The aim of this study was to improve clinical management through rationalization of repeat prescribing in an inner-city practice with a high percentage of older adults with extensive comorbidity through systematic review and cost containment. Outcome measures were based on an analysis of PACT data for level and cost of prescribing before and after the systematic reviews, reported patient and staff satisfaction with changes and the identification of drug interactions. The formalization of a 28-day prescribing cycle and systematic review every 6 months was almost universally acceptable to patients and staff. The systematic review led to a decrease in prescribing costs of 12% over 2 years. The number and cost of wound dressings decreased by almost 50%. The prescribing of inappropriate medications, over-the-counter drugs, benzodiazepines and combinations of drugs that interacted was reduced. The study demonstrates that monitoring and rationalization of repeat prescribing can reduce costs and improve quality of care. In addition, increased surveillance on the part of the reception staff improved communication both between members of staff and between members of staff and patients. This led to increased confidence in repeat prescribing among all staff.