Improving the quality and safety of care: Supporting safe and effective use of medicines

Polypharmacy: getting the balance right

Challenge

In England, the NHS primary care system dispenses over 1 billion prescription items every year. Medicines are intended to help patients, but they can also cause harm.

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.

Approach

We are leading the Health Innovation Network’s national Polypharmacy programme. This aligns with recommendations such as the National Overprescribing Review (2021), which identified overprescribing had increased dramatically in 25 years.

We are supporting local systems to reduce problematic polypharmacy through three pillars of activity:

1. using data to support population health management to identify patients at potential risk and prioritise them for a Structured Medication Review.
2. supporting the workforce by providing national and local Action Learning Sets and bespoke training sessions to improve confidence in stopping unnecessary medicines.
3. focusing on public behaviour change, supporting patients to consider their prescribed medications and encouraging conversations with healthcare professionals.

This year we have funded pilots focused on improving access to Structured Medication Reviews for patients in seldom-heard communities, particularly those living in areas of high deprivation and from ethnic minority groups. The insights report will be published in summer 2025.

Result

So far, nearly 6,000 GPs, pharmacists and healthcare professionals around the country have attended our education and training sessions, including over 600 practitioners here in the West of England. Nationally, 123 polypharmacy communities of practice are sharing best practice and learning.

In February 2025 we published a “game changing” guide for tackling overprescribing and problematic polypharmacy, which has been extremely well received by prescribing and primary care colleagues across the country.

All 42 of England’s integrated care boards (ICBs) have engaged with some or all elements of the programme.

Encouragingly, 21 ICBs are now showing evidence of a decline or ‘flattening of the line’ in one or more of the NHSBSA polypharmacy prescribing comparators. These indicate how many patients are on eight, 10, 15 and 20 or more medicines.

You can read more about the Health Innovation Network’s national Polypharmacy programme here.

Reducing harm from high-risk opioids

Challenge

There are over one million people in England taking high-risk opioids.

There is no evidence for the efficacy of high dose opioids (over 120mg a day of morphine or equivalent) on long-term pain. Furthermore, the Faculty of Pain Medicine warns that increasing opioids above this dose exposes patients to increased harm.

Approach

As part of the NHS Medicines Safety Improvement Programme, we are encouraging a reduction in the prescribing of high-risk opioids for non-cancer chronic pain. We have supported our local systems to move away from the medical model of prescribing towards a biopsychosocial model, including supported self-management.

Over the last two years, we have provided 155 colleagues with access to the Ten Footsteps to Living Well with Pain programme, helping practitioners to developing confidence in pain self-management and regain control of their lives. Many of these have gone on to group facilitation training, leading to the development of six new pain cafes and groups in the West of England.

Results

Modelling shows that by taking this biopsychosocial approach, we have saved around 17 lives by reducing the use of high-risk opioids use, while the risk of opioid-related deaths has been halved for around 487 people.

The skills developed through this programme are now being utilised to develop groups and wider service improvements related to other chronic health conditions, particularly around tackling health inequalities issues such as unconscious bias and inaccessibility of services.

You can read more about the national NHS Medicines Safety Improvement Programme here.