Skill Profile
Medicines Optimisation
"The observable action of reviewing a patient's complete medicine regimen — assessing efficacy, safety, adherence, and appropriateness — and making evidence-based recommendations to maximise therapeutic benefit while minimising harm."
YOUR SKILLS
Problems This Skill Solves
- Patients on 10 or more medicines (polypharmacy) accumulate prescriptions from multiple clinicians without anyone reviewing the regimen as a whole — medicines optimisation identifies therapeutic duplication, unnecessary drugs, and dangerous combinations that no individual prescriber spotted.
- Subtherapeutic dosing caused by prescribers following standard doses without accounting for renal impairment, drug interactions, or pharmacogenomic variation — review adjusts doses to achieve the intended clinical effect.
- Avoidable hospital admissions driven by medication-related harm (falls from antihypertensives, bleeds from anticoagulants, delirium from anticholinergics) — structured review identifies and removes or reduces the causative agents.
- Poor adherence caused by complex regimens patients cannot realistically follow — simplification (once-daily formulations, pill organisers, dose synchronisation) improves adherence and outcomes without changing therapy.
Tools Used
Roles That Use This Skill
1 total · 1 industryThis skill is concentrated in one industry.
Pharmacy / Healthcare / NHS
"Medicines optimisation is mainly about clinical review — review the patient's medication list and stop anything that is no longer indicated."
Stopping inappropriate medicines is one outcome of optimisation. The practice also involves ensuring that indicated medicines are being taken effectively, identifying patients who would benefit from medicines they are not receiving, managing polypharmacy interactions, ensuring patients understand their medicines and can use them correctly, and monitoring for therapeutic response and adverse effects. Medication review without these elements identifies what to remove but not how to achieve better outcomes.
Research & Outlook
NHS England's Clinical Pharmacist in General Practice programme has embedded pharmacists in GP practices across England, creating a major expansion in the workforce delivering medicines optimisation at scale. AI-powered prescribing safety tools integrated into EPR systems are increasingly flagging medicines optimisation opportunities automatically — but the clinical judgement to evaluate individual patient context, weigh up risks and benefits, and have the difficult conversation with a patient about stopping a medicine they believe is helping them remains irreducibly human.
See This Skill In Action
Watch a professional demonstrate Medicines Optimisation in a real working environment — what it looks like, how it's applied, and why it matters.
Healthcare / Pharmacy
Medicines Optimisation
Also Known As
Growth Path
Conducts a structured medicines reconciliation on admission, identifying discrepancies between prescribed and actual medicines. Applies the BNF interaction checker and flags high-risk combinations for clinical review. Checks doses against renal function for commonly prescribed drugs. Understands the principles of STOPP/START criteria and can apply them under supervision.
Independently conducts structured clinical medicines reviews for complex patients — applying STOPP/START, assessing adherence, adjusting for organ impairment, and generating a prioritised recommendation list. Communicates recommendations clearly to prescribers and documents interventions. Leads ward-based medicines optimisation activity in hospital or care home settings.
Leads medicines optimisation programmes at organisational or system level. Designs and implements prescribing safety audits, deprescribing protocols, and high-risk drug monitoring policies. Trains clinical pharmacists and prescribers in structured review methodology. Contributes to formulary development and medicines management governance. Works as an independent prescriber managing complex polypharmacy patients autonomously.
How to Practise
- 1.Take the complete medicine list of a fictional polypharmacy patient and apply STOPP/START criteria systematically — identify every drug that should be stopped and every therapy that should be started.
- 2.Practise renal dose adjustment using the Cockcroft-Gault equation for 10 commonly prescribed drugs — see how much doses change across different levels of renal impairment.
- 3.Complete the CPPE (Centre for Pharmacy Postgraduate Education) medicines optimisation e-learning programme, which includes case-based assessments.
- 4.Attend or observe a structured medicines review consultation and note how the pharmacist structures the conversation — what they ask, what records they access, and how they communicate recommendations.
How to Prove
- ·Documented medicines optimisation consultations in a clinical portfolio demonstrating interventions made, clinical rationale recorded, and outcomes tracked (e.g., number of medicines stopped, hospital admissions prevented).
- ·Pharmacy independent prescribing qualification (RPS-accredited) — the highest credential demonstrating medicines optimisation at the level of autonomous clinical practice.
- ·CPPE or RPS medicines optimisation credentials, or completion of a clinical pharmacist training pathway approved by NHS England.
- ·Audit data showing measurable improvement in prescribing quality indicators (e.g., PINCER measures, polypharmacy rates, high-risk drug monitoring) attributable to your review activity.