Structured medication reviews should last at least 30 minutes, confirms NHS official

Structured medicine reviews (SMRs) should last at least 30 minutes to maximize the scope of shared decision-making, the national clinical director for prescribing in England has said.

According to a slide presented by Tony Avery at the 2022 Primary Care Pharmacy Association (PCPA) conference on June 8, 2022, increasing the number of clinical pharmacists in primary care (RCP) networks and expanding the use of SMRs were “key approaches” to address overprescribing.

“For example, there is currently no set duration for an SMR, although they are supposed to last at least 30 minutes,” the slide says.

“It is important that the SMRs are maintained in terms of quality, including the time allocated to each and the experiences of the patients who participate in them.”

At the Clinical Pharmacy Congress in May 2022, pharmacists complained that they were having “difficulty convincing” GPs to grant them long enough appointments with patients to perform SMR and that the introduction financial incentives in April 2022 worsened the situation.

At the time, Avery said he would “review” the issues raised.

Commenting on the PCPA presentation, Alisdair Jones, PCN Chief Pharmacist at Total Health Excellence PCN, said it was “great” to hear the support and enthusiasm for the role pharmacists play in SMRs.

“They provide a great opportunity to review the need for each drug, but it can’t be done in five to ten minutes,” he said.

“Thirty minute appointments should be considered the minimum for most of our target groups, and indeed some patients may require more than one appointment. I’m happy that [Avery] I agree with that and I hope that this message will reverberate with the leaders of the NCP.

Rosalyne Payne, chief clinical pharmacist for Coventry and Rugby GP Alliance, also welcomed Avery’s comments on SMRs and the acknowledgment that in some patients an SMR could be much longer if they are on a complex diet or have a lot to discuss.

“We also need to be aware that the RMS are not self-contained, they are part of a series of consultations – it’s not just a 30 minute consultation, tick, it’s done until next year, it is the recognition that this is the start of a relationship as we support someone in optimizing their medication; it can be a fortnightly follow-up call for weeks or months.

“SMR is a start, not a complete thing.”

Payne added that the duration of SMRs is currently “mixed” in the more than 50 GP practices she works with, ranging from 15 minutes to no time limit and “everything in between”.

However, she pointed out that for the number of points awarded through the NHS England Investment and Impact Fund and the amount of work required, there was a risk that SMRs would not be the priority.

“This is where I really welcome Tony Avery’s comments and hope he has the clout to really lead this and influence his fellow GPs.”

Graham Stretch, president of the PCPA, said it was clear Avery understood the need for pharmacy to support its overprescribing program.

“He seems determined to get the message out about longer SMR appointments; he said it unequivocally and mentioned it more than once [during the session],” he said.

“[Avery] was clear that he would support the concept that pharmacists would need a 30 minute appointment to perform SMRs and help clear up any misunderstandings [around this] fellow general practitioners.

Study results published in May 2022 showed that SMRs conducted by pharmacists working in general practice were plagued by a lack of skills and support and did not put patient outcomes first.

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