Structured Medication Review NHS: How to Get One for Your Parent

If your parent takes ten or more medications and their GP hasn't mentioned a Structured Medication Review (SMR), they're missing out on a service specifically designed to catch the kind of problems that pile up when prescriptions accumulate. NHS Primary Care Networks are contractually required to offer SMRs — but many patients and their families don't know they can request one.

What a Structured Medication Review Is

An SMR is a formal, evidence-based clinical assessment lasting at least 30 minutes. It's conducted by a clinical pharmacist embedded in your parent's Primary Care Network (PCN), either in person, virtually, or as a home visit.

The pharmacist uses the "Seven Steps Review Process" to evaluate:

• Whether each medication has a clear clinical indication
• Whether any drugs are causing adverse effects
• Whether interactions exist between medications
• Whether doses are appropriate for your parent's current health status (especially kidney function)
• Whether the patient's own preferences and goals have been considered
• Whether any evidence-based treatments are being omitted

The results are documented directly in your parent's GP clinical record, so the information feeds into all future care decisions.

Who Gets Prioritised

PCNs are contractually required to prioritise SMRs for patients who fall into specific categories:

• Care home residents — the highest priority group due to polypharmacy prevalence
• Complex or problematic polypharmacy — typically patients on 10 or more regular medications
• Medications commonly associated with errors — opioids, gabapentinoids, and other controlled substances
• Severe frailty — patients with documented frailty scores
• Recent hospital admissions or falls — transitions of care are high-risk moments for medication errors

If your parent fits any of these categories, they should be actively offered an SMR. If they haven't been, you can request one.

How to Request an SMR

Step 1: Contact your parent's GP surgery. Ask specifically for a Structured Medication Review with the PCN clinical pharmacist. Don't just ask for a "medication check" — the SMR is a distinct, longer, more thorough service.

Step 2: Prepare before the appointment. Compile a complete list of every medication your parent takes — including over-the-counter products, supplements, and any medications prescribed by hospital consultants or specialists that the GP may not know about.

Step 3: Document concerns. Write down any symptoms you've noticed that might be medication-related: drowsiness, confusion, falls, constipation, dizziness, dry mouth. Include when they started and whether they correlate with any medication changes.

Step 4: Attend with your parent if possible. The pharmacist assesses the patient's own views and preferences. Having a family member present ensures nothing is missed — particularly if your parent has memory difficulties.

What Happens After the Review

The clinical pharmacist will make recommendations that may include:

• Stopping medications that are no longer needed
• Switching to safer alternatives (especially for high-anticholinergic drugs)
• Adjusting doses based on current kidney or liver function
• Consolidating duplicates from different prescribers
• Starting treatments that should have been prescribed but weren't (the START criteria)

These recommendations go into your parent's GP record and are discussed with the prescribing GP before changes are made. You should receive a clear summary of what was recommended and what actions will be taken.

Beyond the NHS: Reviews in Other Countries

If your parent lives outside England:

• US: Medicare Part D Medication Therapy Management — free annual comprehensive medication review for qualifying beneficiaries
• Canada (Ontario): MedsCheck — free pharmacist review for patients on 3+ chronic medications
• Canada (BC): PharmaCare medication reviews for patients on 5+ qualifying medications
• Australia: Home Medicines Reviews every 24 months or after care transitions

The Understanding and Managing Polypharmacy toolkit includes preparation worksheets and cross-jurisdictional eligibility guides for medication review programs in the US, UK, Canada, and Australia — so you know exactly what's available and how to access it.