Insight · Polypharmacy
Insight — polypharmacy in the over-75s — a programme that actually works.
Why over-75s, why now.
Over-75s account for a disproportionate share of medicines-related hospital admissions, falls and avoidable harm. Many are on medicines that were started years ago for a condition that has resolved, or whose risk-benefit profile has shifted with age, frailty and changing renal function. Deprescribing safely requires time, expertise and a willingness to have an honest conversation with the patient or family — none of which fits easily into a ten-minute appointment. A pharmacist-led programme builds that time and expertise into the network.
Programme cohort
Where the polypharmacy programme starts.
- All registered patients aged 75+ on 10 or more regular medicines
- Patients with documented frailty coding
- Care home residents
- Patients with recent falls or admissions
- Patients with high anticholinergic burden
- Patients on long-term opioids, benzodiazepines or gabapentinoids
How the programme runs
A working PCN polypharmacy operating model.
The most effective polypharmacy programmes we run combine technician-led cohort identification with pharmacist-led structured medication reviews and clear GP sign-off for any change outside the pharmacist's independent prescribing scope. The clinical pattern is consistent: anticholinergic burden review first, then high-risk drug combinations, then symptomatic burden, then deprescribing conversations with the patient and family. Each review takes around 60 to 90 minutes of pharmacist time and produces a documented plan that the patient and GP both see.
- Technician-led cohort identification and recall
- Pharmacist-led structured review
- Anticholinergic burden scoring before and after
- Family or carer involvement where appropriate
- GP sign-off for changes outside IP scope
- Six-month follow-up review
The conversation matters as much as the chart.
Deprescribing only works if the patient and family understand why. Pharmacists in our programmes are trained to have the polypharmacy conversation properly — what the medicine is for, why it might no longer be needed, what to look out for if symptoms recur, and how the change will be reviewed. Patients and families overwhelmingly respond positively to this; the most common feedback is that nobody has previously had the time to explain why they were on the medicines they had accumulated over decades.
What the programme produces.
A mature polypharmacy programme typically reduces the average medicine count in the reviewed cohort by two to three regular medicines per patient, with measurable reductions in anticholinergic burden, improvement in QOF cardiovascular and diabetes achievement, and a reduction in falls-related contacts over the following twelve months. PCNs that run the programme consistently see a meaningful drop in repeat prescription volume, which feeds back into reduced GP workload and reduced ICB prescribing spend.
Evidence base
What to track for every patient.
- Medicines count before and after
- Anticholinergic burden score before and after
- Deprescribing actions taken with rationale
- Patient-reported outcome
- Follow-up review date
- QOF and IIF indicator linkages
FAQs — polypharmacy programmes.
How many over-75s should we plan to review per year?+
A typical full-time pharmacist with technician support reviews 600 to 1,000 patients per year, depending on complexity and care home loading.
Do GPs need to sign off every change?+
No — changes within the pharmacist's IP scope are made by the pharmacist with documented rationale. Out-of-scope changes are signed off by the GP.
How do families respond?+
Overwhelmingly positively, especially when the conversation is framed around safety and quality of life.
How is this evidenced for the DES?+
Polypharmacy reviews count as SMRs in the DES framework and are reported monthly against the PCN's SMR target.
Talk to BCS.
If you'd like to walk through what this would look like for your PCN specifically, talk to our Service Development team. We'll cost a plan against your remaining ARRS allocation and your existing pharmacy workforce, and have a written proposal back within a week.
Talk to our Service Development team
30-minute discovery call. We'll show you how BCS maps to your PCN's specific priorities.