In a healthcare system increasingly shaped by multimorbidity, polypharmacy has become a familiar challenge in UK primary care. While prescribing is a vital skill, deprescribing—the planned and supervised reduction or discontinuation of medicines—is equally critical. For non-medical prescribers (NMPs), deprescribing offers a powerful opportunity to enhance safety, reduce harm, and optimise outcomes, especially in older adults.
Why Deprescribing Matters
Polypharmacy, commonly defined as the use of five or more medications, is prevalent among older adults in primary care. While some medications are clearly beneficial, many persist beyond their usefulness—either because the original indication is no longer valid, side effects outweigh benefits, or the patient’s priorities have changed.
Older people are particularly vulnerable to adverse drug reactions (ADRs), which are a leading cause of hospital admissions and often related to high-risk medications such as benzodiazepines, anticholinergics, opioids, and proton pump inhibitors. Research shows that inappropriate prescribing increases the risk of falls, frailty, cognitive decline, and poor adherence (Rankin et al., 2019).
Deprescribing is not just about “stopping medicines.” It is a thoughtful, evidence-based approach to improving care. For NMPs, especially in roles such as practice nurses, pharmacists, and advanced clinical practitioners, deprescribing is part of responsible prescribing.
How NMPs Can Lead Safer Prescribing Practices
1. Build Deprescribing into Routine Care
Structured medication reviews—now a core part of the GP contract—are an ideal place to implement deprescribing. NMPs can take the lead in asking questions like, “Is this still needed?”, “What are the risks?”, and “What does the patient want?”
2. Use Evidence-Based Tools
Frameworks like STOPP/START criteria and the NHS Polypharmacy Guidance help identify potentially inappropriate medicines (PIMs). These tools support a structured approach to assessing risks and benefits and are especially helpful for less experienced prescribers.
3. Communicate Clearly and Collaboratively
Deprescribing requires trust. Patients may be anxious about stopping a long-term medication. NMPs are often well-placed to have meaningful conversations with patients and carers, framing deprescribing as a positive, collaborative process rather than withdrawal of care.
4. Monitor and Follow-Up
Effective deprescribing includes clear plans for follow-up and monitoring. NMPs should anticipate potential withdrawal effects or symptom recurrence and provide reassurance that medications can be reintroduced if needed.
5. Stay Current and Confident
Clinical decision-making evolves quickly, and staying up to date is vital. PDUK offers highly relevant CPD options:
- Confident Deprescribing: Practical Skills for Safer Prescribing in Older People – This course provides hands-on tools and techniques to help NMPs safely and confidently review and reduce medications in older adults.
- Annual NMP (V300) Update Course – An essential update for all NMPs, covering key changes in clinical practice, prescribing guidelines, and patient safety.
The Role of Reflection and Professional Growth
Deprescribing also invites self-reflection. It challenges the assumption that “more is better” and encourages prescribers to ask difficult but necessary questions. For NMPs, leading this cultural shift is both a responsibility and a professional development opportunity.
By embedding deprescribing into routine practice, NMPs can actively reduce harm, empower patients, and play a central role in delivering safer, more personalised care.
References
Rankin, A., Cadogan, C. A., In Ryan, C., Clyne, B., Smith, S. M., & Hughes, C. (2019). Core outcome set for trials aimed at improving the appropriateness of polypharmacy in older people in primary care. BMJ Open, 9(5), e025803. https://doi.org/10.1136/bmjopen-2018-025803
NHS England. (2021). Structured medication reviews and medicines optimisation: Guidance 2021-22. Retrieved from https://www.england.nhs.uk/publication/structured-medication-reviews-and-medicines-optimisation/
