Polypharmacy is a defining challenge of geriatric care in the UK. According to NHS England estimates, around one in ten hospital admissions among over-65s is medication-related, and a substantial proportion of those involve adverse drug reactions from medicines that may no longer be clinically necessary. Community and clinical pharmacists are increasingly positioned as the professionals best placed to identify these medicines and recommend their safe withdrawal.

What deprescribing means in practice

Deprescribing is the planned, supervised process of reducing or stopping a medicine that may be causing harm or is no longer providing benefit. It is not the same as non-adherence — it is a clinical decision, ideally made collaboratively between the prescriber, the pharmacist and the patient.

The process typically involves reviewing each medicine against current clinical need, assessing the risk-benefit balance in the context of the patient's overall prognosis and goals of care, and tapering or withdrawing medicines in a structured sequence. Certain drug classes — proton pump inhibitors, benzodiazepines, antihypertensives, statins in very frail patients, and long-term antidepressants — are among the most commonly reviewed for deprescribing.

The STOPPFrail criteria

The STOPPFrail (Screening Tool of Older Persons' Prescriptions in Frail adults with limited life expectancy) criteria, developed by researchers at University College Cork, provide an evidence-based framework for identifying medicines that may be inappropriate in frail older adults. The tool lists 27 criteria covering drug classes that are frequently continued beyond the point of benefit, including lipid-lowering agents in patients with limited life expectancy, long-term proton pump inhibitors without ongoing indication, and memantine or cholinesterase inhibitors in advanced dementia.

STOPPFrail complements the broader STOPP/START criteria used in structured medication reviews. While STOPP/START applies across the older population, STOPPFrail is specifically designed for patients who are severely frail, have a poor one-year survival prognosis, or whose primary goal of care has shifted to symptom control.

NICE guidance on medicines optimisation

NICE guideline NG5 (Medicines Optimisation) and the associated quality standard QS120 establish that all patients on multiple medicines should receive regular medication reviews, with particular attention to those aged 65 and over. The guideline explicitly recommends considering whether any medicines can be stopped.

NICE clinical guideline CG76 (Medicines Adherence) and the more recent NG56 (Multimorbidity: Clinical Assessment and Management) reinforce that clinicians should discuss the possibility of stopping medicines that are no longer needed. NG56 is particularly relevant: it recommends that for patients taking ten or more medicines, an approach to reduce treatment burden should be considered at every review.

The pharmacist's role

Community pharmacists encounter opportunities for deprescribing during several routine touchpoints:

According to PharmSee's tracking of 1,715 active pharmacy vacancies across 11 public sources, two current NHS listings explicitly mention frailty pharmacist roles — a "Band 8a Senior Clinical Pharmacist, Frailty" and a "Lead Pharmacist for Frailty." These specialist posts reflect growing NHS investment in pharmacist-led deprescribing, though the majority of deprescribing work happens within generalist community and PCN pharmacist roles.

What pharmacists should watch for

Several red flags suggest a patient may benefit from a deprescribing review:

• Ten or more regular medicines — the NG56 threshold for considering treatment-burden reduction
• Recent falls — may indicate medication-related dizziness, hypotension or sedation
• Cognitive decline — reduced capacity to manage complex regimens and higher sensitivity to anticholinergic load
• Declining renal function — drugs cleared renally may accumulate to harmful levels
• A recent transition of care — hospital-to-home transfers frequently introduce new medicines without reviewing existing ones

Practical barriers and how to overcome them

Deprescribing can feel uncomfortable for patients who have taken a medicine for years. Research published in the British Journal of Clinical Pharmacology suggests that most older patients are willing to have medicines deprescribed if their doctor or pharmacist recommends it, but few will initiate the conversation themselves. The pharmacist's role is therefore often one of identifying the opportunity and communicating it clearly to the GP or prescriber.

In community pharmacy, the main practical barrier is access to the full clinical record. The NHS Summary Care Record provides some information, but shared care records (where available) give a more complete picture. PCN-based clinical pharmacists, who have full GP record access, are particularly well placed to lead deprescribing reviews.

Where to explore further

Pharmacists looking to benchmark local prescribing patterns can use PharmSee's pharmacy search to examine dispensing volumes by area, or explore job listings for roles with a geriatric or medicines optimisation focus. The salary data section also tracks how specialist pharmacist roles, including those in frailty and older-person care, compare to generalist positions.

Caveats

Deprescribing decisions are clinical judgements that must be made on an individual basis. The STOPPFrail criteria and NICE guidance are decision-support tools, not prescriptive rules. Any change to a patient's medicines should be made in collaboration with the prescribing clinician and with the patient's informed consent. The vacancy data cited above is drawn from PharmSee's tracking of 11 public job sources as at April 2026; sample sizes for specialist roles are small and should be treated as directional indicators only.

Sources

• NICE NG5: Medicines Optimisation (2015, updated)
• NICE NG56: Multimorbidity: Clinical Assessment and Management (2016)
• O'Mahony D et al., STOPPFrail criteria, Age and Ageing (2017)
• NHS England: Structured Medication Reviews and Medicines Optimisation
• PharmSee vacancy database, 1,715 active roles as at 15 April 2026