learning Sets (ALS) are being rolled out across England to support GPs, pharmacists and other healthcare professionals who undertake prescribing or medication reviews to understand the complex issues around stopping inappropriate medicines safely.

We are also working with patients and the public to drive regional testing and evaluation of public-facing initiatives to change public perceptions of prescriptions, and encouraging patients to be open about their medicine concerns and expectations.

An introduction to the AHSN Network Polypharmacy programme

Summary of resources

Below, you will find information collated to help you learn more about this programme’s aims, impact, and wider context, including evidence and information to support your implementation.

The resources have been selected for the benefit of health and care professionals. Some information links out to third party sources, and the AHSN Network is not responsible for the content on those sites.

Subject matter information

In the news:

Getting the balance right: The AHSN Network launches new national programme looking at the potential risks of polypharmacy

On our blog:

Meet the team:

Our polypharmacy teams at the AHSN Network

Evidence

Studies show that over 50% of older people are prescribed a medicine with more harm than benefit, leading to preventable morbidity, hospitalisation and mortality. In England in February 2022, there were over 876,000 people on 10 or more medicines and over 349,000 of these people were 75 or over. Taking 10 or more medications can increase the chance of hospitalisation by 300%. (Source: Payne, 2014)

The National Overprescribing Review’s (NOR) Good for you, good for us, good for everybody report was published in 2021 by the Department of Health and Social Care and led by Dr Keith Ridge, former Chief Pharmaceutical Officer for England.

It found that overprescribing is a serious problem in health systems internationally that has grown dramatically over the last 25 years. The report identifies two main causes: systemic and cultural.

The response to the NOR report is now an NHS England Programme, which sets out 20 cross-system recommendations to be led by a range of NHS and affiliate organisations. The AHSN Network national polypharmacy programme directly supports the delivery, and potentially acceleration, of recommendations 8, 16, 17 and 18 into operational practice.

Polypharmacy is also one of the key themes of the World Health Organisation’s Global Patient Safety Challenge. They are aiming to reduce severe avoidable medication related harm by 50% globally over five years from 2017 to 2022.

A 2022 BMC Medical Education journal paper evaluates the impact of a polypharmacy Action Learning Sets (ALS) tool on healthcare practitioners’ confidence, perceptions and experiences of stopping inappropriate medicines. The paper notes “This evaluation contributes to developing understanding of the role of educational initiatives in improving inappropriate polypharmacy, demonstrating the effectiveness of the ALS tool in improving healthcare practitioners’ awareness, confidence and perceptions in stopping inappropriate medicines”.

Our programme aligns with the GP Directed Enhanced Service (DES) Contract Specifications and the NHS Long Term Plan around medication safety.

Implementation

Population health management

We’ve created support networks across England to identify local priorities and make better use of the NHSBSA Polypharmacy Comparators to identify and assess patients in high-risk groups. Watch a recording of one of our recent webinars or register here for a forthcoming webinar.

Education and training for GPs and pharmacists

We are running a series of Action Learning Sets from April 2023 to March 2024. Please register your interest and we will contact you when dates are released.

Find out more about our Action Learning Sets in this short film:

Public behaviour change

We have developed a suite of patient-facing resources designed to encourage shared decision making about medicines. The NHS-branded resources are free for healthcare professionals to use with patients and are available here in a range of formats and languages.

Guidelines and supporting policies

Several key policy papers set the context for the work needed to deliver effective services for individuals taking multiple medicines:

The Primary Care Network (PCN) Direct Enhanced Services (DES) sets out the core requirements and entitlements for PCNs.
The 2020/21 Network Contract DES introduced three new services to be delivered by PCNs, including structured medication reviews and medicines optimisation for tackling polypharmacy.
The NHS National Patient Safety Strategy includes the aims and ambitions of the Medicines Safety Improvement Programme – to reduce medication-related harm in the NHS, focusing on high-risk drugs, situations and vulnerable patients. This includes priority projects to: “enable structured medicines reviews across an advanced strategic transformation partnership (STPs) or integrated care systems (ICSs) starting with population at risk due to polypharmacy.”
The newly published National medicines optimisation opportunities 2023/24 Integrated Care Boards (ICBs) Guidance identifies problematic polypharmacy as one of the agreed 16 national medicines optimisation opportunities for the NHS to deliver on.
The NHS Long Term Workforce Plan for Pharmacy sets out: “In general practice and urgent care, pharmacists supported by pharmacy technicians, and working more closely with community pharmacy teams, will continue to use population health techniques to case-find and see patients who need structured medication reviews. As more care moves out of hospital settings, pharmacy professionals will work in teams with their specialist colleagues in secondary care to treat more complex cases.”