This time last year life had become a struggle for Ron Rigby, who was facing a growing number of health problems.

‘I like to be independent, but walking had become difficult because my feet were so badly swollen – I had to keep buying bigger and bigger shoes,’ says Ron, 88, a retired heating engineer who is widowed.

‘I had terrible insomnia, too. For about two years, I would get by on a few hours’ sleep a night.’

But a meeting last summer would prove transformational for the father of three.

He has since regained his mobility, shed a stone in weight, is sleeping through the night – and has an improved outlook on life as a result.

It wasn’t a new medication that helped – quite the opposite. What transformed Ron’s health was cutting down the number of pills he takes daily.

Having relocated from London to Poole, Dorset, to be near his daughter Loraine, 67, Ron – who had ‘a whole cupboard in my kitchen for all my tablets’ – was offered a review of the medication he was taking (known as a structured medication review, SMR), as he had enrolled at a new GP practice.

He had been taking ten of the drugs since having a heart bypass in 1995.

But the medication review led to a reduction in the number of tablets he took daily, from 14 to nine – with the result that he now feels like a new man.

Out went the lacidipine, which reduces blood pressure (but can also cause fluid to redistribute, especially in the lower legs and ankles – hence Ron’s swollen feet).

Out too went the anti-diuretics (indapamide and furosemide) he was taking to stop his feet from swelling but that were making him pee more and interrupting his sleep. Tests revealed that the furosemide, which forces the kidneys to expel excess salt and water, had caused Ron’s kidney function to decline. He says: ‘I feel so much better now. I can walk about, do my own cooking and I’m enjoying life.’

He has thrown out the extra-roomy shoes he had to buy to fit his swollen feet and says: ‘I’ve even been able to get my golf shoes back on and play the game I love again. I’ve got 13 grandchildren and 16 great-grandchildren, so that keeps me busy,’ and having previously been virtually housebound, he now says: ‘I am just back from Spain.’

Ron’s situation is far from unique. In the UK, 8.4 million people regularly take five or more medications a day and 3.8 million take eight or more, according to figures from the Department of Health and Social Care. Some people take as many as 40 different types of medication daily.

‘Appropriate combinations of multiple medicines can be good for a person’s health – but the data is also very clear that the wrong combinations of multiple medicines for an individual can also be very bad,’ says Steve Williams, a clinical pharmacist at Poole Bay and Bournemouth Primary Care Network, who carried out Ron’s medication review.

Indeed, many will be given extra drugs to counter the effect of other medication, he says. ‘I have seen it many times before. Typically, one drug causes a side-effect, which leads to another prescription, which causes further problems, which require more medication – it becomes a vicious cycle.

‘If you keep adding and never subtracting, you multiply the harm.’

In fact, every year there are one million emergency hospital admissions to the NHS in England because of harmful side-effects from medication. This represents 16.5 per cent of all unplanned admissions to hospital. 

And at least 40 per cent of them are preventable, according to figures from the Health Innovation Network (an NHS organisation that brings together medics, academics and industry), presented at a recent conference on polypharmacy – the use of multiple drugs at once.

Older people are especially at risk because not only are they likely to be taking multiple medications but also the way the body responds to medicines changes with age. For example, the liver and other organs start to process them differently.

That can mean a drug that once suited them well may have a stronger effect, or bring a higher risk of side-effects – and so the dose might need to be changed or the medicine stopped altogether, says Steve Williams.

Without SMRs, people may continue on drugs they don’t need or that do more harm than good and suffer adverse effects such as falls because of low blood pressure or low blood sugar, he adds.

Ron’s case is a good example: he was on two different blood pressure-lowering medications, ‘but these were having such a strong effect together that we actually found his blood pressure was too low’, says Steve Williams.

‘So we were gradually able to reduce the doses with careful monitoring. His blood pressure is now back to normal range.’

