Normalizing safe deprescribing: a qualitative study of primary care professionals’ views using normalization process theory

Objectives The aim of the study was to enhance understanding of how proactive deprescribing can be implemented in primary care. This study explored the views of healthcare professionals (HCPs) on the normalization of safe and routine deprescribing in English primary care.

Methods An interview guide was developed from deprescribing literature and underpinned by Normalization Process Theory. Interviews and focus groups were conducted with general practitioners, primary care pharmacists, community pharmacists, and clinical commissioning group staff involved in medicines optimization. Focus groups were conducted online, while interviews were conducted via telephone or online using Microsoft Teams®. Focus groups and interviews were transcribed verbatim, and data were analysed using Framework analysis to generate themes.

Key findings Thirty participants (57% female), consisting of general practitioners (n = 9), community pharmacists (n = 6), primary care pharmacists (n = 14), and a clinical commissioning group staff member (n = 1), were recruited to three online focus groups, eight online interviews, and one telephone interview. Three themes were developed: (i) ‘Current deprescribing climate’ highlighted factors promoting pressure to prescribe rather than deprescribe; (ii) ‘Routine implementation, roles and responsibilities’ emphasized the role of patients and pharmacists in routine deprescribing; (iii) ‘Keeping deprescribing safe’ identified strategies for maintaining safety during deprescribing. Deprescribing normalization can be strengthened by leveraging cognitive participation (engagement work) and collective action (the work required to implement the intervention).

Conclusions Normalizing deprescribing is challenging due to entrenched prescribing habits, safety concerns, and legal uncertainties. HCPs’ personal experiences shaped confidence in deprescribing. Participants emphasized the importance of structured guidelines and teamwork in embedding deprescribing into practice. Expanding roles, establishing clear protocols, and fostering collaboration were viewed as essential for safe implementation.