What is the health problem?

The use of multiple medicines to manage a range of conditions, known as polypharmacy, is very common, with one in five adults in the UK taking five or more medicines. While this may be appropriate for those with long-term conditions, it can be problematic if the medicines are no longer effective, no longer needed, cause adverse side effects, or are burdensome.

All patients with polypharmacy require medication reviews, usually by a GP or pharmacist within primary care.  The aim of medication reviews is for the patient and healthcare professional to discuss the patient's health conditions, their priorities and the different treatment options available in order to tailor medicines for the individual patient. But guidelines on the management of medical conditions rarely take into account other health conditions a patient might have, meaning decision-making can be challenging.

Previous NIHR-funded research exploring the effective management of medicines for patients with polypharmacy, highlighted the need for more support for healthcare professionals, access to data to inform decision making, and tailored explanations for patients. Clinical pharmacologists, doctors with a specialist interest in medicines, are ideally placed to support primary care in managing problematic polypharmacy.

Aim of the project

This project aims to develop and evaluate a clinical pharmacology service in south-west London to optimise medicines for patients with problematic polypharmacy, particularly those with long-term conditions, such as diabetes and cardiovascular disease. The project's objectives include:

  • describing variation in problematic polypharmacy across south-west London
  • describing primary care practitioners' preparedness to manage problematic polypharmacy
  • assessing the feasibility of a novel integrated clinical pharmacology service, which aims to reduce harm and burden of treatment and improve the quality of care.

A range of approaches are being taken to address the objectives including scoping reviews, observational studies, a survey, and qualitative and quantitative analysis.

The project is being led by Professor Emma Baker, Professor of Clinical Pharmacology at St George’s, University of London. Professor Baker, says: “The introduction of integrated care systems to foster closer working relationships between healthcare organisations, and the rapid adoption of technology in healthcare brought about by the pandemic, provide the ideal environment to develop a novel clinical pharmacology service to support primary care in the management of problematic polypharmacy.”

The development of an integrated clinical pharmacology service in south-west London has the potential to significantly improve care for patients with problematic polypharmacy and multimorbidity in the region. Learning from this project could help other regions to develop similar models, with access to clinical pharmacology support

Professor Emma Baker, Professor of Clinical Pharmacology, St George’s, University of London

About the new polypharmacy service

The research team has launched a new polypharmacy service at St George’s University Hospitals NHS Foundation Trust to facilitate reviews of patients with problematic polypharmacy, which incorporates approaches developed by the team. The service includes:

  • A review clinic for patients with problematic polypharmacy: an outpatient clinic can review patients via telephone, video link or face-to-face. Patients are then reviewed in follow up appointments, or detailed recommendations are made to their GP or pharmacist.
  • Advice and guidance: advice is offered for simple prescribing questions (via an online advice and guidance platform) and in-depth advice about complex prescribing issues in virtual meetings with healthcare professionals at a GP practice or primary care network level.
  • Skills development network: a network of pharmacists and GPs in south-west London, offering training to healthcare professionals on polypharmacy management.


The research team are collaborating with a range of patients, pharmacists working in primary care in south-west London, GP services, Clinical Network Groups, the South West London Health and Care Partnership, improvement networks, including the Health Innovation Network, and other relevant committees and consortiums.