An SMR (also known as a medicine MOT), as Ron had, can identify problems with a drug regimen. Indeed, the National Institute for Health and Care Excellence (NICE) recommends that all those taking multiple medicines, those with long-term health conditions and older people have a review every year.

‘Data suggests upwards of three million people need a medication review annually,’ says Zoe Girdis, a pharmacist and fellow of the Royal College of Pharmacy. But many are missing out – and the situation could get worse.

An SMR involves a clinician reviewing the patient’s medications to check they are still necessary and that they’re having the desired impact. This is typically carried out by a pharmacist. But as Parliament’s Public Accounts Committee pointed out in a recent new report, too few of those who need medication reviews are actually getting them.

‘GPs are failing to properly assess and support people with, or at risk of developing, frailty. Of the 226,000 patients diagnosed with severe frailty in 2024/25, only 16 per cent had a medication review,’ the report said.

‘Thousands of patients need medication MOTs but they haven’t had them – because there isn’t the capacity or skills to provide them currently in the system,’ says Steve Williams.

Using SMRs to manage over-prescribing and problems of polypharmacy was started by a group of GPs and pharmacists trying to reduce the volume of unnecessary medicines across some GP surgeries in Wessex in 2008.

Its success led to the development of a structured three-step programme across England, called the Polypharmacy Programme. It involves using GP records to identify patients in need of a medication review, as well as educating GPs to be more confident about stopping unnecessary medicines – and sometimes not starting patients on them in the first place.

‘As doctors, we’re trained to prescribe – but not to deprescribe,’ says Dr Lawrence Brad, a fellow of the Royal College of GPs who was one of the original Wessex GPs behind the approach.

‘It’s never been taught to us and so the net result is that patients – especially older patients – have the increasing potential to end up on ten-plus medicines per day.

‘I’ve known patients to be on up to 25 different medication types per day.’

The third strand of the initiative is running patient education campaigns in GP surgeries to change their perception of needing ‘a pill for every ill’ and to encourage them to be more questioning about their medication.

Last year, economic modelling of the impact of the deprescribing programme nationwide showed that it would not only reduce the number of unnecessary medicines prescribed to patients over a three-year period (from 2022/23) but for just three types of medicine it would also save the NHS £1.1million in drug costs. There will also be significant savings from fewer hospital admissions.

Steve Williams says: ‘With this deprescribing approach, we can make patients feel better and free up the system so that there are more appointments for people who have undiagnosed conditions or who are acutely unwell.’

However, despite its success, last September programme managers said they had been unsuccessful in securing its future because of a lack of ongoing funding as part of the Government’s wider plan to abolish and restructure NHS England.

Clare Howard, a pharmacist and clinical lead for the programme, warned that once the work is paused, it would be ‘really difficult to resurrect it’ and that without continued funding, training will cease and the momentum of the initiative will be lost.

In an 11th-hour rescue, the team secured charitable donations from the Vivensa Foundation, which funds research into ageing well, which will see the Polypharmacy Programme continue until March 2027. Beyond that, its future remains in doubt – even though the NHS acknowledges how useful it is.

A spokesperson for NHS England told Good Health: ‘Over three years, this programme has been vital in training doctors how to reduce inappropriate prescribing and also how to train their colleagues to do the same.’

The end of such training would be bad news for patients like Ron, who would otherwise continue to be put on more and more medications despite unwanted side-effects.

There are some drugs doctors simply fail to stop prescribing, says Steve Williams.

A typical case, he says, is people remaining on blood thinners that were only intended to be given as a short course to reduce the risk of blood clots, but the prescription is not reviewed (and taken longer term, the drugs can cause internal bleeds). Another example, he says, is people remaining on GLP-1 obesity drugs, even after they have lost a lot of weight, which means they are at risk of dangerously low blood sugar.

He points to the example of a patient he dealt with, an 83-year-old widower, who had atrial fibrillation (an irregular heartbeat), diabetes and who last year had an operation on his prostate.

