Cluster page — medicines optimisation
Structured Medication Reviews (SMRs)
What an SMR is
The NHS-defined intervention, not a routine medication review
A Structured Medication Review is a comprehensive, IP-led, patient-centred review of all of a patient's medicines, conducted against a defined cohort under the PCN Network Contract DES. It explicitly differs from a routine medication review or QOF medication check: it is structured (uses a defined framework — typically the seven steps of the RPS polypharmacy guidance or NHS England's SMR competency framework), face-to-face or video by default, and outcome-coded for ICB return.
The DES priority cohort is mandated nationally — over-75s on 10+ medicines, care home residents, patients on high-risk drugs, frailty plus polypharmacy, and SMI on multiple psychotropics — and PCNs may extend locally. A typical 50,000-patient PCN holds 1,800–2,400 eligible patients per year and is expected to deliver to a population-share target agreed with the ICB.
Seven-step SMR framework
How an IP pharmacist actually runs an SMR consultation
- Step 1: Aim — agree what matters to the patient before opening the medication list
- Step 2: Need — is each medicine still indicated against current evidence and patient priority?
- Step 3: Effective — is it achieving the intended outcome at the current dose?
- Step 4: Safe — adverse effects, interactions, monitoring currency, anticholinergic burden
- Step 5: Cost-effective — formulary alignment, biosimilar/therapeutic switch opportunity
- Step 6: Patient-centred — adherence, formulation, polypharmacy burden, deprescribing preference
- Step 7: Plan and code — agreed changes, GP communication, recall date, SNOMED coding
Delivery benchmarks
SMR productivity standards
Frequently asked questions
SMR — FAQs
Who is eligible for a Structured Medication Review under the PCN DES?+
The DES priority cohort: over-75s on 10+ medicines, care home residents, patients on high-risk drugs (DMARDs, lithium, amiodarone, anticoagulants, opioids), frailty plus polypharmacy, and patients with severe mental illness on multiple psychotropics. PCNs may extend to local population priorities agreed with the ICB.
How long should an SMR take?+
Typically 30 minutes face-to-face or video, with an additional 15 minutes for record review, deprescribing letter drafting and coding. High-complexity reviews (care home residents, severe frailty) can run to 45–60 minutes.
Does an SMR require an independent prescriber?+
Best practice is IP-led, because the most clinically valuable SMR outcome — deprescribing or therapeutic switching — requires prescribing authority. Non-IP pharmacists can deliver SMRs but require a GP or IP pharmacist co-sign for prescribing changes, slowing throughput materially.
What SNOMED codes evidence SMR delivery?+
Use the agreed PCN SNOMED set — typically 'Structured medication review' (1239881000000109) plus outcome codes for each medicine change (started, stopped, dose changed, switched). Coding consistency drives DES return accuracy.
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