Deprescribing: The pharmacists' role in stopping inappropriate medications

Drug shortages, supply issues, polypharmacy, and the rising cost of medicines are combining to make deprescribing a more pressing issue than ever before. Saša Janković reports

Many patients across the UK are taking medications they started on years ago that they no longer need, or for which the guidelines and evidence have since changed. Not only may these medicines no longer be appropriate, they can cause potential harms such as dependence, tolerance, risk of falls and cognitive impairment – with many patients having further medications added to their regimen on top of these.

Overprescribing is a complex problem driven by many factors, and with a range of consequences. According to The Department of Health and Social Care’s (DHSC) National Overprescribing Review, 8.4 million patients regularly take five or more medicines, with one in five hospital admissions in patients aged over-65 resulting from adverse drug effects.

One in five hospital admissions in patients aged over-65 result from adverse drug effects

DHSC data shows that 10% of prescriptions in primary care are inappropriate, with alternative treatments often better for a patient’s needs and preferences – a situation that Sarah Trust, lead pharmacist at Deans and Central Brighton PCN, says she sees on a regular basis.

‘For me the massive issues around overprescribing are not sharing with patients the outcomes expected [from their medicines] or the side-effects that they need to worry about ‘, she says. ‘For example, I did an opiate reduction consultation for a patient on the fentanyl patch, and he said he would never have taken it if he'd realised it was linked to heroin.’

Polypharmacy and overprescribing

In its report on Understanding polypharmacy, overprescribing and deprescribing, the NHS Specialist Pharmacy Service (SPS) says tackling overprescribing requires a system-wide approach requiring collaboration, support and behaviour change from clinicians, patients and their carers – and Noel Wicks, community pharmacist and owner of the Right Medicine Pharmacy chain of independent pharmacies, and adviser to OTC opioid-free pain relief medicine Combogesic, agrees.

When addressing overprescribing and optimising patient care, there needs to be a joined-up, multidisciplinary approach

‘When addressing overprescribing and optimising patient care, there needs to be a joined-up, multidisciplinary approach, involving the pharmacist, GP and any other relevant healthcare professionals ‘, says Mr Wicks, ‘with areas of intervention to consider include deprescribing, medicines reconciliation, reviews and repeat prescribing; inappropriate or problematic polypharmacy; social prescribing; reducing medication waste and errors; and self-management plans. ‘

Deprescribing

Nonetheless, deprescribing is a complex process of tapering, stopping, discontinuing, or withdrawing of medications that are no longer appropriate, beneficial or wanted.

The National Overprescribing Review and the BNF’s medicines optimisation advice highlight deprescribing as essential for reducing inappropriate polypharmacy, particularly for older patients at risk of medication-related harm, and Mr Wicks says there are several key policies and incentives to deprescribe, including:

• Polypharmacy Guidance 2026-2029: The updated national guidance promotes a 7-step medication review process, focusing on person-centred care to safely reduce or stop medications
• National Overprescribing Review: This 2021 initiative directs more resources into primary care to address overprescribing, targeting medicines associated with dependency, such as opioids and antidepressants
• Quality and Outcomes Framework (QOF) 2026/27: The 2026/27 GP contract introduces new incentives to improve the ‘appropriateness ‘ of prescriptions

Structured Medicine Reviews

In addition, integrated care boards (ICBs) and primary care networks (PCNs) are required to deliver structured medication reviews (SMRs), specifically targeting patients with complex needs or frailty, often leading to deprescribing.

The SMR framework follows a seven-step process, adapted from established polypharmacy, multimorbidity and frailty guidelines:

1 Assess the patient to establish their perspective and priorities for their health and medicines and what’s important today.
2 Agree goals by clarifying and negotiating what the patient and you aim to achieve during this visit.
3 Identify potentially inappropriate medicines with potential risks.
4 Assess risks and benefits in the context of the person's situation and preferences.
5 Agree actions, whether to stop, reduce, continue, or start a medicine, and explain the rationale to the patient or carer.
6 Communicate with others, documenting recommendations and agreed actions and support needed from all relevant parties to ensure changes are implemented safely.
7 Monitor, review and adjust regularly, with clear accountability for who is responsible for implementing and managing the actions agreed at each step.

Deprescribing targets

Mr Wicks says that ‘all medicines should be considered as part of a SMR' and the NHS Long Term Plan (LTP) has identified the following key categories for medicines optimisation to reduce inappropriate prescribing:
a. Antimicrobials
b. Medicines that can cause dependency, such as opioids, z drugs, benzodiazepines, Gabapentin and Pregabalin
c. Higher-carbon inhalers
d. Nationally identified medicines of low priority

Ms Trust says, after opioids, her ‘top choices‘for deprescribing are‘antihypertensives for older patients, then allopurinol, and SSRIs are up there too.'

For Reshma Malde, pharmacist at John Bell & Croyden, the targets are: ‘Medications such as PPIs, laxatives, and antiemetics, which are prescribed for short term symptom control and should be reviewed to assess if they are still needed.'

A role for community pharmacy

A systematic review, published in 2021, concluded that community-based pharmacists can lead deprescribing interventions and are valuable partners in deprescribing collaborations, providing necessary monitoring throughout tapering and post-follow-up to ensure the success of an intervention.

Ms Trust agrees community pharmacist pay a valuable role by ‘flagging patients they think are abusing or misappropriating medication like opiates, monitoring patients for expected outcomes and letting us know when they don’t have them.‘

As of 2026, all newly qualified pharmacists will be independent prescribers, with a focus on clinical services and, by extension, the chance to reduce unnecessary hospital prescriptions. Ms Malde says GP practice pharmacists have already shown the benefits of this kind of oversight: ‘IPs working in their scope of practice in GP practices have definitely play a key role in reviewing patients' medications and deprescribing where necessary‘, and she also believes Pharmacy First and NHS 111 referrals have been ‘great touch points to pick up on medication issues or concerns and communicate this to GPs for follow up'.

Patient communication

When it comes to talking to patients about deprescribing, Ms Trust says one of the hurdles is that ‘when things have been prescribed it can be quite hard to justify taking them away, and this can sometimes be a really tough conversation to address with patients.'

In its 2025 polypharmacy report – The mechanics of tackling overprescribing and problematic polypharmacy – the Health Innovation Network sets out responsibilities for all primary care prescribers, whether prescribing or deprescribing, to ask patients what matters most to them; their ideas, concerns and expectations (ICE) of their medicines; and what medicines they are taking, and not taking. Prescribers should also commit to shared decisions before initiating a medicine (Start Well), continuing (Carry on Well) or stopping existing medicines (Finish Well) and tailor interventions to align with their patient’s goals and priorities.

Deprescribing shouldn’t be a one-off discussion with patients

Mr Wicks adds that ‘deprescribing shouldn’t be a one-off discussion with patients. In fact, ideally there will be ongoing communication. For instance, if a medicine that can cause dependency, such as an opioid, is prescribed for the first time, it makes sense to introduce the idea upfront that this is a medicine for short-term use only.'

Community pharmacists’ view

In general, Mr Wicks says community pharmacists view deprescribing as ‘a positive, patient-centred, and essential service for optimising medicine usage ‘, but since the process is complex ‘there are concerns over time constraints, lack of access to clinical records, and the need for closer collaboration with GPs.'

Ms Trust’s advice to community and practice pharmacists who want to get involved with deprescribing, is to ‘make friends and get to know the people that you can have an eye-to-eye chat with around the system. I welcome working with community pharmacists, and knowing each other makes things happen a lot smoother across the integrated care pathway and facilitates the easiest kind of care for patients by clinicians working at the highest level of competence.'