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Enjoying those SMRs they have these days? That’s ‘Structured Medication Review’ for those of you who aren’t down with the kids on the DES street of PCNville (and that’s ‘Directed Enhanced Service’ and ‘Primary Care Network’ for those of you who have dozed off for the last few years).

Apparently, SMRs are a ‘NICE approved clinical intervention that help people who have complex or problematic polypharmacy’, and they’re on the job description of all those pharmacists who have been riding over the hill to rescue us.

And what could possibly go wrong? Well, me falling off my chair, for a start. Which is what happened when I heard that some pharmacists want up to one hour per SMR. That’s right. A 60 (sixty) minute consultation with the patient.

I’m still reeling from this. In 30+ years of practice, I’ve never had a consultation lasting anywhere near an hour, despite the fact that some felt like a lifetime.

So what on earth is that ‘structure’ that can be so time consuming? Does it start with, ‘I’ll get the drinks in and let’s get to know each other?’ Or are pharmacists labouring under the misapprehension that ‘structure’ refers to something they literally have to build, such as a methotrexate molecule made of matchsticks?

What is clear is that SMRs are a fabulous example of how deconstructing general practice and hiving off its constituent parts to noctors and phoctors sounds great in theory but is a disaster in practice.

Because, to use the SMR example, you have not only the marathon consultation – there’s also the dysfunctional spin-offs such as the unnecessary blood tests, the injudicious meddling and the fact that the patient will inevitably want a subsequent consultation with me to explain what just happened and check that it’s OK. And, on the other, the fact that I’ve been doing SMRs effectively and efficiently for years without knowing they were called that, while managing a heap of other issues, all in 10 minutes.

Or, to put it another way, SMRs are a well-intentioned but massive waste of time, effort and money which serve only to chip away at our USP. If there’s a real structured review needed, it should be of the delusion that is the ARRS scheme. And if you don’t know that one from your elbow, tough – I’m done with explaining abbreviations for today.

Dr Tony Copperfield is a GP in Essex. Read more of Copperfield’s blogs at



Please note, only GPs are permitted to add comments to articles

Patrick Flynn 15 October, 2020 5:09 pm

‘the fact that I’ve been doing SMRs effectively and efficiently for years without knowing they were called that,’

Apologies – just a wee edit/synopsis – did enjoy your rant

David Mummery 15 October, 2020 8:57 pm

Yes it’s the extended roles paradox : the scheme actually creates work rather than takes it away . The prime skill of the GP is to know when to do nothing , and what actually doesn’t matter and can be ignored, and that’s quite a lot….

Hot Felon 16 October, 2020 12:06 pm

LMFAO TBH IMHO rolls eyes

Patrufini Duffy 16 October, 2020 4:06 pm


Farrukh Javid 16 October, 2020 11:07 pm


Paul Hartley 19 October, 2020 4:28 pm

Right on!

Avish Punater 20 October, 2020 5:42 pm

Limited sympathies only – everyone knew what the ask was when they signed up. Why VOLUNTARILY sign up to something stupid and THEN moan about it?

Christine Harvey 20 October, 2020 6:00 pm

‘I’ve never had a consultation that lasted anywhere near and hour, despite the fact that some felt like a lifetime’
Best reflection ever – LOL

Richard Greenway 27 October, 2020 1:41 pm

Hit the nail!