As part of the Health Innovation Network’s national programme, ‘Polypharmacy: getting the balance right’, we are supporting healthcare professionals to identify patients at potential risk from problematic polypharmacy and support better conversations about medicines.

Watch our short introductory video featuring the national Clinical Lead, Clare Howard:

 

What is the problem we’re addressing?

We dispense over one billion prescription items per year in primary care in England.

Polypharmacy simply means many medicines. As more people live longer with multiple long-term conditions, the number of medicines they often take increases. This can have a significant burden on the person managing and trying to adhere to multiple medicines regimes and can also be harmful.

Studies have shown that that over 50% of older people are prescribed a medicine with more harm than benefit, leading to avoidable morbidity, hospitalisation and mortality. In England in February 2022 there were 876,317 people on 10 or more medicines and 349,653 were 75 or over. A person taking 10 or more medicines is 300% more likely to be admitted to hospital.  Polypharmacy adds preventable cost to the healthcare system and diminishes quality of care for the patient. The most deprived areas tend to have the most issues around polypharmacy, also making this a health inequality issue.

Most of the harm from polypharmacy is preventable.

The National Overprescribing Review (NOR) Good for you, good for us, good for everybody (September 2021) led by Dr Keith Ridge, former Chief Pharmaceutical Officer for England, found that overprescribing is a serious problem in health systems internationally that has grown dramatically over the last 25 years. It identifies two main causes: systemic and cultural. The response to the NOR report is now an NHS England programme.

The NOR sets out 20 cross-system recommendations to be led by a range of NHS and affiliate organisations – the Polypharmacy programme directly supports the delivery, and potential acceleration, of recommendations 8, 16, 17 and 18 into operational practice.

What are the outcomes we are trying to achieve?

Successful delivery of the programme within the West of England will result in:

  • A regional Polypharmacy Community of Practice, with members working to address the system-wide challenges of problematic polypharmacy in our geography. This was established in August 2022.
  • Routine use of the NHSBSA Polypharmacy Prescribing Comparators to identify and prioritise patients for a shared decision-making Structured Medication Review.
  • Increased confidence amongst the region’s primary care prescribing workforce to safely stop medicines identified to be inappropriate or unnecessary.
  • A contribution to the evidence base around how to help patients to feel more empowered to open up about their medicines issues.
  • A contribution to the evidence base around how to tackle problematic polypharmacy.

How will we do this?

The programme is based on three pillars that are supported by a West of England Community of Practice:

 

Pillar 1: Population Health Management

Using data (NHS BSA Polypharmacy Comparators) to understand Primary Care Network risks and identify patients for prioritisation for a Structured Medication Review.

Pillar 2: Education and Training

Investing in clinical leaders – Polypharmacy Clinical Leads and expert Polypharmacy Trainers and delivery of local Polypharmacy Action Learning Sets (ALSs) to upskill the primary care workforce to be more confident about stopping unnecessary medicines. The ALS model was originally developed and piloted by Health Innovation Wessex and supported by Health Education England (HEE).

Pillar 3: Public Behaviour Change

Local testing and evaluation of public-facing initiatives to change public perceptions of prescribing and encourage patients to open up about medicine concerns and expectations.

Find out more

To understand more about the programme and its ambitions, read the blog ‘getting the balance right on polypharmacy’ by Amy Semple, national Programme Manager and Clinical Lead, Clare Howard. You can also read the findings of our interim evaluation of the programme’s first year.

Resources and events

West of England polypharmacy community of practice 

Join colleagues with an interest in medicines optimisation and/or frailty and geriatrics at our regular regional community of practice events focused on tackling problematic polypharmacy. These events provide a platform for members to hear from nationally and locally recognised expert guest speakers, meet other colleagues in the region, share experiences, challenges and project work. Contact healthinnowest.transformation@nhs.net to find out more.

Polypharmacy Action Learning Set (ALS) – national cohorts throughout 2023/24

The Polypharmacy ALS is an evidence-based learning model that helps GPs, pharmacists and other healthcare professionals who undertake prescribing, medication reviews and de-prescribing on a regular basis, to understand the complex issues surrounding stopping inappropriate medicines safely.  The course offers three half-day online interactive sessions, over two months, via Zoom. Learn more about the Action Learning Sets in this short video.

Register your interest for the Health Innovation Network Polypharmacy Action Learning Sets here.

Polypharmacy: understanding the data webinars: multiple dates in 2023/24

The programme is encouraging routine use of the NHSBSA Polypharmacy Comparators to assess patients in high-risk groups. The NHSBSA Polypharmacy Prescribing Comparators tool is available to all GPs and pharmacists. Over 1,000 delegates have joined these webinars since April 2022 and multiple dates are available during 2023/24. Find out more and book here.  Alternatively, watch a recording of the November 2022 webinar.

Resources to support patients having a Structured Medication Review

We have developed a range of new evidence-based resources as part of the Health Innovation Network’s national Polypharmacy programme to support and help prepare people who have been invited for a Structured Medication Review with their GP, pharmacist or other healthcare professional.

The resources include this new animation.

Designed to encourage shared decision making about medicines, the NHS-branded resources are free for healthcare professionals to use with patients and are available in a range of formats and languages. These include English, Arabic, Bengali, Gujarati, Polish, Punjabi Gurmukhi, Punjabi Shahmukhi, Romanian, and Urdu, as well as audio versions for visually impaired people. Visit the Health Innovation Network website to download the resources.

Helping patients take their medicines safely: reasonable adjustments

Health Innovation West of England has also created a suite of a free resources to help patients take their medicines safely. These resources focus on improving understanding of the range of, and process for selecting reasonable adjustments for patients who may be encountering challenges with taking multiple medicines. Resources include a video, decision tree poster and assessment form for use by healthcare professionals. We have also created a short video for patients, carers and families.

Additional resources and information are available from the Health Innovation Network’s Polypharmacy webpage.

Contact

If you have any questions about our Polypharmacy programme, or would like to join our community of practice, please contact healthinnowest.transformation@nhs.net.