What are the 4 principles of medicines optimisation?

• 11th February 2026

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The 4 principles of medicines optimisation offer a person-centred way to improve patient outcomes and reduce system waste. For PCNs, applying this framework is the most effective way to manage rising polypharmacy, improve safety, and make prescribing sustainable across primary care.

Key Takeaways

• Person-centred care: This framework focuses on shared decision-making, not compliance, by prioritising the patient’s experience.
• Evidence and safety: The principles require clinicians to balance guidelines with patient-specific factors, particularly for high-risk therapies.
• System integration: The framework must be embedded into routine workflows and linked to long-term condition (LTC ) management.
• Workforce strategy: Clinical Pharmacists and Pharmacy Technicians working together is the most effective model for delivering on these principles.

What are the 4 principles of medicines optimisation?

The four principles, set out by the Royal Pharmaceutical Society and reflected in the NICE guideline (NG5), provide a framework for ensuring patients get the best outcomes from their medicines. They are straightforward in theory. The challenge is applying them consistently in a busy primary care setting.

Principle	Focus
1. Understand the patient’s experience	Shared decision-making and adherence
2. Evidence-based choice of medicines	Right medicine, right patient, right time
3. Make medicines use as safe as possible	Harm reduction across the medicines pathway
4. Make it part of routine practice	Embedding into daily workflows

How does understanding the patient’s experience improve outcomes?

This first principle focuses on shared decision-making. The goal is to understand what matters to the patient – how medicines fit into their life, what side effects they experience, and what barriers affect adherence. This is not about checking compliance; it is about listening.

In practice, this often reveals adherence issues or side effects that never surface in routine repeat prescribing.

For PCNs, Structured medication reviews (SMRs) are the primary vehicle for these conversations. A well-conducted SMR creates the time that transactional reviews do not. Without it, non-adherence and avoidable prescribing cascades continue unchecked.

Why does evidence-based prescribing matter long-term?

This second principle requires clinicians to balance national guidelines with individual factors such as frailty, renal function, and comorbidities. It is not about rigid guideline adherence – it is about intelligent application.

A common failure in primary care is long-term medicines that were appropriate at initiation but never reassessed. For example, medicines started years earlier for short-term benefit are often continued without review, increasing risk without clear ongoing value. This drives unnecessary polypharmacy and increased monitoring burden. Clinical Pharmacists are central to addressing this within PCNs, where they can see the full clinical picture.

The four principles give us a clear framework, but they only work when applied by a team with the time and expertise to see the whole picture. An integrated pharmacy team turns principles into practice.

Adeem Azhar, Co-Founder and Chief Executive Officer – Core Prescribing Solutions

How do you make medicines use as safe as possible?

Safety underpins all four of these medicines optimisation principles and is where poor systems cause the most patient harm. This third principle targets harm reduction across the entire pathway – prescribing, dispensing, monitoring, and administration. Key risks in primary care include high-risk medicines (anticoagulants, opioids, insulin), inadequate monitoring, and poor reconciliation after hospital discharge.

Pharmacy Technicians add significant value here by managing data quality, patient recalls, and medicines reconciliation. This frees Clinical Pharmacists to focus on complex clinical decisions rather than chasing blood tests.

How do you embed these principles into routine practice?

This fourth principle is the one most practices struggle with. This approach only delivers sustained value when it is part of daily workflows, not a separate project. It requires clear role definitions, consistent processes, and integration with long-term condition (LTC) reviews and care planning.

In high-performing PCNs, this framework is built into SMR clinics and supported by a stable pharmacy workforce. Without this structure, practices firefight medicines issues rather than prevent them.

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