Understanding the deprescribing landscape: what our survey of NHS pharmacy stakeholders tells us

Polypharmacy is one of the defining challenges of an ageing population. More than 718,000 people aged 65 and over in England are now taking 10 or more medicines, a figure projected to exceed 1.1 million by 2035.¹ Adverse drug reactions are implicated in an estimated 18.4 per cent of hospital admissions, with a projected annual cost to the NHS of £2.21bn.² The clinical case for deprescribing, defined as the systematic process of identifying and stopping medicines where harms outweigh benefits, is well established.

To understand how this evidence is translating into practice, HSJ Information, working in partnership with Aspire Pharma Ltd, surveyed 39 NHS pharmacy stakeholders across acute, primary care and system-level roles in March 2026. The findings offer a useful, evidence-based picture of where deprescribing activity currently stands, and what would help it progress.

Current activity: a mixed picture

Deprescribing is recognised as important, but our survey shows that delivery varies significantly between systems, organisations and care settings.

• 5 per cent of respondents described embedded, system-wide deprescribing with governance and outcome measures in place
• 23 per cent reported established activity across several pathways or settings
• 36 per cent described developing activity, with some structured work at limited scale
• 31 per cent had no current plans for a formal deprescribing programme or workstream

Deprescribing was rated a moderate-to-high system priority, with an average score of 6.74 out of 10. This suggests that recognition of the issue is broadly strong, even where formal programmes are not yet in place.

Where deprescribing is working well

Several consistent features emerged among respondents describing effective practice:

• Structured medication reviews and polypharmacy reviews, often targeted at patients with frailty, high falls risk or those on 10 or more medicines
• Frailty and falls pathways, including post-fall multidisciplinary (MDT) “swarm” reviews
• Pharmacist-led MDT models, particularly where pharmacists hold prescribing authority
• Practical tools, such as anticholinergic burden scoring and risk-stratification searches being embedded into everyday clinical workflow

One acute trust reported 78 per cent comprehensive falls-medication review coverage across its frailty beds, an example of what sustained, embedded practice can achieve.

The main barriers reported

Respondents were clear about the key barriers holding progress back:

• Lack of time and capacity in appointments and reviews (cited by 90 per cent of respondents)
• Insufficient training, skills and confidence (59 per cent)
• Unclear responsibility and ownership across primary and secondary care (54 per cent)
• Inadequate follow-up and monitoring capacity (51 per cent)
• Concerns about medico-legal risk (41 per cent)

Cultural factors also featured strongly. Just over half of respondents (53.9 per cent) disagreed that clinicians feel psychologically safe stopping a medicine initiated by another clinician or specialty, pointing to a cultural asymmetry between starting and stopping treatment that many systems have not yet addressed.

“Deprescribing will not succeed through isolated initiatives. Without aligned leadership, pathways, workforce, education and system incentives, medication harm and polypharmacy will continue to grow despite best intentions.”

Patients are generally receptive

One of the more encouraging findings was around patient engagement. Eighty-two per cent of respondents agreed or strongly agreed that patients and carers understand and are willing to accept deprescribing when it is explained clearly as a safety-focused, patient-centred intervention. This suggests that, where deprescribing stalls, the barriers tend to sit within the system rather than with patients themselves.

What would help: recommendations for system leaders

Drawing on what respondents identified as the most supportive enablers, we would encourage system leaders to consider the following:

1. Formalise deprescribing as a governed workstream within medicines optimisation, frailty and patient safety strategies, with named leadership, agreed pathways and routine outcome reporting
2. Protect time for structured medication reviews, which respondents ranked as one of the most valuable enablers of progress
3. Scale pharmacist-led MDT models across primary, secondary, mental health, frailty and care home settings, supported by clear prescribing authority
4. Embed practical tools into routine workflow, including structured review templates, anticholinergic burden scoring and electronic prompts
5. Invest in delivering training on shared decision-making and risk communication, to help build clinician confidence in stopping medicines initiated by others
6. Align incentives, data dashboards and performance measures with medicines safety outcomes

In summary

Our survey suggests that the evidence base and clinical appetite for deprescribing are not in question. What varies is the extent to which systems have built the governance, workforce capacity, training and pathways needed to deliver it consistently. Where these elements are aligned, the results reported by respondents, in reduced falls, safer prescribing and more sustainable services, suggest the investment is worthwhile. We hope this report provides a useful, evidence-based reference point for system leaders looking to develop or strengthen their own approach.

References

^1. Health Innovation Network. Polypharmacy programme: getting the balance right. Available at https://thehealthinnovationnetwork.co.uk/wp-content/uploads/2025/09/Polypharmacy-Impacts-Report.pdf (accessed July 2026).

^2. Osanlou R, Walker L, Hughes DA, et al. Adverse drug reactions, multimorbidity and polypharmacy: a prospective analysis of 1 month of medical admissions. BMJ Open 2022;12:e055551. doi:10.1136/bmjopen-2021-055551