PrescQIPP

Safer Prescribing at Scale: A PCN‑Wide Approach to Reducing Overprescribing and Improving Patient Safety

Apex PCN

Project summary

Overprescribing of high‑risk medicines is a well‑recognised contributor to avoidable harm, particularly among vulnerable populations such as older adults with dementia and patients prescribed long‑term psychotropic medication. The APEX PCN Pharmacy Team identified unwarranted variation in antipsychotic use, sedative prescribing and medicines contributing to high anticholinergic burden, alongside limited system visibility for patients at risk of dependence and misuse. This project aimed to improve patient safety by proactively identifying and addressing high‑risk prescribing at scale.

Using prescribing data and population health insights, the team developed and implemented a PCN‑wide, pharmacist‑led deprescribing programme. Structured medication reviews were targeted at patients with dementia, long‑term antipsychotic use (including those under 60), Z‑drug exposure and high anticholinergic burden. Evidence‑based deprescribing protocols were applied, supported by close clinical collaboration with GPs, Community Mental Health Teams and Lincolnshire Partnership NHS Foundation Trust.

In parallel, a digital alert system was designed and embedded into routine workflows to flag patients at risk of addiction, dependence or misuse. This alert ensured full visibility across practice and PCN teams, supported early intervention, and was incorporated into staff induction to ensure sustainability.

The project delivered clear, measurable improvements in patient safety outcomes. Following clinical review:

  • 42% of dementia patients had antipsychotics safely stopped.

  • Z‑drug use reduced by 50%, with switches to PRN use and deprescribing plans in place.

  • 40% reduction in medicines contributing to high anticholinergic burden (ACB >3), reducing risks of falls, sedation and cognitive decline.

Patients benefited from fewer adverse drug effects, safer prescribing, and more individualised medication regimens. Clinicians reported improved confidence in deprescribing and greater clarity when managing high‑risk prescribing.

The programme required minimal financial investment, relying on advanced pharmacist capability and data‑driven targeting. Cost avoidance was achieved through reduced inappropriate prescribing, fewer adverse events, and decreased long‑term medicines dependency, supporting a strong return on investment.

Crucially, the work is fully embedded into routine practice, reproducible across other PCNs, and aligned with wider system priorities on medicines optimisation and patient safety. This project demonstrates how proactive, data‑led deprescribing can deliver sustained reductions in overprescribing while improving patient outcomes at scale.