PCPA ACB Toolkit

Welcome to the PCPA Anticholinergic Cognitive Burden (ACB) Toolkit.

Developed to support our members and colleagues in reducing the risks associated with anticholinergic medicines, this practical toolkit brings together the key resources, guidance, and tools needed to optimise medicines use.

Whether undertaking medication reviews or leading quality improvement projects, the toolkit provides a structured approach to identifying and reducing anticholinergic burden, helping to improve patient outcomes, enhance medication safety, and support high-quality, person-centred care.

This Toolkit is supported by sponsorship from Astellas Pharma Ltd. The sponsor has had no input into the content, selection of contributors, or educational materials, and all views expressed are those of the contributors.

This toolkit is intended to support, not replace, professional clinical judgement. The PCPA and Astellas accept no liability for decisions made or actions taken based on its content. Clinicians remain responsible for individual patient assessment and adherence to relevant national and local guidance.
PCPA ACB Toolkit: June 2026

Acknowledgements

The development of this toolkit has been made possible through the expertise, collaboration, and commitment of numerous individuals.

We extend our sincere thanks to the following contributors for their valuable input, professional knowledge, and dedication throughout the development process:

Dr Graham Stretch (Lead Author), PCPA President - Partner, Argyle GP - Head of Pharmacy, Ealing Community Partners.

Philip Griffiths, Clinical Pharmacist Specialising in Care Homes.

Abigail Stirling, PCPA National Pharmacy Technician Lead, Research Lead & Clinical Pharmacy Technician.

Gareth Malson, PCPA Editor, PCPA North West Vice President and Lead PCN Pharmacist.

Lelly Oboh, PCPA Specialist Pharmacy Chair, Consultant Pharmacist (care of older people) and Overprescribing Pharmacist Lead, SE London ICS.

Robin Conibere, PCPA South West Vice President, Lead PCN Pharmacist and Partner.

We are particularly grateful to Dr Graham Stretch for their leadership, guidance, and support in bringing this project to fruition.

We also acknowledge the contributions of stakeholders, practitioners, reviewers, and subject matter experts who provided feedback, insights, and practical perspectives that strengthened the quality and relevance of this toolkit.

We are grateful to Beverley Bazant-Hegemark, Crystal Cheng, Sarah Vaukins and Laura O’Hanlon for the contribution of their Quality Improvement Projects, developed for our PCPA Frailty Academy.

We would like to acknowledge the Clinical Digital Resource Collaborative for their excellent System One ACB searches.

Finally, we also recognise the valuable support of all individuals and organisations involved in this work, whose contributions help drive improvements in best practice for reducing ACB and optimising patient care.

Disclaimer

This Toolkit is supported by sponsorship from Astellas Pharma Ltd. The sponsor has had no input into the content, selection of contributors, or educational materials, and all views expressed are those of the contributors.

This toolkit is intended to support, not replace, professional clinical judgement. The PCPA and Astellas accept no liability for decisions made or actions taken based on its content. Clinicians remain responsible for individual patient assessment and adherence to relevant national and local guidance.
PCPA ACB Toolkit: June 2026