As part of the AHSN Polypharmacy Programme: getting the balance right <we/name of AHSN> are supporting health care professionals to identify patients at potential risk from polypharmacy and to support better conversations about medicines.

 

What is the problem we’re addressing?

We dispense over 1 billion prescription items per year in primary care in England.

Polypharmacy simply means many medicines. As more people live longer with multiple long-term conditions, the number of medicines they often take increases. This can have a significant burden on the person managing and trying to adhere to multiple medicines regimes and can also be harmful.

Studies have shown that that over 50% of older people are prescribed a medicine with more harm than benefit, leading to avoidable morbidity, hospitalisation and mortality. In England in February 2022 there were 876,317 people on 10 or more medicines and 349,653 were 75 or over. A person taking 10 or more medicines is 300% more likely to be admitted to hospital.  Polypharmacy adds preventable cost to the healthcare system and diminishes quality of care for the patient. The most deprived areas tend to have the most issues around polypharmacy, also making this a health inequality issue.

Most of the harm from polypharmacy is preventable.

 

The National Overprescribing Review (NOR) Good for you, good for us, good for everybody (September 2021) led by Dr Keith Ridge, former Chief Pharmaceutical Officer for England, found that overprescribing is a serious problem in health systems internationally that has grown dramatically over the last 25 years. It identifies two main causes: systemic and cultural. The response to the NOR report is now an NHS England programme.

The NOR sets out 20 cross-system recommendations to be led by a range of NHS and affiliate organisations – the Polypharmacy programme directly supports the delivery, and potential acceleration, of recommendations 8, 16, 17 and 18 into operational practice.

 

What are the outcomes we are trying to achieve?

Successful delivery of the programme within the Kent Surrey Sussex AHSN region will result in:

  • A regional Polypharmacy Community of Practice, with members working to address the system-wide challenges of problematic polypharmacy in our geography.
  • Routine use of the NHSBSA Polypharmacy Prescribing Comparators to identify and prioritise patients for a shared decision-making Structured Medication Review.
  • Increased confidence amongst the region’s primary care prescribing workforce to safely stop medicines identified to be inappropriate or unnecessary.
  • A change in patient expectations – to anticipate having a shared decision-making conversation about their medicines regularly, especially as they get older.
  • A contribution to the evidence base around how to help patients to feel more empowered to open up about their medicines issues.
  • A contribution to the evidence base around how to tackle problematic polypharmacy.

 

How will we do this?

 

The programme is based across three pillars which are supported by a Kent Surrey Sussex AHSN Community of Practice:

 

Pillar 1: Population Health Management

Using data (NHSBSA polypharmacy prescribing comparators) to understand population health risks and support prioritisation of patients for a structured medication review.

Pillar 2: Education & Training

Investing in clinical leaders – AHSN Polypharmacy Clinical Leads and expert Polypharmacy Trainers and delivery of local Polypharmacy Action Learning Sets (ALSs) to upskill the primary care workforce to be more confident about stopping unnecessary medicines. The ALS model was originally developed and piloted by Wessex AHSN and supported by Health Education England (HEE).

 

Pillar 3: Public Behaviour Change

Local testing and evaluation of public-facing initiatives to change public perceptions of prescribing and encourage patients to open up about medicine concerns and expectations.

 

Resources  

Polypharmacy: understanding the data webinar recording

The national Polypharmacy programme is establishing communities of practice around the country to identify local priorities and encourage routine use of the NHSBSA Polypharmacy Comparators to assess patients in high-risk groups. The NHSBSA Polypharmacy Prescribing Comparators tool is available to all GPs and pharmacists. Watch a recording of the April 2022 webinar.

 

Additional resources and information are available from the AHSN Network’s Polypharmacy webpage.

 

Events

The AHSN Polypharmacy Programme is helping primary care colleagues tackle potential harm from multiple medications through improved use of data, education and training, and public behaviour change. We are supporting the education and training by setting up a Community of Practice.

Community of Practice (CoP) cultivates change through collaboration. It is self organising, self-governing cross-professional and cross-organisational offering potential to reduce fragmentation of practice. The issues discussed are typically complex and beyond the scope of any individual, profession or organisation.

This is a network of key stakeholders that will meet regularly to support the delivery of this national programme, but also foster a culture of engagement, collaboration, learning and innovation to reduce problematic polypharmacy for their populations most at risk from harm.

We will be launching three Communities of Practice in the coming months, which will meet online. These events are free, for GPs, pharmacists, geriatricians, nurses, AHPs and anyone with an interest in tackling polypharmacy.

  • Surrey Heartlands Community of Practice, on Tuesday 13 September, from 12-2pm. Book via Eventbrite.
  • Sussex Community of Practice, on Wednesday 28 September, from 12-2pm. Book via Eventbrite.
  • Kent Community of Practice, Date TBC. Booking details to follow.

 

Contact

 If you have any questions about our local Polypharmacy programme, please contact Hinal Patel, Programme Manager – Medicine Optimisation on hinal.patel13@nhs.net

If you have any questions about the national Polypharmacy programme, please contact Amy Semple, Programme Manager: a.semple@nhs.net (West of England AHSN).