Structured medication reviews (SMRs) are a core PCN pharmacist activity. Deprescribing — safely stopping unnecessary medications — is where pharmacists add unique value.
Medstopper: Primary deprescribing guidance tool. Provides evidence-based protocols for stopping common medications — PPIs, antihypertensives, statins, antidepressants, bisphosphonates. Free.
STOPPFrail criteria: Deprescribing framework specifically for frail and end-of-life patients. Identifies medications that may be futile or harmful in the context of limited life expectancy.
NICE polypharmacy guidelines: NICE NG5 (medicines optimisation) provides the framework for medication review and deprescribing decisions.
BNF: Monitoring requirements, withdrawal schedules (particularly for antidepressants, benzodiazepines, opioids), drug interaction impacts of stopping one medication in a polypharmacy regimen.
Ask iatroX: Synthesises deprescribing queries across guidelines — "is it safe to stop X in a patient with Y?" with cited evidence.
SMR process: Holistic medication review → identify potentially inappropriate medicines → discuss with patient and GP → plan deprescription with monitoring → follow up.
CPD value: SMRs and deprescribing consultations generate excellent CPD and reflective evidence for revalidation.