New “game changing” guide to tackle overprescribing and support Government’s shifts to prevention and community

A new guide aimed at helping primary care organisations and integrated care boards understand and address problematic polypharmacy has been launched by the Health Innovation Network as part of its national Polypharmacy Programme. 

Developed in response to a clear need identified by primary care and prescribing colleagues, this essential resource provides practical, evidence-based strategies to help organisations and healthcare professionals help to reduce overprescribing and improve patient outcomes.

With the government and the NHS prioritising prevention and moving care from hospitals to communities, tackling polypharmacy is a key approach to encouraging safer, more effective medication use, especially in our older population.

The new guide offers simple yet impactful solutions to optimise prescribing practices, supporting integrated care boards (ICBs), primary care networks (PCNs) and GP practices in organising their teams and improving the quality of structured medication reviews.

Professor Tony Avery, National Clinical Director for Prescribing for NHS England, said: 

“I’m delighted to welcome the publication of this guide, which I believe is a vital tool in addressing the important challenge of problematic polypharmacy. Tackling this complex topic can sometimes feel overwhelming, and this guide offers healthcare professionals structured approaches to ensure that medicines are being used effectively and safely, aligning with patient goals and reducing unnecessary prescriptions.”

The publication draws on insights from frontline healthcare professionals who have participated in Health Innovation Network Polypharmacy Action Learning Sets over the last two years. It also features contributions from leading experts, including clinical pharmacists, general practitioners, and patient representatives, ensuring the guidance is both practical and informed by real-world experience.

The growing challenge of polypharmacy

• In England, over 1 billion items are prescribed every year in primary care and over 1 million people in this country take 10 or more medicines for their long-term conditions1. Almost half of these patients are aged 75 and over.
• Taking 10 or more medicines, especially in later life, increases the risk of medication-related harm2.
• Problematic polypharmacy affects millions of people across England, contributing to hospital admissions and avoidable adverse drug reactions. 
• 16.5% of unplanned hospital admissions in adults are due to adverse drug reactions, with polypharmacy being a major driver. One study estimates the annual cost of this to the NHS in England as £2.21 billion3. 
• As more people live longer with multiple long-term conditions, this issue is a real and growing challenge for the NHS.
• Supporting patients to explore their use of multiple medicines with their healthcare professionals will support the shift to a more preventative, holistic and community-based model of care.

Key highlights from the guide

• A systematic approach to identifying and addressing overprescribing.
• Strategies for conducting structured medication reviews, particularly for older patients and people living with multiple long-term conditions.
• Tools for measuring success, including dashboards for tracking prescribing trends and patient outcomes.
• Case studies showcasing successful interventions and their impact on patient care.

Called ‘The Mechanics of Tackling Overprescribing and Problematic Polypharmacy’, the guide is available to download from the Health Innovation Network’s website. 

As most people can relate to the experience of purchasing, running and maintaining a car, the authors use the analogy of the patient as driver, with their body as the car and the prescriber as the mechanic. This analogy tries to bring to life the nuts and bolts of overprescribing stewardship.

Graham Prestwich, Patient, Innovator and Founder of Me and My Medicines, said:

"Being told that you should now stop taking a medicine that you have been regularly ordering, storing safely and remembering to take every day for years, regardless of the circumstances, is a lot to come to terms with. Unwittingly confusing the unwanted effects of a medicine with symptoms of one’s disease is easy to do and this may contribute to problems not being addressed. 

“I for one am very pleased to see this approach to helping more people take the medicines they need and benefit from and to stop taking anything that is now causing more harm than good. I hope there will be a concerted and coordinated local effort to implement this widely and effectively to improve the health and wellbeing of a great many people."

Lelly Oboh, Clinical Care and Professional Lead for Overprescribing at NHS South East London said:

"This resource is a game-changer for clinicians tackling problematic polypharmacy or overprescribing, offering a practical and accessible guide to structured medication reviews. With practical tools, insightful tips, relatable metaphors and real-world case examples, it is designed to make patient-centred care straightforward and achievable in the process. 

“Whether you’re looking for a quick overview or a deep dive into specific areas, this visually appealing and well-organised guide will equip patients, commissioners or anyone passionate about tackling overprescribing with the knowledge and inspiration they need."

Tom Gentry, Joint Head of Health Influencing at Age UK, said: 

“As we get older, we are much more likely to be on multiple medicines and other treatments, particularly when living with frailty. Getting medicines right for older people is one of the best ways to improve everyday health and wellbeing, optimising what they are taking and hopefully reducing the medicines burden wherever possible.

“This excellent guide could help clinicians and commissioners alike to start making lasting change to medicines management and reducing problematic polypharmacy. Driven by evidence and focused on people and patients, we hope ICBs can translate this guide into an everyday reality for older people’s care.”

Neil Hardy, Chief Pharmacist for NHS Hampshire and Isle of Wight, said:

“The Health Innovation Network’s problematic polypharmacy manual brings together all the evidence, why it is so important to patients, and how to address this vital topic in one, easy-to-use document. I think this is an essential resource for all clinicians working in primary care, as well as commissioners of those services.”

Healthcare professionals are encouraged to use this resource to enhance their approach to medication management and help drive forward the NHS’s prevention agenda.

To download the guide, visit the Health Innovation Network website.

Find out about the polypharmacy programme overview and the polypharmacy masterclasses happening in Wessex.