SMR – Structured Medication Reviews

The 2021/22 PCN Contract DES requires that Primary Care Networks (PCN)  to carry out SMR s on targeted cohorts of patients.

These cohorts include:

• Carehome patients,
• Polypharmacy patients defined as patients taking more than 10 medications.
• Patients on medications commonly associated with errors.
• Severely frail patients
• Patients on medication with a high risk of addiction.

SMR definition

The definition of a Structured Medication Review is ” a structured, holistic and personalised review of an individual who is at risk of harm or medicines-related problems because of their current medicine regimen.”

The concept of an SMR is laudable. Who can argue with a process that allows patients to play a full and active part in decisions related to their care? My concern is that the focus on delivering SMRs means that the significant number of clinical pharmacists recruited to PCN posts have had a minimal impact on a key aim of the programme, reducing GP workload. An average SMR is predicted to take “considerably longer than an average GP appointment.” Historically, GPs have completed medication review, and to be fair to GPs, they would be the first to say that their medication review process may not be as robust as it could have been. Apologies to any GPs reading if you disagree!

Clinicians working at the top of their profession

So, If PCN pharmacists are taking some of the reviews away from GPs by completing SMRs, then that has to be a good thing, right? I’d argue that the time would be better spent completing what used to be called level 2 and level 3 reviews on less complex patients. We want all clinicians to be working at the top of their profession to deliver the best care to all patients.

We want GPs to be spending their time supporting those patients with the most health challenges, and that happens to include all of the groups above. Carehome patients, multimorbidity patients (=polypharmacy patients,) the severe frail and patients of medications with a high risk of medication-related safety incidence, including those medications most likely to cause admissions or addiction.

Instead, we have the least experienced primary care pharmacists conducting the reviews. I’m not sure how this makes sense?  By all means, have SMR completion as a target for the end of the training pathway. However, we need to leave the care of our most complex patients to our most effective clinicians, which are GPs, experienced clinical pharmacists and ANPs with experience supporting multimorbidity patients.

One last thing. Don’t get me started on the nonsense that only pharmacists who have completed one of the Primary Care Training Pathways can complete an SMR. I thought we’d moved away from the idea the passing an exam or test proves effectiveness to a competency-based model. Of course, experienced practice pharmacists can complete an SMR… as long as they can demonstrate the competencies to carry out the review.

The jury is out on whether the SMR is a panacea or a luxury, and I guess only time will tell.