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 Health Innovation Network national polypharmacy programme is creating clinical, multi-stakeholder communities of practice across England, 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. See dates for forthcoming webinars and book your place here.

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. Get details of our upcoming ALS cohorts and book your place here.

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 Health Innovation 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 Health Innovation Network is not responsible for the content on those sites.

Nurse smiling with patient

Briefings:

In the news: 

On our blog: 

Masterclass:

Meet the team: 

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 Health Innovation 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.

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 through to June 2024. Find out more and book here.

Read our ‘state of the nation’ report, showcasing the learning from our Action Learning Sets and providing recommendations for change.

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.

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.”

Polypharmacy Action Learning Sets

Date(s): Multiple dates, June 2024 – February 2025
Location: Online
Organised by: The Health Innovation Network
Email:healthinnowest.polypharmacyprogramme@nhs.net

Event summary

The Health Innovation Network National Polypharmacy Programme: Getting the balance right invites GPs and prescribers with a minimum of 12 months’ experience to join our Polypharmacy Action Learning Sets (ALS). The Polypharmacy ALS is an evidence-based learning model developed by Wessex Health Innovation Network in partnership with Health Education England.

The aim is to help 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 ALS will also help primary care networks (PCNs) deliver the Medicines Optimisation elements of the Directed Enhanced Services and Investment and Impact Fund contracts and meet recommendation 18 of the National Overprescribing Review report.

This online interactive course is held over three half-days (9.30am – 12.15pm) over one month on Zoom. Multiple cohorts are being set up over the year ahead. Book your place on your preferred dates below.

The programme

  • Session 1: Polypharmacy – the scale, impact and challenges around stopping medicines safely. We will define inappropriate medicines and look at the patient perspective.
  • Session 2: What tools are available to help? We will explore shared decision-making, the evidence and tools to help conduct high-quality medication reviews.
  • Session 3: Workshop and facilitated discussions with consultant geriatricians to share experience of medication reviews and consolidate learning.

Book via the below links:

Polypharmacy: understanding the data webinars

Date(s): Multiple dates, April – January 2025
Location: Online
Organised by: The Health Innovation Network
Email:healthinnowest.polypharmacyprogramme@nhs.net

Event summary

The Health Innovation Network Polypharmacy: Getting the Balance Right Programme aims to support local systems and primary care to identify patients at potential risk of harm and support better conversations about medicines by promoting shared decision-making. One of the core principles of this is population health management.

To consider how best to understand and utilise available data, the Health Innovation Network and NHS Business Services Authority (BSA) are hosting a series of webinars with dates through to September 2024.

What will I learn?

The event will share information and insights into how the NHS BSA polypharmacy prescribing comparators can:

  • Support primary care and wider health systems understand the variation in prescribing of multiple medicines
  • Identify patients who are more likely to be exposed to the risks that can be associated with taking large numbers of medicines or certain combinations of medicines.

The webinars will be introduced by Clare Howard, Chair of the Polypharmacy Prescribing Comparators Group and Medicines Optimisation Clinical Lead for HI Wessex.

The programme

12:00 – Introduction to the NHS BSA Polypharmacy prescribing comparators, Clare Howard, Medicines Optimisation Lead, Health Innovation Wessex

12:30 – Live demonstration of how to access and use the NHS BSA Polypharmacy prescribing comparators, Ben Baker, Customer Engagement and Training Lead, NHS BSA

13:00 – Q&A

13:30 – Webinar end

Who should attend

We encourage attendance from Health Innovation Network nominated polypharmacy and clinical leads, ICS medicines optimisation leads and Primary Care Network (PCN) teams, including GPs and pharmacists.

Book via the below links:

Polypharmacy: Supporting patients to get the most out of their Structured Medication Review. Launch of patient facing resources.

Date(s): 16 July 2024, 12-1pm
Location: Online
Organised by: The Health Innovation Network
Email:healthinnowest.polypharmacyprogramme@nhs.net

Event summary

The Health Innovation Network Polypharmacy: Getting the Balance Right Programme aims to support local systems and primary care to identify patients at potential risk of harm and support better conversations about medicines by promoting shared decision making.

