The PCN pharmacy workforce is “moving away from” structured medication review (SMR) delivery despite “strong evidence” of their clinical and economic impact, the Royal Pharmaceutical Society (RPS) warned in a policy statement last month (July 23).

It raised concerns that the requirement for PCNs to detail measures taken to “improve medicines optimisation including SMRs” under their 2024/25 contract is “non-contractual” so it “may be missed or de-prioritised by hard-working practices”.

Read more: Why I'll miss primary care pharmacy's focus on structured medication reviews

“With continued pressures across the health service, our members have warned that pharmacists are being re-directed from delivering structured medication reviews and tasked with other activities,” RPS England vice-chair Brendon Jiang 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,” he added.

More than one million patients are taking at least 10 regular medications, while a third of patients aged 65 or over are taking at least five regular medications, the RPS revealed.

Recommendations

The RPS recommended that PCNs should recognise medicine optimisation and SMRs as part of their core contract and be held accountable for their delivery, adding that pharmacy teams should be “enabled to prioritise” SMR activity in the highest risk patients.

Read more: Structured medication reviews mark a huge success for PCN pharmacy

Other recommendations included regular monitoring and review of SMR uptake and delivery at integrated care system (ICS) and PCN level, an improvement in the “quality and accuracy” of SMR coding and structure and funding towards further research.

The statement added that community pharmacy is an “important regular point of contact” for patients with long-term conditions, suggesting that the sector works “in collaboration with their PCN colleagues” on this.

“Hugely beneficial”

“When an SMR is conducted correctly with an in-depth review of a patient medication and lifestyle, it can be hugely beneficial to the management and treatment of long-term conditions with high levels of morbidity,” senior clinical pharmacist Chris Grahame told C+D.

“For many elderly and frail patients, SMRs are often an incidental way of identifying medication issues, adverse drug reactions and preventing poor compliance,” he added.

Grahame said that a “simple and straightforward” way to address this would be to add SMRs back into PCN Impact and Investment Fund (IIF) targets, with the same four categories and an additional fifth category to include severe mental illnesses.

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This would address patients who “fall off the radar” by not engaging with surgeries for routine reviews, he added.

In April 2021, the community pharmacy medicines use review (MUR) service was decommissioned and replaced with structured medication reviews (SMRs), which are completed by GP or PCN pharmacists.