Greater Manchester, Salford

Polypharmacy – Getting the Balance Right

Through regional communities of practice, working to address the system-wide challenges of problematic polypharmacy and improve dialogue with patients about their medicines

As part of the AHSN Polypharmacy Programme: getting the balance right, we are supporting health care professionals to identify patients at potential risk from polypharmacy and to support better conversations about medicines. 

 

What is the problem we’re addressing?

We dispense over 1 billion prescription items per year in primary care in England.

Polypharmacy simply means many medicines. As more people live longer with multiple long-term conditions, the number of medicines they often take increases. This can have a significant burden on the person managing and trying to adhere to multiple medicines regimes and can also be harmful.

Studies have shown that that over 50% of older people are prescribed a medicine with more harm than benefit, leading to avoidable morbidity, hospitalisation and mortality. In England in February 2022 there were 876,317 people on 10 or more medicines and 349,653 were 75 or over. A person taking 10 or more medicines is 300% more likely to be admitted to hospital.  Polypharmacy adds preventable cost to the healthcare system and diminishes quality of care for the patient. The most deprived areas tend to have the most issues around polypharmacy, also making this a health inequality issue.

Most of the harm from polypharmacy is preventable.

The National Overprescribing Review (NOR) Good for you, good for us, good for everybody (September 2021) led by Dr Keith Ridge, former Chief Pharmaceutical Officer for England, found that overprescribing is a serious problem in health systems internationally that has grown dramatically over the last 25 years. It identifies two main causes: systemic and cultural. The response to the NOR report is now an NHS England programme.

The NOR sets out 20 cross-system recommendations to be led by a range of NHS and affiliate organisations – the Polypharmacy programme directly supports the delivery, and potential acceleration, of recommendations 8, 16, 17 and 18 into operational practice.

 

What are the outcomes we are trying to achieve?

Successful delivery of the programme within NHS GM will result in:

  • A regional Polypharmacy Community of Practice, with members working to address the system-wide challenges of problematic polypharmacy in our geography.
  • Routine use of the NHSBSA Polypharmacy Prescribing Comparators to identify and prioritise patients for a shared decision-making Structured Medication Review.
  • Increased confidence amongst the region’s primary care prescribing workforce to safely stop medicines identified to be inappropriate or unnecessary.
  • A change in patient expectations – to anticipate having a shared decision-making conversation about their medicines regularly, especially as they get older.
  • A contribution to the evidence base around how to help patients to feel more empowered to open up about their medicines issues.
  • A contribution to the evidence base around how to tackle problematic polypharmacy.

Programme Support

Pillar 1: Population Health Management

Pillar 2: Education & Training

Pillar 3: Public Behaviour Change

Resources

Polypharmacy: understanding the data webinar recording

The national Polypharmacy programme is establishing communities of practice around the country to identify local priorities and encourage routine use of the NHSBSA Polypharmacy Comparators to assess patients in high-risk groups. The NHSBSA Polypharmacy Prescribing Comparators tool is available to all GPs and pharmacists. Watch a recording of the April 2022 webinar.

Additional resources and information are available from the AHSN Network’s Polypharmacy webpage.

 

Contact
If you have any questions about our local Polypharmacy programme, please contact:

Nancy McNeilance, Programme Development Lead

Angela Devine, Project Manager

GM Polypharmacy Community of Practice launch

We’re introducing the Polypharmacy programme to healthcare colleagues and patients in NHS GM to a new community of practice. It’ll help to reduce potential patient harm from multiple medications and support effective dialogue between patients and healthcare teams. 

As set out in the NHS National Patient Safety Strategy we’re working to support the ambitions around structured medicines reviews and populations at risk due to Polypharmacy. 

We hosted our first Polypharmacy Community of Practice (CoP) on 23rd September 2022. We’re looking for colleagues from primary and secondary care, prescribers, patients, commissioners and community pharmacy to get involved.

The next GM Polypharmacy Community of Practice (CoP) will hold on 11 November 2022.

Please complete this form if you are interested in joining our community of practice; or contact: 

Nancy McNeilance, Programme Development Lead 

Angela Devine, Project Manager 

Russ's experiences of polypharmacy as a carer

A study in Greater Manchester providing evidence for the implementation of inclisiran in a primary care setting VICTORION-SPIRIT STUDY OVERVIEW: Phase IIIb, multicentre, open label, randomised controlled trial.Study will take place in 18 primary care centres in Greater Manchester, UK. 900 Primary or secondary prevention participants. interventions Include: Inclisiran, Usual Care, Behavioural Support. Objective: To evaluate the implementation of inclisiran in a regional primary care setting in the UK. Evaluate efficacy with standard clinical trial endpoints. Use implementation science methodology to assess patient and HCP satisfaction and healthcare resource utilization. Develop a patient identification report and process evaluation report that will support the launch of inclisiran, along with future novel therapies. Data sources -
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