Embrace deprescribing and stay curious in complex cases, pharmacists told

Practice pharmacists should build deprescribing into routine care, an exclusive event has heard, with delegates encouraged to stay curious, listen to patients and ask the right questions when faced with complex prescribing decisions.

Lelly Oboh, consultant pharmacist for older people at Guy’s and St Thomas’ NHS Trust and overprescribing lead for South East London ICB, told delegates at the GP Pharmacy virtual event that problematic polypharmacy in patients with multimorbidity and frailty requires a shift in mindset to one that places patients, not medicines, at the centre of decision-making.

Speaking at The Pharmacist’s inaugural online event, Ms Oboh urged delegates to approach reviews with critical thinking and clinical courage.

‘Start thinking deprescribing, even if you don’t actually do the deprescribing,' she advised. 'Begin to ask those questions.’

Deprescribing, she said, is not just about stopping medicines, but also about recognising when treatments no longer serve the patient’s goals, function or safety.

Drawing on national guidance and real-world case studies, Ms Oboh emphasised that structured medication reviews (SMRs) should be seen as an ongoing process, not a single task.

‘The SMR is not a one-off,’ she explained. ‘Whatever we decide for this patient, somebody needs to keep an eye on them, because we don’t know if it’s going to work or how it’s going to turn out.’

Ms Oboh highlighted that definitions of overprescribing now explicitly include medicines that are unwanted by the patient or not aligned with their current needs – even if the drug has a valid clinical indication.

‘Even if there's an indication, if the patient doesn't want it, if it doesn't fit well with their goal, you're overprescribing,’ she argued.

She added: ‘Be curious. Look at the patient. Look at the medicines. Ask your patients to bring their medicines in, because they can tell you a better story sometimes than what you have on your computer list.’

Ms Oboh encouraged pharmacists to see deprescribing not as the sole preserve of specialists, but as a shared responsibility across the multidisciplinary team.

However, with their insight into how medicines are used in daily life, pharmacists are well placed to support person-centred care and contribute meaningfully to clinical decision-making.

‘You are the expert on the patient – because you see the patient,’ she told pharmacist delegates.

Ms Oboh acknowledged that clinicians often feel unsure about deprescribing when multiple conditions and therapeutic goals compete – such as prescribing for heart failure that may worsen incontinence or increase fall risk in frail patients.

Such therapeutic competition, along with prescribing cascades – when a new medicine is prescribed to treat the side effect of another drug – and guideline conflicts are all common challenges, but Ms Oboh insisted that they should not prevent action.

Instead, pharmacists should draw on their networks, consult other clinicians, and take steps collaboratively.

‘We can’t walk alone. Nobody is that clever,’ she added. ‘You need to find the clever people in your locality. It could be a clever GP, a clever pharmacist, your pharmacy network, geriatricians, cardiologists – whoever it is.’

Ms Oboh also discussed how frailty, more than age, should trigger review of long-term medications.

She suggested that many older patients are less concerned with long-term risk reduction than with quality of life, independence and avoiding side effects like dizziness, falls or fatigue.

‘Guidelines are helpful tools, but they’re not strict mandates,’ she said. ‘The balance for you as a practitioner is “how do I navigate this” – and the answer is, you can’t do it on your own.’

She urged pharmacists to use available resources – such as risk assessment tools and shared decision-making aids – and to document reviews clearly so that other professionals can follow the patient’s evolving treatment journey.

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‘Prescribe with deprescribing in mind,’ she concluded. ‘This is not about perfection. It’s about prioritising what’s safe, realistic and right for each patient.’

The free-to-attend GP Pharmacy event was held on Tuesday 24 June and also heard about the opportunity to practice pharmacists to expand their clinical role in managing ADHD, particularly through SMRs and shared care.

The event also heard a warning from a consultant pharmacist about the risks to patients when obtaining weight loss jabs online.