The role of social prescribing in Medication Review and Deprescribing (SPiDeR)

Problem

In the UK, a third of all people aged 65 years and above regularly take five or more medications, known as polypharmacy. Polypharmacy can increase the risks of side effects and hospital admissions. One of national priorities for NHS England set by the Chief Pharmacist, is to reduce prescribing unnecessary medication (overprescribing) by 10% for patients being treated by their GPs. A Structured Medication Review (SMR) provides an opportunity for Primary Care clinicians to identify and support deprescribing. Social prescribing within SMR may be useful to support clinicians recommend alternatives to medication which may improve health, such as changes in diet, ways to reduce stress, increase exercise, or group activities. The overprescribing report suggested that NHS England and NHS Improvement should expand the use of SMRs in Primary Care to benefit patients most at risk of overprescribing. However it is currently unknown how social prescribers could be integrated into SMR processes in Primary Care to support deprescribing for older people.

Approach

The aim of this realist inquiry is to explore the potential role of social prescribers in the medication review process and identify any training needs or resources required to enable their active involvement in the process. Further objectives include identifying barriers and facilitators for social prescribers involvement in SMR and further training or resource requirements. The team are conducting qualitative focus groups with up to 40 primary care staff (GPs, pharmacists, social Prescribing link workers) and interviews with 20 older patients and caregivers. This is a work in progress and the findings are being developed using thematic analysis by the project team.

Findings

Initial insights into patient perspectives on their medications suggest that they would welcome a holistic approach to their medicines management and often feel unsure where to gain advice on reducing unnecessary medications. Focus group participants were interested in the potential for incorporating social prescribers into their SMR processes to support sustainable work practices in Primary Care. The participants described considerable variation in how medicines management was being conducted, in some areas, pharmacists and social prescribers were already involved in proactive deprescribing processes for older people.

Consequences

The study is ongoing but there are initial implications for sustainable health systems. SMR processes provide an opportunity for targeted medicines review and could considerably reduce the incidence of side effects and adverse drug reactions for older people. There may be benefits from reducing prescription costs but economic analysis is needed to consider the potential additional costs from social prescribing activities. Social prescribing approaches to deprescribing may have additional positive effects on overall health and wellbeing, but further research is warranted on the implementation. A team based approach to primary care prescribing may support sustainable work practices.