📊 Structured Medication Reviews: A Core Function of PCN Pharmacists
Introduction: Why Structured Medication Reviews Matter
Medicines can save lives — but when not optimised, they can also cause harm. With rising levels of polypharmacy, structured medication reviews (SMRs) have become one of the NHS’s most important interventions to improve patient safety, reduce harm, and deliver better outcomes.
PCN pharmacists are at the centre of this work. SMRs are not just routine checks — they are clinical consultations focused on optimising therapy, engaging patients, and making prescribing safer and more effective.
What Are Structured Medication Reviews?
SMRs are comprehensive, evidence-based reviews of a patient’s entire medication regimen. They are designed to:
- Ensure each medicine is appropriate, effective, and necessary
- Identify side effects, interactions, or duplications
- Support shared decision-making with patients
- Align treatment with up-to-date guidance
- Reduce unnecessary prescribing and adverse events
Unlike basic medication checks, SMRs are proactive and patient-centred.
Who Benefits from SMRs?
NHS England recommends prioritising SMRs for:
- Patients with polypharmacy (particularly ≥10 medicines)
- Those living with frailty
- Residents in care homes
- People with long-term conditions such as hypertension, diabetes, COPD, or CVD
- Patients taking high-risk medicines (e.g. anticoagulants, opioids, NSAIDs)
These groups face the highest risk of medication-related harm — and benefit most from structured review.
The Pharmacist’s Role in SMRs
PCN pharmacists are trained and supported to lead SMRs. Their responsibilities include:
- Reviewing the patient’s full medication list and medical history
- Assessing each drug for clinical appropriateness
- Identifying potential interactions or therapeutic duplications
- Discussing with the patient how they use and feel about their medicines
- Liaising with GPs or other clinicians about necessary changes
- Documenting outcomes clearly and safely
Pharmacists bring unique expertise and time to these reviews, often uncovering issues that might be missed in routine consultations.
Why SMRs Improve Patient Safety
Unsafe or unnecessary prescribing is a major cause of avoidable harm. SMRs:
- Reduce the number of unnecessary or duplicate medicines
- Prevent dangerous drug interactions
- Improve patient adherence by simplifying regimes
- Identify and address side effects early
- Support safe deprescribing
Evidence shows that pharmacist-led SMRs can significantly lower hospital admissions related to adverse drug events.
Supporting Better Outcomes and QOF/IIF Delivery
SMRs are not only clinically valuable — they are also strategically important for PCNs:
- They contribute to IIF targets linked to medication safety and optimisation.
- They help practices meet QOF indicators related to LTC control.
- They support NHS England’s medicines value and safety strategy.
This makes SMRs both a clinical and organisational priority.
Involving Patients in Their Care
SMRs are not just about clinical decisions — they are about listening to patients. Many patients:
- Don’t fully understand why they take certain medicines
- Experience side effects but don’t report them
- Struggle with complex dosing schedules
Pharmacists use SMRs to have honest, patient-centred conversations that lead to better engagement and adherence.
Future Outlook: Expanding SMRs Through Pharmacist Leadership
As more pharmacists become independent prescribers, SMRs will become:
- More efficient, with pharmacists able to implement changes directly
- More widely available to different patient groups
- Better integrated with digital tools and population health strategies
SMRs will continue to evolve from being a “target to hit” to a core pillar of safe, effective primary care.
How Prescribing Care Direct Supports SMR Delivery
At Prescribing Care Direct, we support PCNs and GP practices to:
- Deploy experienced pharmacists to deliver high-quality SMRs
- Integrate SMR activity with LTC clinics and care home reviews
- Provide clinical governance and reporting support
- Train and upskill pharmacists to deliver advanced SMRs
Our approach ensures SMRs aren’t just completed — they make a meaningful impact on patients and practices.
Conclusion: SMRs as a Cornerstone of Safer Care
Structured medication reviews are one of the most effective tools in primary care to prevent harm, optimise treatment, and empower patients. PCN pharmacists are uniquely skilled to deliver them with the time, expertise, and focus they require.
By embedding SMRs into routine practice, PCNs can improve outcomes, reduce hospital admissions, and meet strategic priorities — all while improving patient experience.
📞 Call to Action:
To strengthen your SMR programme and enhance medicines safety in your PCN, partner with Prescribing Care Direct.
👉 Contact us to explore tailored pharmacist support for your network.