Cluster page — medicines optimisation
Deprescribing in primary care
Why deprescribing matters
Deprescribing is a clinical intervention, not a cost-saving exercise
Deprescribing is the planned, supervised dose reduction or cessation of medicines where harm exceeds benefit, where the original indication has resolved, or where the patient's goals of care have changed. It is the most evidence-based intervention available to a PCN clinical pharmacist working in the over-75, frailty or care home cohorts — and it produces measurable outcomes across falls reduction, cognitive function, treatment burden and prescribing cost.
Done well, deprescribing is patient-centred, framed positively, and uses validated tapering schedules and monitoring plans. Done badly — as a rushed, cost-driven stop without patient conversation — it generates complaints, relapses and reputational risk. This page describes the framework primary care pharmacists use and the medicine classes that account for most deprescribing activity.
High-priority deprescribing targets
Where the evidence base is strongest
- Long-term PPIs without ongoing GORD or ulcer-prophylaxis indication
- Opioids in chronic non-cancer pain (Faculty of Pain Medicine guidance)
- Benzodiazepines and Z-drugs in older adults (>4 weeks use)
- Antipsychotics in BPSD beyond 12 weeks (NICE NG97)
- Anticholinergics where ACB score ≥3 in older adults
- Statins in advanced frailty, limited life expectancy or palliative care
- Antihypertensives where SBP has fallen <120 mmHg post-frailty progression
- Bisphosphonates beyond 5 years without re-evaluation
Deprescribing impact
What good deprescribing delivers
Frequently asked questions
Deprescribing — FAQs
What is deprescribing?+
The planned, supervised process of dose reduction or stopping of medicines that may be causing harm or no longer providing benefit, with the goal of improving outcomes. It is a positive clinical intervention, not 'taking medicines away'.
Which medicines are deprescribed most often in primary care?+
PPIs (long-term use without ongoing indication), opioids in chronic non-cancer pain, benzodiazepines and Z-drugs, antipsychotics in BPSD, anticholinergics, statins in advanced frailty or limited life expectancy, and antihypertensives where blood pressure has drifted low post-frailty progression.
What deprescribing frameworks do primary care pharmacists use?+
STOPP/START, the NHS Scotland Polypharmacy Guidance deprescribing prompts, PrescQIPP deprescribing tools, and condition-specific guidance (e.g. Bruyère deprescribing algorithms for PPIs, benzodiazepines, antipsychotics).
How do you communicate deprescribing to patients?+
Frame as a positive intervention aligned to what matters to the patient. Use shared decision-making (NICE NG197), explain the rationale (e.g. falls risk, no ongoing indication), agree a tapering plan with safety-netting and review date, and document in the consultation note plus deprescribing letter copied to the patient.
Talk to our Service Development team
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