Scotland currently has a well-developed polypharmacy review programme, which is now in its fourth year. National Polypharmacy Guidance (2012, 2nd edition 2015) was developed by a multidisciplinary group and has been adopted by all 14 health boards (100%) across Scotland, with each board having developed plans to identify priority patients with potentially inappropriate elements to their polypharmacy and to implement reviews for those patients at highest risk of harm. These reviews are now embedded in standard working practices across primary care supported by direct funding to General Practitioners (GP) to enable this work to be undertaken in a sustainable fashion. Employment of pharmacists working in primary care in collaboration with GPs and as independent prescribers to undertake polypharmacy reviews in line with the national strategy ‘Prescription for Excellence’ (Scottish Government, 2013) also supports sustainability, with ministerial funding for 140 pharmacists initially in 2015 to be expanded to a pharmacist for all GP practices in Scotland. Most recently the introduction of mobile app (ref) has sustained acceleration of implementation. This case study, conducted as a desk review of available documents plus multiple interviews with key players in policy development followed by stakeholder focus group discussions, served to detail the development of what is considered to be a sustainable programme, focused on identifying the key factors which enabled the programme to be rolled out at national scale.