ADOPTED: Social Prescribers In Deprescribing Role (SPiDeR)
Dr Kinda Ibrahim, Pharmacist and Lecturer, Faculty of Medicine, Deputy Lead Ageing and Dementia, ARC Wessex
Dr Sara McKelvie, NIHR Clinical Lecturer in General Practice
Dr Eloise Radcliff, Research Fellow, Faculty of Medicine
Emma Ward, 3rd Year Medical Student
Lizzie Wimbourne, PhD candidate and Policy Intern (supported by Gareth Giles)
Dr Laura Bryant, GP and School of Primary Care Apprentice
Pam Douglas and Neil Wilson, Public Contributors and Co-applicants
Senior Support Prof Hazel Everitt, Dr Stephanie Tierney, Prof Peter Griffiths and Prof Joanne Reeve
Starts: April 2023
Ends: September 30, 2024
In the UK, a third of all people aged 65 years and above regularly take five or more medications, known as polypharmacy. Polypharmacy can increase the risks of side effects and hospital admissions. One of national priorities for NHS England set by the Chief Pharmacist, is to reduce prescribing unnecessary medication (overprescribing) by 10% for patients being treated by their GPs.
One important way to identify and stop harmful medication is called a Structured Medication Review (SMR) but only half of older patients attended their GP practice for this in 2018-19. Instead of medicines, some people might benefit from other activities such as changes in diet, ways to reduce stress, increasing exercise or participating in group activities. Social prescribers are starting to work within GP teams to direct people to some of these activities.
The Chief Pharmacists report on overprescribing suggested that NHS England should expand the use of SMRs in GP practices to benefit patients most at risk of overprescribing. They also recommended the involvement of trained social prescribing link workers as part of GP teams to support patients during and after a SMR.
We currently don’t know how social prescribers can be integrated in the SMR process or whether this will have an impact on overprescribing for older people. The aim of this study is to explore the role of social prescribers in the SMR process and identify any training needs or resources required to enable their active involvement in the process.
We will hold focus groups with healthcare professionals (GPs, pharmacists and social prescribing link workers) and interview older people who have experience of taking several medicines and/or their caregivers to:
1- Understand whether there is a role for social prescribers in SMR in Primary Care teams
2- Identify training needs for social prescribers to be actively involved in Primary Care teams who are doing SMR reviews
3- Identify factors that might prevent or improve social prescribers’ involvement in SMR
4- Consider what older people and healthcare professionals felt about alternatives to medications and map relevant activities and guidance that could be used as a substitute to medications such as dietary advice, exercise groups or cognitive behaviour therapy
5- Develop a model to describe how social prescribers can be best involved in SMR
Understanding the role of social prescribing link workers in the SMR process might increase the use of non-medical solutions for health-related problems and reduce overprescribing. This study could help develop the role of social prescribers and understanding how they could work in primary care to support SMR. We hope this research will help us design and test different models of how social prescribers can work within GP teams to support deprescribing.