Empowering patients and upskilling clinicians to tackle overprescribing

As the Health Innovation Network’s Polypharmacy: Getting the Balance Right programme draws to a close, a suite of new reports highlights its transformative impact on patient safety and clinical practice across England.

The programme has successfully engaged with over 12,000 healthcare professionals to support them with the skills and confidence to tackle overprescribing, delivered 124 communities of practice across the country, and co-developed vital resources to empower patients in conversations about their medicines.

The programme was launched in April 2022 to address the urgent and growing challenge of problematic polypharmacy - when a patient is taking multiple medicines, some of which may no longer be necessary or could be causing harm.

The scale of the issue is considerable. In March 2025, more than 718,000 people aged 65 and over in England were taking 10 or more medicines, a figure projected to exceed 1.1 million by 2035 without effective intervention.

To address this, the programme, which engaged all 42 Integrated Care Boards (ICBs) across England, was built on a core three-pillar approach:

1. Population health management: using NHS data to identify patients most at risk of harm from their medicines.
2. Education and training: upskilling the primary care workforce to confidently and safely stop unnecessary medicines.
3. Changing public behaviour: co-producing resources to support patients in having better, shared-decision-making conversations about their medicines.

A range of Polypharmacy education and learning events reached 12,891 health and care professionals, including 1,301 GPs and pharmacists who completed the Polypharmacy Action Learning Sets (ALS) course, which has been exceptionally well-received:

• 99% of ALS participants said they would recommend the course to colleagues.
• 83% reported making changes to their practice as a result, including increasing shared decision-making with patients and actively stopping medicines.

Participants highly valued the interactive, peer-to-peer discussions and specialist input, particularly from geriatricians. One GP described the course as transformative, saying: "This will change my practice more than any learning event I have ever done."

Giving patients a voice in their own care

Before the programme, there were no nationally available resources to help patients understand or prepare for a Structured Medication Review (SMR). The programme filled this gap by co-producing a suite of evidence-based materials with patients, academics and VCSE sector organisations to support patients in primary care and care homes.

Downloaded over 9,600 times to date, the impact of these resources has been significant. Patient feedback showed that 86% felt able to have meaningful conversations with their GP or pharmacist after using the materials, and 64% were more confident talking about their medicines. Clinicians reported that patients were arriving at appointments better prepared, “turning up knowing what they wanted to talk about” and feeling empowered to bring their questions.

Tackling health inequalities

As part of an ambition to improve access to SMRs for seldom heard or marginalised communities, the patient resources were translated into 12 community languages and made available in easy read and audio formats. The impact of this was captured powerfully in patient feedback, with one person commenting: "I feel this is our best review because my mum had chance to read the information about why we need to review the medicines in Bengali."

Demonstrating wider system benefits

A health economics analysis of the programme led by Unity Insights, based on five case study ICBs, estimated the financial and environmental value of the interventions.

In these regions, the programme prevented an estimated £20,000 in hospital admission costs and saved £76,000 in medicines expenditure over three years. When extrapolated across England, this indicates a potential total saving of over £1.1 million in three years, comprising £280,000 in avoided healthcare utilisation costs and £880,000 in reduced drug costs.

The programme also had a positive environmental impact. By reducing unnecessary prescriptions in the five case study areas, an estimated 33,002 kgCO2e (tonnes of carbon dioxide equivalent) was avoided, equal to a value of over £8,500.

Lessons for future programmes

A learning review of the programme conducted by Health Innovation Network South London provides important insights for the design and delivery of future large-scale health programmes.

One of the programme’s key strengths was its flexible design, blending a nationally coordinated, evidence-based offer with autonomy for delivery teams to adapt activities to their local system and stakeholder needs. This led, for example, to the development of bespoke training sessions that were often shorter and open to a wider range of staff, including junior prescribers, complementing the national ‘gold standard’ Polypharmacy Action Learning Sets.

The learning review also highlights strong local leadership and buy-in from system partners as critical success factors. Where the programme’s objectives aligned with local priorities, engagement and impact were significantly amplified.

A lasting legacy

As the programme concludes, its legacy is clear. It has raised national awareness of problematic polypharmacy, provided practical tools for change, and demonstrated that this complex issue is not insurmountable.

National Clinical Lead for the Polypharmacy Programme, Pharmacist Clare Howard said: “This work has been developed, delivered and evaluated by the Health Innovation Network and is starting to show how, by taking this three pillar approach, we can identify patients at risk from harm and improve the quality of Structured Medication Reviews to ensure that patients, but particularly our older people, are only taking the medicines that they need. The last three years have been incredibly hard work but we are proud of the impact to date and hope that this work will continue in the NHS in England.”

Professor Tony Avery, National Clinical Director for Prescribing for NHS England, said: “Tackling the complex challenge of problematic polypharmacy can sometimes feel overwhelming, so with support from NHS England, the Health Innovation Network has successfully developed structured approaches for healthcare professionals that provide a valuable resource to help ensure that medicines are being used effectively and safely, aligning with patient goals.”

The Yorkshire and Humber National Institute for Health and Care Research (NIHR) Patient Safety Research Collaboration were a key partner in developing the resources to help patients understand and prepare for an SMR.

David Alldred PhD, Professor of Medicines Use and Safety, Yorkshire and Humber NIHR Patient Safety Research Collaboration, said: "A key solution to tackling problematic polypharmacy is to ensure that patients can share their thoughts and concerns about their medicines with healthcare professionals in a meaningful way. The resources we co-designed with patients and healthcare professionals mean that they can work in partnership to make sure patients are taking the most effective and safest medicines for them."

Natasha Swinscoe, Chief Executive of Health Innovation West of England and Senior Reporting Officer for the Polypharmacy Programme, said: “This programme has demonstrated the power of the Health Innovation Network to tackling an incredibly complex issue by coordinating a collaborative approach with a wide range of stakeholders. By coproducing meaningful guidance and toolkits, empowering patients to be able to make shared decisions about their medicines and giving healthcare professionals the skills and confidence to tackle overprescribing, the Polypharmacy programme has made significant inroads into showing what is possible.”

Find out more:

• To learn more about the programme's achievements, read the Impact Report, Health Economics Analysis, and Learning Review.
• Read a reflective blog from the programme leads, Clare Howard and Amy Semple.
• Access patient materials, webinar recordings and guides from the Health Innovation Network website.
• Stay connected with future work by joining the Health Innovation Network Polypharmacy Shared Learning Network.