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The Royal Pharmaceutical Society (RPS) has called for a greater focus on structured medication reviews (SMRs) in primary care in England, warning that the reviews are being deprioritised despite evidence of their clinical and economic benefits.
In a policy statement, published on 23 July 2024, said: “The RPS is concerned that the focus of the pharmacy workforce in primary care is moving away from the delivery of SMRs in practice.”
SMRs are comprehensive, personalised medication reviews, intended to address problematic polypharmacy and optimise medicines. They are undertaken through a shared decision-making process between the clinician and patient.
The reviews have been offered to patients since October 2020, with priority given to people diagnosed with frailty or living in care homes; patients with complex polypharmacy (specifically taking ten or more medications) or using potentially addictive pain management medication; and patients taking medicines commonly associated with medication errors.
In the policy statement, the RPS noted that the 2024/2025 ‘Network contract directed enhanced service (DES)’ specification has asked primary care networks (PCNs) to detail the measures they will take to improve medicines optimisation, including SMRs.
However, the RPS added: “Whilst we welcome the inclusion of high-risk patient cohorts in the accompanying guidance, we are concerned that this is non-contractual and may be missed or deprioritised by hard-working practices.
“The impact of SMRs on improving patients’ understanding of medicines and safety, reducing unnecessary prescribing and healthcare costs is understood.
“Gathering further evidence to quantify the impact on patient outcomes should not be a barrier to the continued delivery and expansion of SMRs in primary care,” the statement said.
Citing evidence on the benefits of SMRs, the RPS also pointed out they had been shown to reduce inappropriate polypharmacy in care homes and that patient feedback noted that SMRs had contributed to their improved understanding of medicines and reduced side effects.
In its recommendations, the RPS said that PCNs “must recognise that medicines optimisation and SMRs remain part of the core PCN contract and that PCNs are accountable for their delivery”, adding that pharmacy teams “should be enabled to prioritise SMR activity in the highest risk patients”.
It also said that SMR uptake and delivery should be monitored and reviewed regularly at integrated care system and PCN level, with a particular focus on the patient cohorts included in the guidance published alongside the DES specification.
Commenting on the policy statement, Brendon Jiang, vice-chair of the RPS English Pharmacy Board and RPS treasurer, told The Pharmaceutical Journal: “We are doing this now because of the feedback we have had from members, and this is a good time to try and influence or change practice ahead of the new contract discussions for April 2025.
“We have also seen an increase in patient safety issues that could have been mitigated had the patients had an SMR.”
He added that the RPS is concerned following changes to the PCN contract, which “mean that SMRs are being deprioritised by practices that are working flat out”.
“With continued pressures across the health service, our members have warned that pharmacists are being redirected from delivering structured medication reviews and tasked with other activities,” he said.
“Polypharmacy can potentially cause significant harm and it is vital that pharmacists can maximise their role in helping patients to get the most from their medicines and reducing avoidable hospital admissions.”
Analysis by The Pharmaceutical Journal, published in April 2024, showed that the number of SMRs in England increased by 15% to 2.9 million in 2023/2024, compared with the previous year, despite the removal of a financial incentive for PCNs to prioritise them.
