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General Practice
Within general practice, we recognise the challenges are many and varied. It’s really easy to prescribe, and much harder to deprescribe.
Before we overthink it, we’re simply saying, can you ask patients the question: Are your medicines working for you?
The aim is to help patients, help your workload, and most importantly help deliver better health outcomes.
Job role
Select your profession:
The information below is for General Practitioners, Clinical Pharmacists, Practice Managers and Practice Nurses. Click on the link below to navigate to the section relevant to you.
For General Practitioners
Depending on the type of medication review you’re performing, you may find different parts of the deprescribing toolkit helpful. See some of suggestions below.
Short medication reviews with patients (10mins)
Use one question from either the patient or the clinician checklist. This will enable you to explore any potential deprescribing ‘quick wins’. These can then be followed up with you or someone else in the practice team.
Deprescribing clinics with patients
Use the symptom trackers to help both you and the patient understand if medicines are working, or monitor the impact of a deprescribing decision. Helpful for longer-term deprescribing programmes, for example pain, benzodiazepines, hypnotics.
For Clinical Pharmacists
Patient checklist
The patient checklist is designed to support Structured Medication Reviews (SMRs). Send out the questions by email, text message or include in your invitation letter (example below) before patients attend a SMR. You can also post out the A5 size card (below).
Clinician checklist
The clinician checklist is designed to prompt questions about a patients’ current medication list during an appointment. You could have a hard copy on your desk or it displayed on your screen.
Symptom trackers for structured medication reviews
Why use a symptom tracker?
It can be sometimes difficult to know if some medicines are working. Two versions of a symptom tracker are provided, one blank and one with a 0-10 scale to help track severity of symptoms. These are generic with space to add your own directions to patients on what you want them to record, and when you will review these to make decisions about medication.
Before a structured medication review
Send out a symptom tracker with instructions completed for the patient to monitor their health or symptoms in the lead up to a Structured Medication Review. This could help you make more infomed decisions about what medicines are working.
Following a deprescribing decision
Provide a tracker to monitor changes following stopping or reducing a medicine in a Structured Medication Review.
To inform a deprescribing decision
If you and/or the patient are unsure if a medicine is working, provide a tracker so that the patient can actively monitor whether or not a medicine may be working to support a decision in a follow-up appointment. This may be helpful in longer-term deprescribing clinics e.g. benzodiazepines, pain.
For Practice Managers
Medication review types in the practice
The ‘Are your medicines working for you?’ toolkit is designed to be compatible with all GP practice workforce models. However, practices should consider how they will approach deprescribing in their particular practice. For example, if patients request a medication review, which clinician appointment slots will patients be booked in to.
Patient facing communication tools
Patient facing communications have been developed to let patients know that the practice is asking patients if their medicines are working.
These include short animations and still images. These could be used on any practice social media accounts, websites, newsletters, and practice screens.
The message to patients in these is to “book an appointment to have a medication review”. This allows admin staff to book patients into the appropriate appointment slots for the practice.
Why use the ‘Are your medicines working for you?’ patient facing communications?
To reduce medication review DNAs
The ‘Are your medicines working for you?’ questions are a reminder to patients about why medicines reviews are important and engages them in the review process. This may reduce DNAs for medication review appointments in the practice.
Improve quality indicator performance
A high quality medication review should improve patient experience, and provides opportunities to ensure quality indicator targets are met by engaging patients in their care.
Reduce unwanted or not needed prescriptions
It is estimated that 10% of medicines prescribed are not needed by patients. Encouraging patients to attend medication reviews provides opportunities to identify and stop prescriptions which are longer wanted or needed by the patient. Some medicines may even be causing or increasing the risk of harm to patients which could be avoided by stopping these problematic medicines.
For Practice Nurses
Decisions about the continuation of medicines often take place in long-term condition clinics ran by Practice Nurses. These are a good opportunity to consider if medicines are working and if any could be stopped or changed. The tools below can support review of medicines in these clinics.
Patient checklist
The patient checklist is designed to get patients to reflect on whether their medicines are working before attending an appointment with a healthcare professional. Send out the questions by email, text message or post before patients attend a long-term condition clinic. The checklist is available below for printing as an A5 double sided postcard.
Clinician checklist
The clinician checklist is designed to prompt questions about a patients’ current medication during an appointment. You could have a hard copy on your desk or displayed on your screen.
The questions aren’t long-term condition specific, so they can be used with any type of clinic.
If patients take multiple medicines, you could book them into an appointment with your practice Clinical Pharmacist.
Symptom trackers for long-term condition reviews
Why use a symptom tracker?
It can be sometimes difficult to know if some medicines are working. Two versions of a symptom tracker are provided, one blank and one with a 0-10 scale to help track severity of symptoms. These are generic with space to add your own directions to patients on what you want them to record, and when you will review these to make decisions about medication.
Before a long-term condition clinic
Send out a symptom tracker with instructions completed for the patient to monitor their health or symptoms in the lead up to a long-term condition review. This could help you make more infomed decisions about what medicines are working.
Following a deprescribing decision
Provide a tracker to monitor changes following stopping or reducing a medicine in a long-term condition review.
To inform a prescription continuation decision
If you and/or the patient are unsure if a medicine is working, provide a tracker so that the patient can actively monitor whether or not a medicine may be working to support a decision in a follow-up appointment. This may be helpful in longer-term clinics e.g. dose titration or initiating a new or add-on therapy.