The Royal Pharmaceutical Society has said it is concerned the focus of pharmacy’s workforce in primary care is shifting away from structured medication reviews (SMRs) and today (July 23) made a series of recommendations to ensure pharmacy teams are supported to deliver medicines optimisation services for patients.

The professional leadership body outlined four broad recommendations, including ensuring primary care networks “recognise that medicines optimisation and SMRs remain a part of the core PCN contract and they are accountable for their delivery”.

SMRs were introduced as part of the 2020-21 network contract direct enhanced service specification (DES) for PCNs, which have offered SMRs to patients over the last four years, including those living in care homes, those who take 10 or more medicines, the severely frail who are at risk of hospital admission, those at risk of harm due to medication errors and patients who have been prescribed potentially addictive medicines such as opioids.

The RPS, who said pharmacy teams in PCNs “should be enabled to prioritise SMR activity in the highest risk patients”, called for SMR uptake and delivery to be monitored and reviewed regularly at integrated care system and PCN level.

“This activity and monitoring should particularly focus on the patient cohorts highlighted in the guidance published alongside the network contract DES, for example, those in care homes, those taking 10 or more medicines, or those taking specific higher-risk medications,” the RPS said, calling for greater transparency around SMR uptake and delivery at PCN and ICS level.

The RPS also said the quality and accuracy of the coding and structure of SMRs should be improved “to support benchmarking and evaluation possibly via local population health management dashboards” and “further patient outcome-orientated research” must be funded so the value of SMRs is measured and evaluated.

The RPS said although the 2024-25 network contract DES asks PCNs to outline the measures they will take to improve medicines optimisation and had included high-risk patient groups in its guidance, it was concerned that it was “non-contractual and may be missed or de-prioritised by hard working practices”.

“The impact of SMRs on improving patients' understanding of medicines and safety, reducing unnecessary prescribing and health care costs is understood,” the RPS said.

“Gathering further evidence to quantify the impact on patient outcomes should not be a barrier to the continued delivery and expansion of SMRs in primary care.”