Tackling Overprescribing

Why Overprescribing Matters

Overprescribing is a growing concern in healthcare, particularly when patients are prescribed multiple medications that may no longer be necessary or beneficial. This can lead to:
•    Increased risk of adverse effects and falls
•    Higher rates of hospital admissions
•    Unnecessary strain on GP practices
•    Medication waste and environmental impact
By addressing overprescribing, we aim to improve patient safety, reduce waste, and support more sustainable healthcare practices.

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Our Approach

We are actively working with our GP practices to identify and reduce overprescribing. This includes:

  • Reviewing patients on multiple or high-risk medications
  • Focusing on vulnerable groups, such as those over 75 on 10+ medications
  • Focusing on particular medications or combinations of medicines known to be at a higher risk of causing problems for patients https://www.hantsiow.icb.nhs.uk/your-health/medicines-optimisation/information-patients/my-medicines/medicines-waste
  • Empowering patients to manage their own health, and encourage them to ask their GP or pharmacist if they would like to discuss their medication
  • Promoting the “Only Order What You Need” campaign to reduce medicine stockpiling

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In 2021 DHSC published: Good for you, good for us, good for everybody: a plan to reduce overprescribing to make patient care better and safer, support the NHS, and reduce carbon emissions 

The Health Innovation Network have developed this helpful guide: The mechanics of tackling overprescribing and problematic polypharmacy
 

What is an SMR?
A Structured Medication Review (SMR) is a comprehensive, person-centred review of a patient’s medications. SMRs are the best tested intervention for reducing problematic polypharmacy, go beyond a basic check list and involves:
•    Reviewing treatment goals
•    Assessing the benefits and risks of each medication
•    Reducing harm and unnecessary prescribing
•    Engaging patients in shared decision-making

Quality statement 1: Shared decision making | Medicines optimisation | Quality standards | NICE

Who Should Receive an SMR?
SMRs are especially beneficial for:
•    Patients over 75 on 10 or more medications
•    Residents in care homes
•    Patients on high-dose opioids or other high-risk medicines
•    Patients experiencing side effects from their medication
•    Patients struggling to manage their medication, or who have a large supply of unused medication

Who Can Conduct SMRs?
SMRs should be carried out by qualified healthcare professionals who are independent prescribers, such as:
•    GPs
•    Advanced Nurse Practitioners (ANPs)
•    Pharmacists on the Primary Care Pharmacy Education Pathway (PCPEP) Primary care pharmacy education pathway : CPPE

Pharmacy technicians and non-prescribing pharmacists can support the process but cannot conduct or clinically code SMRs independently within the patients’ electronic notes. 

If you have any questions about who can conduct an SMR, please contact the medicines optimisation team.

Conducting targeted SMRs is a key responsibility of pharmacists employed by Primary Care Networks as part of the Additional Roles Re-imbursement Scheme (ARRS): NHS England » Network Contract DES: Contract specification 2025/26 – PCN requirements and entitlements

Recording SMRs Accurately
To ensure accurate data and recognition of work:
•    Use the correct SNOMED codes for SMRs:
 

Description abbreviated Description full SNOMED Code SystmOne CTV3 Code
SMR SMR structured medication review (procedure) 1239511000000100 Y282b
SMR declined Invitation for structured medication review declined (situation) 1363191000000100 Y35da

The first code above must only be used when a full SMR has been undertaken i.e. it must not be used for any other type of medicine review.

•    Use the Ardens template, which includes the appropriate coding

Continuous Improvement – support for GP practices
We’re reviewing SMR data quarterly to reflect the hard work being done across practices. If your data seems inaccurate, it may be due to incorrect coding or system setup — we’re here to help you get it right. You can contact the medicines optimisation team here: Contact the Medicines Optimisation team :: NHS Hampshire and Isle of Wight

The Health Innovation Network has developed a range of evidenced-based resources to support and help prepare people invited for a Structured Medication Review (SMR) with their GP, pharmacist or other healthcare professional. These resources are available in 12 different languages and are available here: Patient Information Resources - The Health Innovation Network and here: Medication review :: NHS Hampshire and Isle of Wight


We’ve partnered with the Wessex Health Innovation Network to streamline the RPS Repeat Prescribing Toolkit, making it easier for practices to identify areas for improvement. A shortened version of the toolkit is available to help teams assess their current processes and implement changes collaboratively.

If you would like a Word version of the toolkit, please contact the medicines optimisation team.

How to utilise the toolkit:

•    Set up a small working group in your practice to review the toolkit
•    Attend our upcoming webinars for practical guidance – Microsoft Virtual Events Powered by Teams or Microsoft Virtual Events Powered by Teams
•    Encourage patients to speak with pharmacists if they have concerns about their medications
•    Ask the medicines optimisation team if you are looking for support on where to start

The full version of the toolkit can be found here: Repeat Prescribing Toolkit

If you would like to look at your own practice data to identify areas of oversupply, you can do so here: Oracle Analytics Interactive Dashboards - Oversupply Dashboard (ePACT2 log-in required)

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