Research has shown that patients may not understand the purpose of a Structured Medication Review (SMR) and so may not attend or may not be prepared for the consultation.

Join our webinar to find out how the HIN Polypharmacy Patient Resources can be used to support patients to get the most out of their SMRs:

  • Developed with patients and translated into a number of languages, hear how PCNs are using these materials to help their patients to engage better with the SMR process.
  • Hear from national speakers about how this work helps us to address health inequalities and problematic polypharmacy.
  • Understand how our work with Leeds and Bradford Universities led to the development of this suite of resources to help patients to get the most from their SMR.
  • Hear from Graham Prestwich, patient and founder of Me and My Medicines on why we need better conversations between clinician’s and patients about medicines.

Guest Speakers

  • Dr Aoife Molloy, Senior Clinical Advisor Health inequalities Improvement, NHS England
  • Sarah Hafeez, Advanced Medicines Optimisation Pharmacist, NHS Greater Manchester Integrated Care
  • Bhavika Lad, PCN Pharmacy Manager, Nottingham City General Practice Alliance
  • Graham Prestwich, patient and founder of Me and My Medicines

Who should attend?

All prescribers including GPs, PCN / Community Pharmacists, Frailty and Complex Care Teams, Social Prescribers, Health and Wellbeing Coaches, ICB colleagues and commissioners. Colleagues from academia, secondary care or the voluntary and Third sectors interested in addressing problematic polypharmacy and shared decision making.

Book your free place.

Polypharmacy: medicines and the risk of falls in older people lunchtime masterclass

Date(s): 10 October 2024, 12-1:30pm
Location: Online
Organised by: The Health Innovation Network
Email:healthinnowest.polypharmacyprogramme@nhs.net 

Event summary

The Health Innovation Network Polypharmacy: Getting the Balance Right Programme aims to support local systems and primary care to identify patients at potential risk of harm and support better conversations about medicines by promoting shared decision making.

Falls are a frailty syndrome and a common presenting complaint for older patients attending healthcare facilities. They can cause injury, pain, distress, loss of confidence, loss of independence and increase mortality. Around 1 in 3 adults over 65 years and half of people over 80 years of age will have at least one fall per year. As well as the human cost, falls are estimated to cost the NHS more than £2.3billion per year. Medicines are a common precipitating or contributory factor to falls and medication review alongside multifactorial assessment can reduce risk of falls.

What will you learn?

  • The importance of medication in falls causation.
  • How medication reviews can reduce the risk of falls.
  • Information and guidance that can be used when conducting a falls related medication review.

Our Guest Speakers are Ðula Alićehajić-Bečić, Consultant Pharmacist Frailty, Wigan and Leigh NHS Foundation Trust and Heather Smith, Consultant Pharmacist Older People, NHS West Yorkshire Integrated Care Board.

The masterclass will also include a Q&A session.

Who should attend?

Our Polypharmacy Masterclass Series is open to GPs, Pharmacists, Nurse prescribers and other interested health professionals.

Book your free place.

Polypharmacy and health inequalities lunchtime masterclass

Date(s): 5 November 2024, 12-1:30pm
Location: Online
Organised by: The Health Innovation Network
Email:healthinnowest.polypharmacyprogramme@nhs.net 

Event summary

The Health Innovation Network Polypharmacy: Getting the Balance Right Programme aims to support local systems and primary care to identify patients at potential risk of harm and support better conversations about medicines by promoting shared decision making.

We know that patients from more deprived areas experience more polypharmacy and may be at greater risk of harm from it.

In this masterclass we will hear from Prof Adam Todd who has led a number of studies looking at a polypharmacy and health inequalities.

We will also hear from Pharmacist Magnus Hird who will describe some of the ways his PCN have tackled the dual challenges of polypharmacy and health inequalities.

What will you learn?

  • How to address problematic polypharmacy in areas of high deprivation.
  • What the evidence tells us about polypharmacy and inequalities.

The masterclass will also include a Q&A session.

Who should attend?

Our Polypharmacy Masterclass Series is open to GPs, Pharmacists, Nurse prescribers and other interested health professionals.

Book your free place.

National enquiry

To find out more about any of our national programmes, please complete this form.

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