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Deprescribing Older Patients: A Practical Framework for Primary Care Networks

17th July 2026
Clinically reviewed by: Adeem Azhar, MPharm, IPres

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What is deprescribing in older patients?
When should medicines be deprescribed?
How can PCNs implement a safe deprescribing framework?
What are the common barriers to deprescribing?
Can Clinical Pharmacists deprescribe?

Older patients often take multiple medicines to manage long-term conditions. While many remain appropriate, changing health, frailty, and treatment goals can alter the balance of benefit and risk. For PCNs, a structured approach to deprescribing older patients supports safer medicines optimisation and helps ensure every medicine continues to provide meaningful benefit. Getting this right makes it a routine part of clinical practice.

Key Takeaways

Structured, patient-led deprescribing supports safer prescribing and may reduce medication-related harm for older patients.
Pharmacy leadership: Clinical Pharmacists and Pharmacy Technicians are best placed to lead this within Structured Medication Reviews.
Operational safety: A robust PCN framework ensures safe, governed, and prioritised medication reduction across the network.

What is deprescribing in older patients?

A figure balancing a scale between multiple pill bottles and a single health icon, illustrating the goal of optimising treatment benefit over medication quantity. — Deprescribing is the planned dose reduction or stopping of medication that may be causing harm or no longer providing benefit to older adults.

Deprescribing in older people is the planned dose reduction or stopping of medication causing harm or no longer providing benefit. It optimises care as physiology changes – critical for older adults facing frailty, polypharmacy, or adverse drug reaction risks. Importantly, not all polypharmacy is inappropriate. The goal is to optimise treatment rather than simply reduce the number of prescriptions.

Expert insight from Adeem Azhar, qualified Clinical Pharmacist and CEO

Effective deprescribing isn’t about reducing medicines for the sake of it. It’s about ensuring every medicine still provides meaningful benefit for the individual patient. A structured review, supported by the right pharmacy team, helps clinicians make safe, person-centred decisions.

Adeem Azhar, MPharm, IPres
Co-Founder and Chief Executive Officer – Core Prescribing Solutions
Qualified Clinical Pharmacist

When should medicines be deprescribed?

Consider deprescribing when harm outweighs benefit. This includes changes in frailty, resolved indications, hospital discharge, or adverse drug reactions. Safe deprescribing for older patients requires assessing health status, treatment burden and patient goals.

NICE guidance on multimorbidity highlights tailoring care to the individual. Clinical judgement can be supported by the STOPP/START criteria, which identify potentially inappropriate medicines and flag omissions.

How can PCNs implement a safe deprescribing framework?

A circular process flow showing the seven stages of deprescribing: Identify, Review, Assess, Decide, Plan, Monitor, and Document. — A structured, multidisciplinary approach to safe deprescribing, from identifying high-risk patients to documenting clinical decisions.

A structured, multidisciplinary approach is essential. Here is a practical 7-stage deprescribing framework for PCNs:

Stage	Goal
Identify	Find high-risk patients
Review	Complete an SMR
Assess	Balance benefits and risks
Decide	Shared decision-making
Plan	Taper safely where needed
Monitor	Review outcomes
Document	Communicate and record

Identify: Target patients with problematic polypharmacy or frailty criteria using clinical system searches.
Review: Conduct a medication review to understand the full clinical picture.
Assess: Evaluate each medicine against current health status and life expectancy.
Decide: Discuss options with the patient, carers, care home staff, or community pharmacy.
Plan: Develop a step-wise tapering plan where stopping suddenly is contraindicated.
Monitor: Schedule follow-ups to check for withdrawal symptoms, recurrence of the original condition, and whether the change continues to meet the patient’s goals.
Document: Record all decisions and inform the wider healthcare team.

Medicines that commonly require careful deprescribing consideration:

Sedatives and hypnotics
Anticholinergics
Proton Pump Inhibitors (PPIs)
Antihypertensives

Icons representing sedatives, anticholinergics, PPIs, and antihypertensives, highlighted for careful clinical review during medication optimisation. — Certain medicine groups, such as sedatives and PPIs, often require careful assessment to ensure they still provide meaningful benefit.

These medicines should never be stopped solely because they belong to one of these groups. Decisions should always be based on individual clinical assessment.

What are the common barriers to deprescribing?

A healthcare professional helping an older patient overcome hurdles like fear and time pressures to achieve safe medicines optimisation. — Addressing patient concerns and operational challenges is the first step toward embedding deprescribing into routine PCN governance.

Real-world barriers slow implementation: patient concerns, multiple prescribers, time pressures, fear of withdrawal effects, and inconsistent documentation. Recognising these is the first step to addressing them within a PCN governance framework.

Can Clinical Pharmacists deprescribe?

A clinical pharmacist leading a multidisciplinary team and conducting a Structured Medication Review to safely manage medication tapering for older patients. — Clinical pharmacists are highly qualified to lead deprescribing efforts, assessing complex regimens and managing safe tapering within PCNs.

Yes, a clinical pharmacist is highly qualified to lead deprescribing in older patients – assessing complex regimens and safely managing tapering. Pharmacy Technicians support this by gathering medication histories and assisting with monitoring. Together, this team model embeds deprescribing into routine care home pharmacy services and general practice.

FAQs

Who should carry out deprescribing reviews?

Deprescribing older patients safely is best led by a clinical pharmacist or GP with expertise in pharmacology, frailty, and patient management. Pharmacy Technicians play a vital supporting role in data gathering and recall.

Is deprescribing part of a Structured Medication Review?

Yes, deprescribing is a fundamental element of an SMR. It is the ideal opportunity to assess medicines and identify opportunities for deprescribing older patients safely.

What is problematic polypharmacy?

Problematic polypharmacy occurs when multiple medications are prescribed inappropriately or their benefit is not realised, increasing adverse events and treatment burden. The British Geriatrics Society provides extensive resources on this.

Supporting safe deprescribing across your PCN

Embedding safe deprescribing for older patients into routine practice takes time, clinical expertise, and consistent follow-up. Whether expanding Structured Medication Reviews or strengthening medicines optimisation across your PCN, the right pharmacy workforce makes the process more effective and sustainable.

Get in touch →

Adeem Azhar, MPharm, IPres

Co-Founder and Chief Executive Officer
Qualified Clinical Pharmacist

Fervent about healthcare, technology and making a human difference.

Adeem writes about Healthcare, wellness, medicines management, medicines optimisation and workforce planning, drawing on his experience supporting GP practices and NHS organisations across nationally.

Adeem is a thought leader and is passionate about using healthcare and technology to improve patient outcomes, enhances access to healthcare services and to support NHS teams.