Structured Medication Review (SMR) DES Requirements

What does Structured Medication Review (SMR) DES Requirements mean?

Structured Medication Review (SMR) DES Requirements are contractual obligations outlined in the Network Contract Directed Enhanced Service (DES) that specify how Primary Care Networks must deliver comprehensive medication reviews. These requirements define which patient groups should be prioritised, the qualifications needed by clinical pharmacists delivering the service, documentation standards, and outcome metrics that must be reported. The requirements aim to optimise medication use, reduce inappropriate polypharmacy, and improve patient outcomes across the NHS.

Which patient groups are prioritised under the SMR DES Requirements?

Under the SMR DES Requirements, PCNs must prioritise several high-risk patient groups for medication reviews. These include patients taking 10 or more medications (severe polypharmacy), those on high-risk medicines such as lithium or warfarin, residents in care homes, patients with severe frailty or complex needs, those with a learning disability or autism, and patients with complex or problematic pain management requirements. The specific priority groups may be updated annually in the Network Contract DES specification to reflect changing clinical priorities and NHS England guidance.

What qualifications do clinical pharmacists need to deliver SMRs under the DES Requirements?

Clinical pharmacists delivering Structured Medication Reviews under the DES Requirements must have completed the CPPE (Centre for Pharmacy Postgraduate Education) Structured Medication Review training or equivalent. They should also possess advanced consultation and clinical assessment skills, have experience in managing complex polypharmacy, and demonstrate competence in deprescribing when appropriate. Most pharmacists delivering SMRs will be employed through the Additional Roles Reimbursement Scheme (ARRS) and should be working at an advanced practice level equivalent to Band 7/8a in the NHS Agenda for Change pay scale.

How do SMR DES Requirements integrate with other PCN services?

SMR DES Requirements are designed to integrate with other PCN services to provide comprehensive care. They align with the Enhanced Health in Care Homes (EHCH) service, where SMRs are a crucial component of regular clinical reviews for care home residents. They complement the Personalised Care approach by ensuring medication regimes reflect individual patient preferences and goals. SMRs also support other DES requirements such as early cancer diagnosis and cardiovascular disease prevention by identifying medication-related issues that might impact these conditions. Integration with social prescribing and structured approaches to managing long-term conditions ensures a holistic approach to patient care across the PCN.

What are the reporting and monitoring requirements for SMRs under the DES?

PCNs must maintain detailed records of SMR activity to comply with DES Requirements. This includes documenting the number of SMRs completed, patient demographics, reasons for review, outcomes (including medication changes), and follow-up arrangements. Networks must submit quarterly activity data through the Calculating Quality Reporting Service (CQRS) and may be subject to random audits by NHS England. Additionally, PCNs should maintain an internal register of patients requiring an SMR, with clear evidence of prioritisation based on clinical need. From 2022/23, specific quality metrics relating to SMR outcomes have been incorporated into the Investment and Impact Fund (IIF), linking financial incentives to the quality of SMR delivery.