Skill Profile
Prescription Review
"The observable action of systematically reviewing a patient's full medication list — checking for clinical appropriateness, interactions, duplications, doses, and omissions — and recommending changes that optimise the therapeutic benefit and minimise the risk of harm from the prescribed regimen."
YOUR SKILLS
Problems This Skill Solves
- Patients on multiple medications with no review of the overall regimen for appropriateness — a structured medicines review identifies drugs that are no longer indicated, drugs that have been continued indefinitely without review, and opportunities for deprescribing.
- Prescribing cascades where a new drug is prescribed to treat a side effect of an existing drug — systematic review recognises cascade prescribing and recommends stopping the causative drug rather than adding a new one.
- Doses that are inappropriate for the patient's current renal or hepatic function — reviewing eGFR and liver function against each drug's dose adjustment requirements prevents accumulation and toxicity in patients with organ impairment.
- Patients on medicines for secondary prevention (statins, antiplatelets, ACE inhibitors) who have deteriorated to a stage where these drugs no longer provide meaningful benefit — deprescribing in appropriate patients reduces pill burden and side effect risk.
Tools Used
Roles That Use This Skill
1 total · 1 industryThis skill is concentrated in one industry.
Pharmacy / Healthcare / NHS
"Adding more medications for more conditions always improves outcomes — if a drug is indicated, it should be prescribed."
The evidence base for most chronic disease medications was developed in patients taking few other drugs, at younger ages, and often excluding the frail elderly. In patients with multiple long-term conditions and polypharmacy, each additional drug adds interaction risk, side effect burden, and pill burden that can itself worsen outcomes. Deprescribing — systematically removing drugs that are no longer providing benefit in excess of their risk for a specific patient — is an evidence-based intervention that improves quality of life and reduces harm in appropriately selected patients.
Research & Outlook
Pharmacist-led Structured Medication Reviews (SMRs) are expanding in primary care under the NHS Primary Care Networks programme — creating new roles for clinical pharmacists embedded in GP practices. AI-assisted prescribing review tools are beginning to automate the identification of STOPP/START flags and renal dose adjustment requirements at scale, shifting pharmacist focus towards complex cases and deprescribing conversations that require clinical judgement.
See This Skill In Action
Watch a professional demonstrate Prescription Review in a real working environment — what it looks like, how it's applied, and why it matters.
Healthcare / Clinical Pharmacy
Prescription Review
Also Known As
Growth Path
Reviews a medication list for obvious problems — duplicate drugs, wrong doses, known contraindications, missing monitoring. Uses STOPP/START criteria systematically. Documents identified problems clearly and escalates recommended changes to the prescriber.
Leads structured medication reviews for defined patient populations (care home residents, patients with polypharmacy, post-discharge patients). Applies clinical knowledge to identify complex interaction and appropriateness issues. Initiates deprescribing conversations with patients and prescribers. Produces a written review summary with clearly reasoned recommendations.
Leads the medicines optimisation programme for a clinical network or ICB — designing review frameworks, training clinical pharmacists and pharmacy technicians, and improving prescribing quality indicators across a population. Contributes to NICE guideline development and medicines optimisation research.
How to Practise
- 1.Conduct a structured medication review using the STOPP/START criteria for a real or hypothetical patient case — identify all potentially inappropriate prescribing, prescribing omissions, interactions, and dose issues.
- 2.Practise deprescribing conversations — role-play discussing stopping a medication with a patient who has been on it for years, addressing their concerns about withdrawal and the reasons for stopping.
- 3.Review ten patient medication lists from a real clinical setting (anonymised) and apply renal dose adjustment requirements — identify how many patients have doses that are potentially too high for their eGFR.
- 4.Study common prescribing cascades — identify 10 classic examples (e.g., NSAID → antihypertensive → diuretic → loop diuretic) and practise recognising them in clinical records.
How to Prove
- ·GPhC registration with clinical pharmacy experience — demonstrating professional qualification and clinical pharmacy practice.
- ·Medicines Use Review (MUR) or Structured Medication Review (SMR) accreditation — NHS-funded services requiring demonstrated competency in medication review.
- ·Clinical medication review records — documented reviews showing identified problems and recommended changes.
- ·Clinical pharmacy diploma or MSc — demonstrating advanced competency in medicines optimisation.