Reconsidering ‘problematic’ polypharmacy: an opportunity for developing advanced generalist skills

Abstract

Managing problematic polypharmacy is a complex area of clinical practice and is increasingly recognised as an educational need for newly qualified and experienced GPs. The RCGP curriculum includes this area as a requirement for completion of training, but how this is achieved is devolved to trainers and trainees working in their local training programmes. GPs at all career stages continue to report feeling unconfident in this important, but complex, area of practice. This article aims to address some of these concerns. We will outline the evidence about barriers preventing clinicians from reducing problematic polypharmacy in practice. We will introduce evidence from the Tailor report describing how these barriers can be overcome and focus on the role of trainees and newly qualified GPs in managing problematic polypharmacy. The Tailor report is a recently published synthesis of the evidence surrounding the management of polypharmacy. In particular we will focus on a key output from the report – the DExTruS framework. This has potential applications in GP training and provides a useful structure for developing the skill of deprescribing by AiTs.