Health Innovation Wessex helps patients to have healthy conversations about their medication

Medicines are the most frequently made intervention in the NHS. They help millions of patients manage their long-term conditions and save many lives. However, as patients get older, their body’s ability to manage taking so many medicines declines. In later years, taking lots of medicines can lead to an increased risk of harm.

Health Innovation Wessex is helping to reduce harm to people taking multiple medicines by developing, delivering and evaluating specialist training that equips clinicians to carry out Structured Medication Reviews (SMRs) with older patients and those with long-term health conditions. This ensures safer prescribing, reducing the risk of adverse effects and hospital admissions, and improving quality of life.

As the region’s health innovation specialists funded by NHS England and the Government’s Office for Life Sciences, Health Innovation Wessex has developed, delivered and evaluated an extensive programme of training to support clinicians to carry out Structured Medication Reviews, especially with their older patients.

Paul's story

When Paul, a seventy year-old man with multiple long-term health conditions, began to lose weight rapidly and feel as though he was “being poisoned”, his family feared the worst.

After repeated hospital admissions and the prospect of invasive surgery, it was only through a Structured Medication Review with his Clinical Pharmacist that the true cause was uncovered: some of his newer diabetes medicines were making him severely unwell.

Working together, Paul and his pharmacist Steven created a safer, more manageable plan then reintroduced only the medicines he really needed, improving his quality of life dramatically. This process is known as a Structured Medication Review, and its introduction has the potential to save lives and prevent tens of thousands of hospital admissions.

A national challenge

Paul’s story highlights a challenge facing millions of people across England who are prescribed several medicines for long term conditions or those living with frailty in their older years. While medicines remain the most common intervention in the NHS, helping countless patients live longer, healthier lives, the risks of polypharmacy (taking ten or more medicines at once) increase significantly as people age.

National data shows that more than 800,000 patients over 65 are currently prescribed ten or more medicines. Without action, that number could rise by over 400,000 more patients by 2035, contributing to an additional 77,000 unplanned hospital admissions.

A small group of dedicated professionals based across Hampshire, the Isle of Wight and Dorset knew that this issue had to be tackled. With the support of the national Health Innovation Network, they developed, delivered and tested innovative training to support GPs, pharmacists and frailty nurses and others to review patients, over the age of 65 years old, taking ten or more medicines and, where appropriate, confidently deprescribe. This training has been scaled up across the country.

What do the experts say?

"If we just keep adding medicines, and never subtracting, we will just multiply the problems. Patients, especially older and frail ones, on lots of medicines need a regular 'Medicines MOT' with a health professional in primary care that they trust. This should ensure that any Polypharmacy is working for them at that time of their life, taking onboard their personal health views & expectations, and that the potential benefits of their current combination of medicines is maximised, and the potential harms minimised." Steven Williams, Lead Clinical Pharmacist Poole Bay and Bournemouth Primary Care Network and Honorary Clinical Lecturer University of Manchester Pharmacy School

Clare Howard, Clinical Lead Health Innovation Network National Polypharmacy Programme and Clinical Lead for Medicines at Health Innovation Wessex, agrees. “Our work with local clinicians was then taken up as a national programme over the last three years. We are now starting to see some of the benefits in terms of more people coming forward for their Structured Medication Review and more clinicians feeling better able to carry out this sometimes complex work. As patients get older, they are likely to be exposed to more medicines, but my hope is that they feel able to discuss any concerns with a Clinical Pharmacist, who are now working in almost all GP practices in England or their GP.”

Nicola Bent, Chief Executive Officer at Health innovation Wessex has praised the impact of the polypharmacy programme, saying,“The need to tackle the potential harm for people taking multiple medicines is clear from the prescribing data we developed here in our region. That’s why Health Innovation Wessex supported the development, delivery and evaluation of the Polypharmacy Action Learning Sets to support clinicians across England to carry out Structured Medication Reviews with their patients more confidently and safely."

The importance of innovation in health and care

Innovations to improve health aren’t always a fancy gadget to produce quick results; some innovations take time to embed. Health professionals are used to prescribing medicines but taking patients off medicines (known as deprescribing) can be more challenging.

The training to help health and care professionals deprescribe medicines, known as the Polypharmacy Action Learning Sets, has spread from Wessex to national adoption across the NHS.

If you'd like to know more about this work, please contact our Medicines Optimisation team.