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

  • Review clinic for patients with complex polypharmacy– to see patients directly
  • Advice and Guidance service – to support healthcare professionals to manage their own patients

Review clinic for patients with complex polypharmacy

We run a weekly telephone clinic in order to review patients, their health conditions, medicines and their priorities for treatments.  We can see patients in follow up appointments to assess their progress, or give detailed recommendations for follow up in primary care.

Who to refer

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

  • High number of medicines
  • Potentially inappropriate medicines
  • Drug interactions
  • Adverse drug reactions or side effects
  • Difficult prescribing decisions
  • Dependency or addiction to prescribed medicines
  • Frequent hospital admissions related to medicines
  • Concerns raised by the patient or their next of kin

How to refer

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 from the Polypharmacy team, for a telephone consultation on a Wednesday afternoon within two weeks

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.

External staff

We welcome referrals from any healthcare professional involved in medicines management (e.g. GPs, pharmacists, nurses) within South West London ICS.  Refer via NHS e-Referral Service (e-RS)

  1. Search for ‘Clinical Pharmacology & Polypharmacy‘ in the General Medicine filter
  2. Alternatively, search for Professor Emma Baker
  3. Please send a copy of the GP summary and a short summary of your concerns
  4. The referrer needs to ensure that they (or the patient) books an appointment in the clinic

We encourage all external referrals to go through eRS.  If you are having problems with this then you can send referrals to stgh-tr.referrals@nhs.net.  Please ensure you are following information governance protocols.

Questions about referrals?

We’d be happy to help.  Please contact us at stgh-tr.clinpharm.enquiries@nhs.net. Please ensure you are following information governance protocols.  We recommend that patient information is sent only via nhs.net email accounts.

 

Advice and Guidance

Any clinician in South West London can contact us to ask questions or request advice.

How to get in touch

Kinesis: Select ‘Clinical Pharmacology’ in the Specialty drop down box and send a message to the consultant of the week.

 

Polypharmacy resources

When reviewing patients with complex health problems and a long list of medicines, it can be challenging to determine the best course of action.  In response to this, we have developed the Clinical Pharmacology Structured Review (CPSR).  The CPSR is a system to help visualise a patient’s diagnoses, test results and prescriptions, along with their priorities and treatment goals.

There are two versions of the CPSR.  The clinician version can be used to structure your thoughts before a consultation. The patient and family version can be used during a consultation to aid shared decision making or added to a patient letter as a record of your discussion.

To access the CPSR, click here.

Details of the development of the CPSR are available here:

Threapleton CJD, Kimpton JE, Carey IM, DeWilde S, Cook DG, Harris T, Baker EH. Development of a structured clinical pharmacology review for specialist support for management of complex polypharmacy in primary care. Br J Clin Pharmacol. 2020 Jul;86(7):1326-1335. doi: 10.1111/bcp.14243. Epub 2020 Mar 16. PMID: 32058606; PMCID: PMC7319011.