A patient who was stable on paper

Rose is 79. She’s been married for sixty years, and her son helps manage her medicines. Across her clinical records, she’s recorded as taking her medicines as prescribed, clinically stable and well managed.

Take the time to sit down and properly review her medicines, and a different picture starts to form. Rose is taking 21 prescribed medicines, including one she’s been on for almost thirty years for an indication that resolved long ago, and an inhaler she’s been using at half the prescribed dose because she believes the correct dose makes her feel unwell, a concern nobody had ever explored.

No individual prescribing decision was wrong when it was made. The problem was that opportunities to review whether those decisions still made sense had been missed. That gap has a name: prescribing inertia.

Naming the problem

Prescribing inertia is the continuation of medicines without active reassessment of their benefit, risk and clinical relevance. It builds quietly, one repeat prescription at a time, and if neighbourhood health is genuinely about prevention and independence, it isn’t a peripheral issue. It’s a leadership challenge.

That’s the thinking behind the Staying Well Service, where I work as a specialist prescribing pharmacist embedded in an integrated neighbourhood team. We support adults aged 55 and over living with mild to moderate frailty, identified through risk stratification and the electronic Frailty Index. For Rose, that meant someone finally asking not whether she was taking her medicines, but whether she still needed them.

Why this still feels difficult

None of this is new. Deprescribing has been part of the professional conversation for years, with guidance, frameworks and tools that most pharmacists already know well. In this blog I want to look at why, despite that, so many of us still hesitate to act on it in practice.

Some of that reluctance is understandable. Stopping a medicine can feel riskier than continuing it, even when the evidence points the other way, and nobody wants to be the person who unpicks a decision made by someone else. But some of it also comes down to how we’ve framed our own role. If deprescribing only happens when a patient looks complicated enough to warrant it, it will always feel like an exception rather than a normal part of the role.

That’s the reframe I think we need. Clinical scrutiny of every medicine on a patient’s list shouldn’t be a special intervention. It should be what a structured medication review is for, working with patients and the wider multidisciplinary team to ensure treatment remains appropriate. If we only ever ask whether a regimen is safe to continue, we’ll keep finding patients like Rose years too late.

A snapshot of what’s possible

This is what prioritising deprescribing can look like in practice. Over five months, the Staying Well Service reviewed 123 patients and generated 281 medicines optimisation interventions, including 37 structured deprescribing plans targeting longstanding prescribing inertia.

Some of the most consistent gains came from targeting specific drug classes where long-term use had quietly outlived its original purpose. Some patients remained on antidepressants long after the original indication was no longer relevant. Others were taking gabapentin at doses that had crept up over time without the original indication ever being revisited. Some proton pump inhibitors continued well past their recommended review point, often started for short-term symptom control and never stopped. Six patients had their high anticholinergic burden eliminated completely.

In each case, the pattern was the same: the opportunity to revisit whether the medicine was still needed had been missed. Once we did, this kind of deliberate, targeted scrutiny brought measurable reductions in polypharmacy, anticholinergic burden and high-risk prescribing, demonstrating what can be achieved when deprescribing becomes part of routine practice rather than a special project.

Why this matters for the profession

This work speaks directly to the profession’s commitment to put patients at the forefront of what we do. True patient-centred care means looking past the reassurance of a repeat prescription and looking at the person in front of us. Rose was stable on paper, but she was carrying risk that had accumulated over years, and her situation wasn’t unusual.

If neighbourhood health is serious about prevention, we need to get better at asking a harder question of treatments that have become routine. Not “is the patient taking this medicine?” but “does this medicine still deserve its place?”

Change like this rarely starts with a new policy. It starts when someone decides that what’s become normal isn’t good enough, and acts on it. For Rose, that meant a holistic medication review with deprescribing built in as a core function, not an afterthought. It meant treatment that better reflected her needs today, rather than the decisions made decades ago. For neighbourhood health, it means pharmacists willing to take on that leadership challenge.

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