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Structured medication reviews require more GP supervision, finds study


structured medication reviews


GPs should provide more supervision to support pharmacists delivering Structured Medication Reviews (SMRs), a study has suggested.

SMRs, which came into effect in October 2020, see clinical pharmacists work with patients who take multiple medicines to help them understand the benefits and risks of those prescriptions.

The reviews are intended to reduce the risk of harm from medicines, such as hospitalisation and addiction, and to alleviate workload pressures on GPs.

PCNs are required to identify patients who would benefit from a review, particularly those in care homes and those on 10 or more medications.

The number of patients who should be offered a SMR depends on a given PCN’s clinical pharmacist capacity.

Published in the BJGP, the study suggested that GPs should be aware that pharmacists may not have experience offering patient-led consultations, suggesting the services ‘did not match’ the shared-decision-making opportunity envisioned in policy papers.

The study said: ‘GPs implementing pharmacist-run SMRs should clarify the distinct purposes of the SMR for their particular practice population and recognise that, because pharmacists have less in-depth experience of consulting with patients, they will require additional supervision to develop the required history taking and shared decision-making skills.’

It added that newer ARRS pharmacists in may benefit from supported introductions to patient-centred SMR practice, supported by ‘clinically experienced’ pharmacists, to help build competence.

Based on multiple interviews with 20 PCN pharmacists across 2020 and 2021, the study highlighted that it must be recognised that clinical pharmacists and SMRs offer new resources for addressing population health and patient needs, notably 30-minute-long appointments.

GPs must pay ‘careful attention’ to how strategically they utilise these resources given the scheme is still in its early phases, it said.

According to the study authors, some pharmacists told the study authors that were frustrated about a lack of support for SMRs at GP practice level.

The authors indicated pharmacists may instead have drawn from prior training, including the ‘the target-driven incentives of corporate community pharmacy’, the authors said, noting this may have shifted SMR focus onto productivity ‘rather than outcomes for patients’.

They suggested that early SMR implementation has been ‘largely delegated’ to individual pharmacists, and that SMRs have not yet met the expectations first set out for the service.

The study said: ‘Early SMR implementation did not therefore match the ideal for patients presented in policy documents of an invited, holistic, shared-decision-making opportunity offered by prescribing pharmacists, experienced in history taking.’

The report came days ahead of the deadline for practice to opt in or out of the 2022/23 Network DES.

NHS England last week confirmed that a GP must be physically present at all times during PCN enhanced access appointments to meet the requirement set out in the DES.

READERS' COMMENTS [3]

Andrew Jackson 3 May, 2022 3:46 pm

SMRs are another pie in the sky idea of a health service with excess staff capacity.
ARRS still doesnt provide enough resource to take day to day prescribing away from GPs yet we are asked to give back some of this resource to devote to SMRs and then support this better.
All good intentions but just not realistic, especially as there isnt really any clinician who has any meaningful training in how to deprescribe except perhaps palliative care.

Turn out The Lights 4 May, 2022 10:10 am

Another prop in the edifice of the PCN folly shown to be a pile of BS.£45k for a pharmacist to to these each one takes 1/2 and hour.Now they need GP supervision.Value for money-NOT.

Andrea Barrow 7 May, 2022 1:22 pm

30 minute.appointments, and need supervision. And still need the medical conditions reviewing, send back to see GP. . In general, seems more likely to be ticking political boxes than holistic medical outcomes.