Gabapentinoid Quality Improvement Project – Normanby Medical (2025)

Normanby Medical Centre

Project summary

The aim of the project was to reduce the prescribing of Gabapentin and Pregabalin.

The need for this project was initially highlighted by GP practice staff feeding back to prescribing leads that patients were increasingly requesting prescriptions for gabapentinoids before they were due for issue. This led to concerns about the potential overuse and dependency on gabapentinoids. In the UK, gabapentin is frequently prescribed in deprived areas, where there is a higher prevalence of chronic pain and other complex health issues. Following the concerns raised the guidance from the National Institute for Health and Care Excellence (NICE);

Neuropathic pain in adults: pharmacological management in non-specialist settings was reviewed. As NICE no longer recommends gabapentinoids for managing conditions like sciatica, low back pain, and chronic primary pain it was decided that efforts should therefore be made to review and potentially reduce these prescriptions due to the concerns about their long-term effects and risk/benefit profile. 

The initiative was run by the multidisciplinary pharmacy team at the practice including, GPs, pharmacists, technicians, and clerks. Each patient underwent an individualised review and reduction plan, initiated by a GP and managed by a pharmacy technician.
The plan created per patient included a gradual reduction in the dose people received with the goal being to stop the medications completely.

Next steps included;

• Learning shared from a chronic pain training session & reference to the NICE guidelines with practice team 
  Project outline, process and role accountabilities established
  Percentage of patient appointments per week prioritised as 'medication reduction' slots for identified patients.
  Patient preference was considered with the initial appointment and conducted either face to face or on the phone with the plan including;
• Initial appointment and reduction plan completed by a GP and then transferred to a pharmacy technician to complete the reduction plan.
• Counselling provided with no time limit applied to allow for a bespoke, per patient approach.
• Signposting made to both national and local pain support services.
• Referrals made to Primary Care Network social prescribers if highlighted that wider support would be helpful such as lifestyle and diet advice, physiotherapy, mindfulness and cognitive behavioural therapy.

A spreadsheet-based system was established to track the active patients in the current project. The status was recorded as completed, in progress, or on hold. A waiting list was also established to fill spaces when active patients completed the reduction programme.

Medications were not on repeat with only the pharmacy team issuing supplies. A pop-up alert was created with all interventions coded on the patients records so all health care professionals were aware of the reduction programme including when reduction was completed.