A Structured Medication Review (SMR) is a patient-centred discussion about medicines, their benefits, risks and the patient’s priorities. It produces an agreed, documented plan. Continuing appropriate treatment can be a valid outcome; a review does not have to change prescribing to be worthwhile.
The 2026/27 Network Contract DES includes medicines optimisation and the use of SMRs for high-risk cohorts. Delivery should reflect clinical need, local capacity and the current contractual requirements.
What an SMR is, and what it is not
An SMR brings the patient’s experience together with the clinical record, treatment goals and medicines evidence. Records checks can prepare for the consultation, but a records-only exercise or training case is not, by itself, a patient-centred SMR.
Allow enough time for the patient’s needs, communication requirements and clinical complexity. Appointment length and follow-up should be agreed locally rather than presented as a universal national slot length.
Who qualifies for an SMR
NHS England’s 2026/27 guidance identifies priority groups including care home residents; people with learning disabilities; complex and problematic polypharmacy, particularly ten or more medicines; medicines associated with errors or harm; severe frailty with isolation, being housebound, recent admissions or falls; and medicines associated with dependence or withdrawal.
These groups are not exhaustive. Use the guidance and local clinical information to prioritise people likely to benefit. An area-wide statistic or a single frailty score should not replace assessment of the individual patient.
A practical approach to the consultation
- Establish the patient’s goals, concerns and understanding of treatment.
- Confirm what they actually take, including non-prescription medicines.
- Review indications, benefit, harm, interactions and monitoring.
- Discuss suitable options, including continuing treatment and alternatives to medicines.
- Agree a plan, record the reasons for decisions and arrange follow-up where needed.
Involve carers where appropriate, respecting the patient’s wishes and decision-making needs. Medicines decisions must remain within the clinician’s competence, with further clinical input arranged when required.
What good documentation looks like
Record the patient’s priorities, the assessment and the agreed medicines plan. Make outstanding actions clear, including who is responsible and when they should be reviewed. The 2026/27 Network Contract DES guidance lists SNOMED CT code 1239511000000100, Structured medication review (procedure), for recording an SMR or follow-up. Apply the current recording rules and make sure the record reflects the care actually delivered.
Where SMR programmes need attention
Quality checks should look for missing patient involvement, incomplete documentation, unresolved recommendations and inadequate follow-up. Coding review can identify recording problems; it cannot substitute for the clinical consultation.
Do not equate the number of medicines stopped with review quality. Appropriate continuation, safer monitoring and better patient understanding can also be useful outcomes.
Planning a sustainable service
Agree the cohort, capacity, consultation arrangements and reporting with the practice or PCN. A shared approach to searches and documentation can help consistency, while allowing for individual needs. Arrange professional supervision and review cases that need further discussion.
Report completed work alongside follow-up, unresolved actions and meaningful patient outcomes. National guidance does not set a universal annual SMR number, a three-week booking rule or a fixed appointment length for every PCN.
Where to get help
Virtual Pharmacist supports SMR programmes through pharmacist-led reviews, searches, documentation and reporting within the agreed service. Read about our clinical medication review service or contact us to discuss your population and priorities.
Primary references
NHS England 2026/27 Network Contract DES Part A, sections 2.2.4–2.2.13 and coding appendix; NICE NG5, medication review recommendations.
Frequently asked questions
Does an SMR always change a prescription?
No. An agreed medicines plan may continue appropriate treatment, change it, arrange monitoring or seek further clinical input. The decision and any follow-up should be documented.
Can a records-only training review count as an SMR?
A records-only check or training exercise is not, by itself, a patient-centred SMR. The review involves the patient and, where appropriate, their carer in discussion and decisions about medicines.
How long should an SMR take?
Allow time according to the patient’s needs, communication requirements and clinical complexity. Appointment length, service volume and follow-up are agreed locally; there is no universal slot length or annual numerical target in the cited 2026/27 guidance.
How should priority patients be identified?
Use the current NHS England priority cohorts, the patient’s medicines and clinical circumstances, and local information about unmet need. The guidance includes learning disability and medicines associated with dependence or withdrawal as well as care homes, problematic polypharmacy and other high-risk groups.
