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Patients taking antidepressants must be considered for structured medication reviews (SMRs) by primary care networks (PCNs) under the network contract directed enhanced service (DES) for 2025/2026, NHS England has said.
According to contract, published on 27 March 2025, PCNs should use SMRs as part of medicines optimisation processes for “high-risk cohorts”.
SMRs were introduced in England in October 2020, with priority given to high-risk patients, which include people diagnosed with frailty or living in care homes, people with complex polypharmacy or taking medicines commonly associated with medication errors, and anyone using potentially addictive pain management medicines.
Under the latest contract, the priority list will include people using one or more medicines associated with dependence or withdrawal symptoms from the following groups: antidepressants, opioids, gabapentinoids, benzodiazepines and Z-drugs.
SMRs are offered by pharmacists as a way for the pharmacist and patient to agree together on the personalised benefits and risks of the medicines that the patient is taking.
Data published by the NHS Business Services Authority in July 2024 show that antidepressant prescribing in England rose by 3.3% in 2023/2024 compared with the previous year — with an estimated 89 million antidepressant drug items prescribed.
Commenting on the updated contract, Elen Jones, director for England and Wales at the Royal Pharmaceutical Society, said: “We welcome the inclusion of antidepressants as medicines that should be considered suitable for SMRs — this aligns with our call to prioritise medicines optimisation in primary care.
“Pharmacists play a key role in helping patients get the most from their treatment, ensuring their medications are regularly reviewed and any concerns are addressed. The addition of antidepressants to SMRs is an opportunity to improve patient outcomes, reduce harm of polypharmacy and strengthen support for those living with mental health conditions.
“However, we’re concerned that changes to the PCN contract and ongoing pressures across the health service mean pharmacists are being redirected from delivering SMRs, despite evidence of their clinical and economic impact. SMRs must be prioritised and properly resourced to ensure they fill their potential in improving patient care.”
A study published in The Lancet in June 2024 found that more than one in six patients who stop taking antidepressants will experience withdrawal symptoms as a direct result.
In October 2024, it was announced that the NHS would provide funding for 25 PCNS in areas of high deprivation to offer supportive material for SMRs from November 2024 — with their use to be evaluated in March 2025.
NHS England had removed financial incentives for carrying out SMRs in 2023/2024.
It has previous been reported that patients living in the most deprived areas of England are 1.5 times more likely to be prescribed dependency-forming medicines compared with those in the least deprived.
