Why Structured Medication Reviews Are the Highest-Value Hour in Primary Care

Structured Medication Reviews were written into the Network Contract DES for a reason: patients with complex polypharmacy are among the highest-risk in any practice population, and their medication is often the least reviewed. Yet many networks still treat SMRs as an obligation to be absorbed rather than a service to be designed.

The difference between an SMR and a medication check

A proper SMR is a structured, evidence-based conversation — not a tick-box telephone call. It examines whether each medicine is still indicated, whether doses remain appropriate, whether monitoring is up to date, and crucially, what the patient actually wants from their treatment. That last element is where deprescribing opportunities usually surface.

Pharmacist-led SMRs consistently identify issues that routine prescribing workflows miss: duplicate therapies, outdated indications, missing monitoring, and medicines whose risks now outweigh their benefits for a frailer patient than the one who started them.

Prioritisation is everything

No network has the capacity to review everyone. The highest-value approach targets patients where harm is most likely: those on ten or more medicines, residents of care homes, patients prescribed opioids or gabapentinoids long-term, and people with frailty whose treatment burden has quietly grown. A structured prioritisation tool, applied consistently across practices, turns an impossible workload into a managed programme.

Making SMRs sustainable

The networks that sustain SMR delivery share a pattern: a named clinical lead, protected pharmacist time, technician support for preparation and follow-up, and reporting that shows the board exactly what was delivered. Whether that capacity comes from recruitment, ARRS roles or a commissioned service matters less than the structure around it.

If your SMR programme lives or dies by one person's goodwill, it is not a programme yet. That is the gap a managed clinical service is designed to close.