Cluster page — medicines optimisation
Medicines optimisation in care homes
EHCH context
Why care home MO is the highest-impact deprescribing opportunity in primary care
The care home population in England is the most polypharmacy-exposed cohort in primary care: average 8–10 regular medicines per resident, frequent prescribing cascades, high anticholinergic burden, and significant rates of inappropriate antipsychotic, hypnotic and opioid prescribing inherited from secondary care or pre-admission community prescribing. The Enhanced Health in Care Homes DES makes this the PCN's responsibility — and it is the single highest-yield deprescribing opportunity available.
A mature EHCH MO programme delivers annual SMR for every resident, monthly MAR-chart audit by a pharmacy technician, weekly MDT input from a clinical pharmacist, structured antipsychotic review where prescribed for BPSD, opioid stewardship, falls-risk medicines review, and anticipatory prescribing readiness for the end-of-life pathway.
Care home MO core interventions
What a PCN care home MO programme delivers
- Annual personalised SMR for every resident with deprescribing focus
- Monthly MAR-chart audit and omitted/refused dose pattern analysis
- Weekly MDT participation by the clinical pharmacist
- Structured antipsychotic review (BPSD prescribing audit, NICE NG97 alignment)
- Opioid and hypnotic stewardship — STOPP/START driven
- Falls-risk medicines review (anticholinergic burden, orthostatic risk)
- Anticipatory prescribing planning with palliative care input
- Controlled drug governance and registered manager liaison
What good looks like
Care home MO benchmarks
Frequently asked questions
Care home MO — FAQs
What does the Enhanced Health in Care Homes DES require?+
Each PCN must align a named clinical lead to every nursing/residential home in its footprint, deliver weekly MDT input, and ensure every resident receives a personalised care and support plan including a medication review. The clinical pharmacist is the primary MO contributor.
How frequently should care home residents have an SMR?+
NHS England guidance and the EHCH framework recommend annual SMR for every care home resident, with intermediate reviews on admission, on discharge from hospital, and after any significant clinical change. High-frailty residents and those on 10+ medicines often benefit from 6-monthly review.
What is the role of the pharmacy technician in care home MO?+
Pharmacy technicians own the operational layer: monthly MAR chart audit, omitted/refused dose review, stock and waste audit, controlled drug reconciliation, ordering process improvement, and preparing the cohort for IP pharmacist SMR clinics.
How does anticipatory medicines work for care home residents?+
End-of-life anticipatory prescribing (typically morphine, midazolam, levomepromazine, hyoscine) is initiated by the registered prescriber following palliative care assessment, with pharmacist support on dose appropriateness, supply chain and CD governance.
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