Outsourcing structured medication reviews means a provider’s clinical team delivers SMRs for your patients, working inside your clinical system to your agreed protocol. You choose the cohort and the escalation route; the provider books the reviews, carries them out, codes every outcome and reports back. The sections below explain each stage, and our 2026 SMR guide covers the clinical method.
What is an outsourced SMR service?
An outsourced SMR service is a managed service in which a provider delivers structured medication reviews on behalf of a practice or PCN. Structured medication reviews are set out in the Network Contract DES as longer, shared-decision reviews for patients who are likely to benefit most, such as those on many medicines, in care homes or at higher risk of harm. With an outsourced service, the provider runs the clinical team, the governance and the cover. The practice or PCN keeps its clinical record and sets the priorities. The model suits practices and networks that want a set number of reviews delivered to one method, with the outcome of each review visible in the record.
How is the patient cohort chosen?
The practice or PCN chooses the cohort, and the provider builds the searches to find it. Common cohorts include patients on ten or more medicines, care home residents, patients on combinations associated with harm and patients with frailty. The searches are agreed in advance, so the list of patients is clear before the first review. The provider can suggest an order for working through the cohort, for example starting with patients on the most medicines or with recent hospital admissions, and the practice confirms it.
Cohorts can be coordinated with other work so patients can discuss relevant medicines and conditions together where appropriate. Some patients need staged reviews, further information, referral or another appointment.
How are patients booked and contacted?
Patients are contacted in the way the practice agrees, usually by phone or text from within the clinical system, with an invitation that explains who will call and why. Booking follows the practice’s preferred method. Clear invitations help patients prepare, for example by having their medicines to hand. Invitations sent from the practice’s own system also reassure patients that the call is part of their usual care.
Where a patient needs or prefers a face-to-face review, agree with the practice how this will be arranged through an appropriate local clinician. Virtual Pharmacist delivers its own reviews remotely.
What happens in the review itself?
Our GPhC-registered pharmacists deliver these reviews remotely by phone or video where clinically appropriate, within their competence and the agreed protocol. The pharmacist looks at every medicine, talks with the patient about what matters to them, and agrees changes with them. 85% of our pharmacists are independent prescribers, so many changes can be made directly within their competence. Anything outside that scope goes to a GP through the agreed escalation route. The review ends with a plan the patient understands, and changes that need monitoring, such as a dose reduction, come with a follow-up date coded in the record.
Patients often raise practical points during a review, such as difficulty swallowing tablets, side effects they had not mentioned or medicines they no longer take. These are recorded and acted on in the same review, which is much of the value of a structured conversation.
Our clinical pharmacist service sets out how reviews fit with the other medicines work we deliver.
How are reviews coded and reported?
Every review is coded in the patient’s record as it happens, using the codes the practice and network need for their reporting. The provider then reports the number of reviews completed, the outcomes and the GP actions raised. For a PCN, the report is available for each practice and for the network. Consistent coding helps the practice’s own searches identify completed reviews and avoid unnecessary duplicate invitations, while allowing follow-up where clinically needed.
How does a PCN run SMRs across several practices?
A PCN agrees one protocol and one clinical standard, and the provider sizes the volume for each practice. The same method runs in every practice, even when they use different clinical systems. We work in EMIS, SystmOne, Vision and Medicus, and one network can use a mix of them. Our structured medication review service for PCNs follows this method.
How do you start?
Start with a counted block of reviews for a defined cohort. It lets the practice or network see the method, the outcomes and the reporting before widening the service. Many networks then extend the block or add workstreams such as high-risk drug monitoring.
Agree the measures for the block before it begins: reviews completed, medicines changed and GP actions raised. They become the basis for the decision to extend. A block also gives each cohort a clear finish line, which helps the practice plan the next one.
What we see in practice
SMR work delivered as a service scales well when the method is fixed. A Norfolk and Waveney PCN received 1,000 structured medication reviews between October 2025 and March 2026, alongside a technician service, all under one governance. A nine-practice Lincolnshire PCN received 315 hours of medication reviews to one pathway across all nine practices, then moved to a full-year contract. In Somerset, a 287-hour block of medication reviews was followed by an extension.
See the detail in our case studies.
Planning an SMR programme? Send us an enquiry and we will reply within one working day.
Frequently asked questions
Who carries out outsourced SMRs?
GPhC-registered pharmacists from our clinical team, 85% of whom are independent prescribers, working under one clinical governance framework.
Can SMRs be done remotely?
Yes. Virtual Pharmacist delivers reviews by phone or video where clinically appropriate, with findings recorded in the practice's clinical system. Patients who need a face-to-face assessment are referred through the agreed local pathway.
Can pharmacy technicians help with an SMR programme?
Yes. Technicians can take work such as searches and preparation, so pharmacist time goes to the reviews.
How are changes to medicines recorded?
Every change is coded in the patient's record as it happens, and GP actions come back through the agreed route.
What do we need to provide for an outsourced SMR service?
Access to your clinical system, the cohort you want reviewed, a named escalation route to your GPs and the coding you need for reporting.