He was admitted to hospital with severe constipation after the urologist and cardiologist had both separately prescribed pills that can cause it. It was not until an SMR was conducted after hospital that the medication errors were noticed and resolved.

‘And you can’t just put a red line through a prescription, you have to review everything and deprescribe in a safe, controlled way, often carefully tapering the dose,’ says Steve Williams.

Sometimes you need to adjust, remove or add to the prescriptions, he says. In Ron’s case, as well as cutting out five tablets that were interacting and worsening side-effects, it was discovered that his insomnia was down to a painful knee because of osteoarthritis (which he hadn’t sought help for). His GP later prescribed amitriptyline to manage his nerve pain.

Another reason SMRs are vital is to ensure patients take their medications correctly: around 50 per cent of all patients don’t – and ‘this is compounded by having multiple things you need to take’, says Dr Brad.

‘The logistics become trickier if you have one thing that needs to be taken on an empty stomach, but two others that must be taken with food – and different pills that need to be taken at different intervals etc.

‘We know that almost a fifth of emergency cases admitted to hospitals [16.5 per cent] are due to harm caused by taking prescribed medicines – and taking multiple medicines increases this risk.

‘And emergency admissions to hospital – certainly the first two days – are pretty much the most expensive activity in NHS care costs. So that all adds up to an enormous drain on NHS resources.’

The total bill for prescriptions is rising year on year. In 2024/25 the NHS spent £21.6billion in England, up from £20.5billion in 2023/24. But it isn’t only about money – it is also a question of needless suffering.

Prior to her medication review, Tracy Smith, 59, a retired nurse from Burnley, was taking 21 tablets daily to cope with a range of ailments, including emphysema and fibromyalgia.

She also has osteoarthritis in both knees and pancreas divisum, a congenital condition where the pancreas has one drainage tube instead of two, causing recurrent inflammation and pain.

‘I was just having medicines added, but I didn’t feel much better,’ says Tracy, a mother of three and grandmother of ten.

‘I experienced side-effects such as a dry mouth and weight gain. I felt like I was constantly in a daze.’

Among the medications she was on were pregabalin, an analgesic used to treat nerve pain.

‘I was on 300mg twice a day and it caused a lot of side-effects,’ she says. ‘I was very tired, had terrible brain fog and I felt drugged up. I just couldn’t get my words out.’

She was under the care of specialists for her pancreas divisum and a clinical pharmacist was assigned to conduct her medication MOT. After starting on a six-month gradual deprescribing process, Tracy is now down to eight medications a day.

The pregabalin was stopped altogether, as well as two opioid painkillers, a muscle relaxant and nerve pain medication. The dose of an antidepressant she’s taking has been reduced by two-thirds (from 75mg to 25mg per day). ‘I feel so much better in the head and myself,’ she says. ‘I think the deprescribing process was really good because I just felt listened to and supported to reduce the medicines gradually.’

Tracy is now enjoying time in her allotment, teaching her great-grandson, Oliver, ten, how to grow grapes and kiwis. She says: ‘I’m less sluggish, no longer have brain fog – and even though some of the pain medication has been removed, my pain hasn’t increased.

‘I’m much better off now that the number of tablets I’m taking each day has reduced.’

So what should anyone do if they are worried about the medication they are on?

Steve Williams says: ‘Don’t stop them without advice. Contact your GP surgery and ask if you can have an SMR to check that all your medicines are working for you.’

But the bottom line is that patients need more help to ensure they only take the medication they need.

‘Patients deserve better than a system that only knows how to add drugs,’ says Zoe Girdis.

‘We cannot ignore this problem any longer. As our population ages and we treat more conditions, more medicines are prescribed but are just multiplying the harm.’

‘This is a system problem, not a prescriber problem,’ she adds. ‘Clinicians are working within a framework that incentivises prescribing and offers nothing for deprescribing.

‘When I ask a frail older person what they want from their health, the answer is rarely another tablet. It is years of healthy life.’