Structured medication review (SMR) is a service delivered by clinical pharmacists in primary care networks (PCNs) to replace a previous scheme, the medicine use review (MUR), conducted by community pharmacists but not considered cost-effective.1,2 Despite nearly 4 years since SMRs were introduced, their uptake, quality, and impact remain unclear. This editorial explores the experiences and challenges pharmacists in England face as they implement SMRs, drawing on collective insights from a small group of GP pharmacists in Greater Manchester and Cambridgeshire. We also propose strategies to enhance SMR uptake and effectiveness, offering a pathway to better medication management and patient outcomes.

The SMR service was launched in October 2020 as an intervention to tackle the increasing polypharmacy, inappropriate prescribing, and medication-related deaths in the UK.3,4The NHS Long Term Plan considers SMRs to be crucial to optimise medication use in primary care, aimed at reducing inappropriate prescribing and enhancing patient care.5 With the increasing ageing population, multimorbidity and polypharmacy have become significant challenges, driving up health and social care costs.6,7 While polypharmacy is sometimes necessary for managing multimorbidity, it requires regular review to ensure treatment effectiveness and safety.

Since the launch of the SMR policy, changes have been made, particularly regarding target populations and the required number of SMRs each PCN must deliver. The service now targets six specific groups:

residents in care homes;

individuals with learning disabilities;

those experiencing complex and problematic polypharmacy, especially those on ten or more medications;

patients on medicines commonly associated with medication errors;

individuals with severe frailty; and

patients using highly addictive medications, such as opioids, gabapentinoids, benzodiazepines, and Z-drugs. …