Intended for healthcare professionals


Tackling overprescribing

BMJ 2021; 375 doi: (Published 20 October 2021) Cite this as: BMJ 2021;375:n2539
  1. Fraz A Mir, consultant physician1,
  2. Lindsay Morgan, senior clinical academic pharmacist2,
  3. Elizabeth Houghton, patient representative3
  1. 1Cambridge University Hospitals NHS Trust, Cambridge, UK
  2. 2University of East Anglia, Norwich, UK
  3. 3Health Education England, East of England, UK
  1. Correspondence to: F A Mir fam31{at}

Long overdue with a lot to do

The UK government recently published its long awaited review led by the chief pharmaceutical officer to evaluate overprescribing in England.1 It revealed how NHS spending on medicines increased sharply from £13bn (€15bn; $18bn) in 2010-11 to £18.2bn in 2017-18. Over one billion prescription items were dispensed in primary care alone, with an estimated 10% being “overprescribed”—that is, not needed or wanted by the patient, potentially more harmful than beneficial, or having more appropriate alternatives.

The negative consequences for patients are clear: a fifth of hospital admissions among adults over 65 are the result of adverse effects of prescribed drugs. But overprescribing has substantial environmental impact too. Currently 25% of the NHS’s carbon footprint comes from medicines, and reducing overprescribing will go some way to achieving a “net zero” NHS.2

A key recommendation of the report is cultural change to reduce reliance on medicines and to support prescribing practices based on shared decision making, reflecting patient values and preferences informed by the best available evidence and expertise.3 We live in an …

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