Structured Medication Reviews (SMRs) 2022-23: Frequently Asked Questions

Can all PCN pharmacists carry out SMRs?

Yes, all PCN pharmacists are on or have completed CPPE Training. Even those at the beginning of their CPPE pathway can carry out SMRs but it may take them longer at the beginning as they are newer to it. Or they could be allocated less complex patients who need a SMR

How do we decide which patients to prioritise for an SMR?

The priority areas for the Investment and Impact Fund are:

SMR-01A: Patients at risk of harm due to medication errors (includes PPIs for NSAIDs, high risk medications)

SMR-01B: Patients living with severe frailty (includes care homes, assisted living, virtual ward, palliative care)

SMR-01C: Patients using potentially addictive medicines

SMR-01D: Permanent care home residents aged 18 years or over

Other Workstreams

  • Gastroprotection- for patients on NSAIDs or anticoagulants
  • Cardiovascular Disease Prevention- earlier diagnosis of hypertension, DOAC prescribing and monitoring renal function, statins in hypercholesterolaemia
  • Environmental sustainability- asthma reviews and changing to low carbon inhalers

How long does an SMR take?

Each case is different and depends on the complexity and capacity of the patient, the number of medications and co-morbidities, and the experience of the pharmacist. Shorter and simpler SMRs can take 30-45 minutes while more complex SMRs may take up to 1 hour. This includes preparation work before the review, talking to the patient/carer, making the changes and follow-up where required.

How are SMRs conducted?

SMRs can be conducted face to face, over the phone or by video conference with the patient, carer or the MDT team. This decision can be made between the pharmacist and patient on what is best suited to them. Teaching inhaler technique and seeing how the patient manages to administer their medication, is best done face to face.

How many SMRs need to be carried out to meet the IIF targets?

In order to qualify for the upper IIF funding level, each whole time equivalent PCN pharmacist would need to do 10 SMRs per week.

What proportion of a pharmacist’s time spent within a practice should be given for SMRs?

SMRs, together with high risk drug monitoring, should take approximately 50% of a PCN pharmacist’s time in the week. The other 50% can be spent on medication queries by phone or DOCMAN, or seeing patients for long term condition reviews such as hypertension, atrial fibrillation or asthma, but this also depends on the needs of the practice. Minor ailments should be managed by direct referral to the Community Pharmacy Consultation Service.

Delivering the PCN DES is an essential part of the PCN pharmacists’ role and is linked to significant practice funding from the IIF. Proactive SMRs are also beneficial to the patient and the practice as they can save appointments, calls and hospital admissions that are linked to the patient’s medications.

What does a good SMR look like?

The pharmacists will use the SMR template they have been provided and ensure they are coding SMRs correctly, so the work can be evidenced on data searches. Pharmacists will also obtain feedback from practices and patients to show the impact of SMRs on patient care and GP practice workload.

Which patient cohort should the PCN pharmacist focus on?

We suggest all the PCN Pharmacists to start with patients in SMR01A – medications commonly associated with errors, as this patient cohort tends to be the largest and would benefit greatly from an SMR from a safety perspective.

Where can we find a list of our eligible patients?

Lists can be found by going to:

Population reporting > Ardens > 5.32 Network Contract DES (NCD) (2022-2023) (30.7) > Investment and Impact Fund > Work done > Structured medication review.

For further information, please discuss with your pharmacists and their PCN team leaders:

Deviata Patel: [email protected] (Wallington and Central Sutton PCN)

Luqman Dawud: [email protected] (Carshalton and CASS PCN)

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