Insight · SMRs
Insight — Structured Medication Reviews — done well.
Who an SMR is actually for.
The DES sets out priority cohorts for SMRs — patients on potentially harmful medicine combinations, patients with frailty, patients in care homes, patients on more than ten regular medicines, and patients prescribed potentially addictive analgesics. In practice the highest-impact cohort for most PCNs is over-75s on ten or more medicines, especially where care home residency, recent hospital admission or polypharmacy with anticholinergic burden is present. Selecting tightly against these criteria is the single biggest determinant of SMR programme value.
Cohort selection
Where to start a new SMR programme.
- Over-75s on 10+ regular medicines
- Care home residents
- Recent unplanned hospital admission with medicines on discharge
- Anticholinergic burden score above target
- Frailty-coded patients
- Patients on long-term opioids, gabapentinoids or benzodiazepines
Workflow
What a well-run SMR actually looks like.
A high-quality SMR runs in three parts. Preparation: the pharmacist reviews the full medication history, hospital correspondence, monitoring blood results and any deprescribing opportunities — typically 20 to 30 minutes per patient. Consultation: the pharmacist meets the patient in person, by phone or remotely, depending on cohort and mobility — typically 30 to 45 minutes. Follow-through: changes are coded, communicated to the patient and GP, and tracked for any follow-up monitoring. The total time per SMR sits around 60 to 90 minutes including documentation, which is the figure PCNs should plan capacity against.
- Preparation 20–30 minutes
- Consultation 30–45 minutes
- Documentation and follow-through 10–15 minutes
- Weekly clinical supervision sign-off
- Outcomes coded into the clinical system
Where SMRs add measurable value.
A well-run SMR almost always produces at least one of: a deprescribing change that reduces anticholinergic burden, an optimisation that improves QOF indicator achievement, a safety change that removes a high-risk combination, or a patient-reported quality-of-life improvement around side effects or adherence. Across a programme of several hundred reviews, PCNs typically see reductions in inappropriate polypharmacy, measurable improvement in CVD and diabetes QOF achievement, and a noticeable reduction in medication queries arriving in the GP inbox.
Supervision and quality assurance.
SMRs are clinical work, not administrative work, and they need clinical supervision to match. Every BCS SMR is reviewed by a senior pharmacist before sign-off in the first weeks of any new placement, with sampled QA throughout the programme. This protects the patient, protects the practice, and protects the PCN's ARRS evidence trail. PCNs running solo SMR delivery without senior pharmacist oversight should treat that as a clinical risk to be addressed before scaling the programme.
Outcomes evidence
What to capture for every SMR.
- Date of review and patient demographic
- Number of medicines before and after
- Anticholinergic burden score before and after
- Deprescribing actions taken
- QOF and IIF indicator linkages
- Patient-reported outcome where applicable
- Pharmacist and supervisor sign-off
FAQs — Structured Medication Reviews.
How many SMRs can one pharmacist deliver per week?+
A full-time pharmacist with technician support typically delivers 15 to 25 high-quality SMRs per week, depending on cohort complexity.
Do SMRs have to be face-to-face?+
No. Remote SMRs are appropriate for many cohorts, with face-to-face reserved for care home and complex frailty patients.
How is SMR work evidenced for the DES?+
SMRs are coded in the clinical system and reported monthly against the PCN's SMR target.
Can technicians support SMR delivery?+
Yes — technicians handle cohort identification, recall, monitoring blood checks and pre-screening, freeing the pharmacist for the clinical consultation.
Embedding SMRs in the wider PCN operating model.
An SMR programme produces its full value when it is woven into the rest of the PCN clinical work rather than run as a standalone activity. SMR outcomes feed the QOF dashboard, deprescribing actions reduce the repeat prescribing volume the practice manages each week, monitoring catch-up from the SMR review feeds the high-risk drug monitoring programme, and patients identified as needing further input are routed back into the polypharmacy or care home pathways. Treating the SMR as one node in the wider pharmacist and technician operation rather than a separate workstream is what turns a good programme into a great one.
Related BCS work.
Talk to BCS.
If you'd like to walk through what this would look like for your PCN specifically, talk to our Service Development team. We'll cost a plan against your remaining ARRS allocation and your existing pharmacy workforce, and have a written proposal back within a week.
Talk to our Service Development team
30-minute discovery call. We'll show you how BCS maps to your PCN's specific priorities.