💊 Structured Medication Review (SMR)

💷 How much is this worth to me?

This template supports delivery of:

• PCN DES requirements for Structured Medication Reviews

• Best practice in deprescribing, optimisation, and personalised care

Accurate use improves safety, identifies medicines-related harm, and supports contractual delivery across frailty, care homes, and long-term condition groups.

📊 High-level overview of the specification requirements

An SMR must be:

• Patient-centred

• Conducted by a trained pharmacist or pharmacy technician

• Appropriately coded and documented

Reviews are prioritised for patients:

• In care homes

• With frailty/polypharmacy

• Taking high-risk medications

• Recently discharged or with poor adherence

📌 What do you need to know?

This template guides a thorough review across several domains:

🩺 Consultation Details

• Record:

  • Type of consultation (face-to-face, phone)

  • Type of activity (e.g. SMR, audit, optimisation)

• Tick who performed the review (e.g. pharmacist, technician)

👵 Frailty and Falls

• Frailty score and severity

• Falls risk assessed by:

  • GP

  • MDT

  • Falls service

  • Morse score or equivalent

⚕️ Technical Review

• Tick if:

  • Directions are adequate

  • Patient understands purpose

• Record:

  • Over-the-counter medication

  • Use of compliance aids

  • Confirmation that all quantities were checked

🧠 Self-Management and Proactive Care

• Is the patient managing their medicines safely?

• Has proactive care been continued or ended?

💬 Lifestyle

• Record:

  • Smoking status

  • Alcohol intake

• These are often revisited during reviews for cardiovascular risk

💡 Therapeutic Review

• Record:

  • Indication checked for each drug

  • Side effects discussed

  • Evidence of shared decision-making

  • Medication discontinued where appropriate

💡 Hints and Tips

• Always tick that the review was done by a trained pharmacist or technician — this validates the SMR for PCN DES

• If the patient has frailty, ensure this is coded and linked to falls or polypharmacy discussions

• Record both what was reviewed and any action taken, even if no change was made

• Use free text for nuance — this supports clinical audit and revalidation

• If the SMR is declined or missed, use a failed encounter code to protect reporting