Polypharmacy Service: Information for clinicians

This page is intended for healthcare professionals. Click here to access the version for patients and the public

Managing the benefits and risks of medicines

Polypharmacy refers to the use of multiple medicines by one person. While often necessary, it can sometimes lead to problems such as adverse drug reactions, drug interactions or difficulties managing treatment. Our service supports healthcare professionals in identifying and managing complex or problematic polypharmacy, with the aim of helping patients get the best from their medicines.

St George’s is one of the leading centres for the management of polypharmacy in the UK.

We run three services for the management of patients with polypharmacy:

• Polypharmacy clinic – specialist review for patients with complex or problematic polypharmacy
• Advice and Guidance service – prescribing advice for healthcare professionals to manage their own patients
• Polypharmacy multidisciplinary team meetings – a supportive forum to discuss complex cases and share expertise with clinicians from different specialties

Polypharmacy clinic

We run a weekly clinic for patients with complex or problematic polypharmacy. We review their medical conditions, medicines and treatment priorities to help optimise prescribing and address any concerns.

Appointments are available face-to-face or by telephone. We offer follow-up appointments where needed, or provide detailed recommendations for ongoing management in primary care.

Which patients may benefit from referral?

We are happy to see any patient that you have concerns about.  Suggested reasons for referral include:

• Taking a large number of medicines or having complex medication needs.
• Potentially inappropriate prescribing.
• Clinically significant drug interactions.
• Adverse drug reactions or troublesome side effects.
• Complex or uncertain prescribing decisions.
• Dependence on, or addiction to, prescribed medicines.
• Frequent hospital admissions related to medicines.
• Concerns raised by the patient, family member or carer.

How to refer

External staff

We welcome referrals from any healthcare professional involved in medicines management (e.g. GPs, pharmacists, nurses) within London.

Refer via NHS e-Referral Service (e-RS):

1. Search for “General Medicine” in the Specialty filter
2. Enter the name of the consultant clinical pharmacologist, either “Chris Threapleton” or “Daniel Burrage” in the Named Clinician box
3. Select “Clinical Pharmacology & Polypharmacy Clinic @ St George’s University Hospital – RJ7″
4. Please send a copy of the GP summary and a short summary of your concerns
5. The referrer needs to ensure that they (or the patient) books an appointment in the clinic.  Please give us at least two weeks to allow time to review the patient’s notes before the appointment.

Download our step-by-step eRS referral guide here.

We encourage all external referrals to go through e-RS.  If you are having problems with this then you can send referrals, and any questions, to MCoutPatientPathwayHub@stgeorges.nhs.uk.  Please ensure you are following information governance protocols.

Internal staff

Refer via iCLIP:

1. Open the patient’s records
2. Click Orders
3. Search for ‘Refer to Clinical Pharmacology / Polypharmacy‘
4. The referring clinician does not need to do anything else. The patient will receive an appointment and information letter by post.

The Polypharmacy team will liaise with the patient and their GP about any advised medication changes. The outcome of the review is documented in iCLIP.

We encourage all internal referrals to go through iCLIP.  If you are having problems with this then you can send referrals to internal.referrals@stgeorges.nhs.uk.  Please ensure you are following information governance protocols.

Advice and Guidance

Healthcare professionals across South West London can contact our team for specialist advice on complex medication-related questions, including problematic polypharmacy, adverse drug reactions, drug interactions and difficult prescribing decisions.

This service supports clinicians in managing their own patients and making informed decisions about their medicines.

How to get in touch

Submit an Advice and Guidance request through NHS e-Referral Service (e-RS):

1. Search for “General Medicine” in the Specialty filter
2. Enter the name of the consultant clinical pharmacologist, either “Chris Threapleton” or “Daniel Burrage” in the Named Clinician box
3. Select “Clinical Pharmacology advice only @ St George’s University Hospital – RJ7″
4. Please send a copy of the GP summary and a short summary of the main issues along with your question(s).

Polypharmacy multidisciplinary team meetings

These online meetings provide a supportive environment for discussing complex medication-related cases, exploring management options and sharing expertise across primary and secondary care.

Our aim is to support clinical decision-making, improve confidence in managing complex prescribing problems and provide opportunities for shared learning.

Chair: Dr Chris Threapleton, Consultant in Clinical Pharmacology

Membership

Any healthcare professional in SW London caring for patients with multiple and complex medicines

Attendees include: GPs, PCN pharmacists, specialist pharmacists (e.g. cardiovascular medicine, mental health), and resident doctors in Clinical Pharmacology

Examples of cases we discuss:

• problematic or complex polypharmacy
• adverse drug reactions/allergies that are problematic or limiting treatment options
• drugs of dependence
• high risk medicines

Agenda

1. Case discussion – approx 3 cases/meeting.  Please aim to share brief details with the Chair in advance
2. General questions/discussions – deprescribing a particular drug class, uncertainty in interpreting a particular test or difficulty in managing aspects of your consultations when discussing medicines
3. Brief teaching sessions (if time allows) on specific areas of prescribing and considerations when making prescribing decisions

Data governance

If you have patient consent, you can provide patient details during the meeting (and please share these with the Chair in advance).

If you don’t have patient consent, cases can be discussed without identifying information.

How to sign up

Fill in your contact details below to get the link to our meetings and keep up to date with training events.  Note, the meeting link can only be sent to an nhs.net or nhs.uk email address. Please do not forward the meeting invites to colleagues. Instead ask them to sign up via the link below.