Polypharmacy means taking five or more drugs on a regular basis. It is common in older adults and people with several long-term health problems. Clinical pharmacists in GP practices play a direct role in finding and dealing with cases where too many drugs cause more harm than good.
Not all polypharmacy is a problem. A patient with diabetes, high blood pressure and raised cholesterol may need several drugs, and each one may be the right choice. The concern is when drugs are no longer needed or when side effects outweigh benefits. It also applies when a patient does not fully know what they are taking or why.
Key takeaways
- 8.4 million people in England take five or more drugs on a regular basis.
- Around 10% of items given out in primary care are not needed.
- Only 17.2% of patients with polypharmacy have received a structured medication review.
- Pharmacist-led reviews have cut the number of drugs prescribed by up to 19.5% in care home settings.
- Clinical pharmacists use validated tools such as STOPP/START to identify and stop harmful or unneeded drugs.
The Scale of the Problem
The Department of Health and Social Care’s National Overprescribing Review found that 8.4 million people in England take five or more drugs on a regular basis. Harmful drug effects account for one in five hospital stays among the over-65s. Patients on ten or more drugs are 300 times more likely to end up in hospital because of a drug-related problem. The review also revealed that approximately 10% of primary care items are unnecessary.
A 2024 study of 1.7 million adults in North West London found that 9.4% were on five or more regular drugs. Age and poverty were both linked to higher rates. Those aged 65 to 74 were over nine times more likely to meet the threshold than adults aged 18 to 44.
What Clinical Pharmacists Do About It
Structured Medication Reviews
Structured medication reviews (SMRs) are the main tool used to tackle polypharmacy in primary care. An SMR is a full review of every medicine a patient takes. It covers whether each one is still needed and whether it is safe. It also looks at harmful clashes between drugs and whether the patient is getting real benefit.
The PCN DES (Primary Care Network Directed Enhanced Service) contract requires PCNs to offer SMRs to high-risk groups. These include care home residents and patients on many drugs. It also covers people on drugs linked to errors, those living with severe frailty and anyone using pain drugs that carry a risk of dependence.
A 2025 national survey in BMJ Open found that 62% of clinical pharmacists doing SMRs were also qualified as prescribers. Most were employed by PCNs. Reviews lasted between 21 and 30 minutes on average and were mostly done by phone. The study found wide gaps in how SMRs were carried out from one area to another. Care home reviews were seen as the hardest to do well.
A cross-sectional study in North West London found that only 17.2% of patients on five or more drugs had received an SMR. The main reason was a lack of clinical pharmacist time within PCNs.
Deprescribing
Deprescribing means tapering, cutting back or stopping a medicine that is no longer right for the patient. It is done with the patient’s input through shared decision-making and with follow-up checks after any changes.
Clinical pharmacists use screening tools such as STOPP/START and STOPPFrail to spot drugs that may be doing more harm than good. These tools flag common risks in older adults.
A review of pharmacist-led work in UK primary care found clear results. In one care home study, pharmacist reviews led to a 19.5% drop in the total number of drugs given. In another, yearly drug cost savings topped £800,000. More than half of that came from stopping drugs that were no longer needed.
Medicines Reconciliation
When patients move between care settings, errors in their drug lists are common. This is most often seen after a hospital stay. Clinical pharmacists cross-reference discharge notes against GP records to find mistakes, doubled-up items and drugs that should have been discontinued.
One UK study looked at what happens when a pharmacist reviews patients in general practice shortly after they leave hospital. 74% of the changes made were to stop drugs that were no longer needed.
Why This Matters for Practices and PCNs
Polypharmacy is not just a clinical concern. It affects drug budgets, GP times and patient safety figures. Practices without pharmacy resources often find that medicine reviews fall to GPs. Most GPs do not have the time or the focus to run full polypharmacy checks on top of their other work.
Bringing in clinical pharmacist support lets practices run SMRs at scale, act on safety concerns and carry out the work needed to cut unneeded drugs. For PCNs, it also helps meet the DES contract rules on structured medicine reviews.
The NHS Business Services Authority puts out data that lets practices and PCNs compare their drug use against national figures. Clinical pharmacists use these reports alongside their own system searches to find the patients most at risk and review them first.
Summary
Polypharmacy is growing in primary care. An ageing population and more people living with several health problems are driving it. Clinical pharmacists deal with it through SMRs, deprescribing and medicines reconciliation. The evidence shows that pharmacist-led work cuts the number of unneeded drugs and brings down costs. Practices and PCNs with clinical pharmacist time are better placed to manage this safely and meet their contract duties around medicine review.