Expanding the role of pharmacists in general practice

A new editorial co-authored by London Met Professor of Applied Health Research, Duncan Stewart, explores the potential of Structured Medication Reviews (SMR).

Date: 30 July 2021

An expansion of the remit of pharmacists through a new Structured Medication Review (SMR) service could alleviate workload pressures on GPs - but concerns remain about its implementation, according to an editorial co-authored by London Met’s Professor Duncan Stewart.

Writing in the British Journal of General Practice (BJGP), Professor Stewart and his colleagues say that the long term drivers of the SMR are clear: to address problematic polypharmacy - the use of multiple medications at the same time by one person; to reduce avoidable hospitalisations; to deliver better value in medicines spending; and ultimately to improve patient care and outcomes through improved quality of prescribing. 

Pharmacist-led medicine reviews have an important role to play in improving prescribing safety, and their proposed scope has recently been expanded to include attention to behavioural factors, such as alcohol consumption.

The authors argue that recognition of the far reaching effects of alcohol is a "welcome first step in advancing thinking about clinical approaches for prevention and treatment," and could "contribute to a strategic shift in how the NHS thinks about and manages the relationships between behavioural risk factors, chronic conditions and care."

They also note that SMRs could be an especially important intervention in socioeconomically deprived areas, where polypharmacy is more common.

However, Covid-19 has interrupted the SMR implementation profoundly, as pharmacists and other healthcare professionals have had to prioritise their response to the pandemic. The authors explain, "the challenges facing the new clinical pharmacist workforce were already formidable, and have been made more so by the Covid-19 pandemic.

"Important changes with implications for the developing PCN clinical pharmacist role have thus been made at short notice, and a time when much of the NHS workforce has been focused on managing the pandemic. This raises questions about expectations, preparedness, and practice development."

They also highlight concerns about the training of pharmacists in general practice to meet the objectives of the SMR service, citing a lack of evidence that pharmacists possess skills in shared decision making with patients. They note that newly recruited clinical pharmacists conducting SMRs are required to have, or be in training for, a prescribing qualification, and to have advanced assessment and history-taking skills.

"Many [however] are coming from the community pharmacy workforce where such skills are not a requirement," they say. "Since an initial 18-month training pathway (or equivalent) must first be completed, the SMR is being introduced when few are fully trained, and when training and supervision provision has been impacted by the pandemic."

Duncan Stewart is Professor of Applied Health Research at London Metropolitan University.

woman filling a prescription at a pharmacy