NHS Specialist Pharmacy Service

• Polypharmacy 5 moments: Frailty: when less is more

  In our final episode, we explore frailty, a state of reduced resilience that makes people—particularly older adults—more vulnerable to adverse drug effects and prescribing cascades. Those living with frailty often have multiple long-term conditions, take polypharmacy, and benefit from a more personalised, “less is more” approach. (12m59s) We discuss what frailty looks like in everyday community pharmacy encounters, which medicines to look out for, and how to identify potentially inappropriate medicines prescribed. Through practical examples, we show how to ask the right questions, focus on what matters most to patients, and collaborate with general practice to reduce overprescribing through Structured medication review referrals. We highlight why, in frailty, taking fewer medicines can reduce harm and improve outcomes. Lelly Oboh, Consultant Pharmacist (Care of Older People) and Older People Lead (NHS Specialist Pharmacy Service) Rakhi Aggarwal, Primary Care Lead (NHS Specialist Pharmacy Service)

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• Polypharmacy 5 moments: Persistent non-adherence

  Here we focus on non-adherence, which often signals that medicines may no longer be appropriate, wanted, or manageable. The reasons are multifactorial and can include side effects, motivation and beliefs, or cognitive, capacity and physical barriers. We discuss how community pharmacy teams, through everyday interactions with patients, relatives and carers, can use curious, patient-centred questions to uncover the real causes of non-adherence and identify any additional support needed. We also explore how, alongside practical interventions such as adjusting formulations or offering compliance aids, pharmacy teams should recognise when deprescribing may be appropriate, advice and refer for a Structured Medication Review- aiming to ensure that solutions always align with the patient’s changing needs, context and priorities. (13m0s) Lelly Oboh, Consultant Pharmacist (Care of Older People) and Older People Lead (NHS Specialist Pharmacy Service) Rakhi Aggarwal, Primary Care Lead (NHS Specialist Pharmacy Service)

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• Polypharmacy 5 moments: Repeat dispensing and supply

  This episode explores repeat dispensing and repeat supply as key moments to start meaningful conversations about medicines. When patients or carers order or collect prescriptions, these touchpoints create space to ask about side effects, check whether medicines are working, still wanted, and being taken as intended We share simple conversation starters, ways to involve the whole pharmacy team, and when to signpost patients for a Structured Medication Review to reduce pill burden, improve adherence, minimise waste, and avoid efficiently dispensing medicines that are no longer needed. (9m52s) Lelly Oboh, Consultant Pharmacist (Care of Older People) and Older People Lead (NHS Specialist Pharmacy Service) Rakhi Aggarwal, Primary Care Lead (NHS Specialist Pharmacy Service)

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• Polypharmacy 5 moments: Significant changes

  In this episode, we focus on significant changes, especially after hospital discharge or when new, uncontrolled or worsening symptoms appear. For older people, these are times when medicines often change and when adverse effects, drug interactions or prescribing cascades can easily be missed. We discuss how simple, everyday community pharmacy conversations can uncover medicine-related problems early, how to recognise when symptoms may be drug-related, and why transitions are the ideal time to rethink, review and realign treatment with what matters most to patients as their needs change. (14m08s) Lelly Oboh, Consultant Pharmacist (Care of Older People) and Older People Lead (NHS Specialist Pharmacy Service) Rakhi Aggarwal, Primary Care Lead (NHS Specialist Pharmacy Service)

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• Polypharmacy 5 moments: Returned medicines

  In this episode, we look at returned medicines as a key moment to spot potential overprescribing. When patients or carers bring back unwanted items, Rather than simply accepting them back, it opens the door to curious, non-judgemental conversations about why medicines weren’t taken and whether they’re still needed, inappropriate or causing harm. Through examples and simple open questions, we show how this everyday moment can reveal prescribing cascades, side effects and unmet needs—and how the whole pharmacy team can frame sensitive conversations to support safer, more appropriate prescribing. (14m52s) Lelly Oboh, Consultant Pharmacist (Care of Older People) and Older People Lead (NHS Specialist Pharmacy Service) Rakhi Aggarwal, Primary Care Lead (NHS Specialist Pharmacy Service)

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