If you take several medicines long-term, you may one day be invited to a Structured Medication Review, usually abbreviated to SMR. It sits at the more ambitious end of the NHS's medicines optimisation work — a longer, deeper conversation than the old Medicines Use Review, and one that is explicitly aimed at people whose prescriptions have become complicated.
This guide explains what an SMR is, who qualifies, what happens during the appointment, and how the service differs from a Medicines Use Review or the New Medicine Service.
What an SMR is
A structured medication review is a comprehensive, clinical review of every medicine a patient takes. According to NHS England's primary care network contract, it is delivered by a clinical pharmacist working within a primary care network (PCN) — the local grouping of GP practices that share services.
It is not a routine box-ticking exercise. The reviewer has the patient's full GP record on screen and uses structured decision-support tools to check each medicine against current evidence, look for duplication or interactions, and check whether every prescription is still doing what it was originally intended to do.
Who qualifies
The service is targeted rather than universal. NHS England's guidance identifies several priority groups, including people living in care homes, those on complex regimens of ten or more medicines, people prescribed medicines commonly associated with adverse events, people with severe frailty, and those with specific long-term conditions such as chronic kidney disease.
If you fall into one of those groups, your GP practice or PCN pharmacist is likely to contact you. You do not have to request the review yourself, though you can ask your practice whether you qualify.
What happens during an SMR
Appointments typically run 30 to 45 minutes. That is several times longer than a standard GP appointment. Reviews may take place at the surgery, over the phone, via video, or occasionally at a care home.
The clinical pharmacist will:
- Go through every prescribed medicine, and usually every over-the-counter one too, asking what you actually take and how
- Check whether each medicine is still needed and whether the dose is right
- Look for medicines that work against each other, or cause side effects the patient has simply learned to live with
- Discuss what matters to you — sleep, pain, mobility, mood — and what the medicines are meant to deliver
- Agree changes with the patient and, where needed, with the prescribing GP
Any prescribing changes are documented in the GP record. You may leave the review with a shorter list of medicines, a dose change, or a plan to stop one drug gradually over a few weeks.
How SMRs differ from MUR and NMS
Three acronyms, three different services. Here is how they sit side by side.
| Service | Where | Length | Who delivers it | Focus |
|---|---|---|---|---|
| Medicines Use Review (MUR) | Community pharmacy (phased out in England from 2021) | ~10–15 min | Community pharmacist | Understanding of existing medicines |
| New Medicine Service (NMS) | Community pharmacy | ~10 min initial plus follow-ups | Community pharmacist | A newly started medicine for specific conditions |
| Structured Medication Review (SMR) | GP practice or PCN | 30–45 min | Clinical pharmacist in primary care | Full medicines review, deprescribing, long-term polypharmacy |
The MUR in England is effectively retired, though it remains part of the pharmacy contract in Wales and some discussions continue about what should replace it. The NMS continues in community pharmacies across England, Wales, Northern Ireland, and in a different form in Scotland. The SMR is the clinical, longer-form review that sits inside general practice.
Why the service exists
The policy driver is polypharmacy. NHS England's medicines optimisation programme has repeatedly highlighted that a sizeable minority of adults over 65 take five or more medicines, and a smaller but significant group take ten or more. Not every one of those prescriptions is still doing more good than harm.
SMRs are also part of the NHS's broader shift to use clinical pharmacists as a workforce in primary care. Job listings tracked by PharmSee across NHS Jobs and the major multiples show clinical pharmacist roles consistently among the faster-growing categories, reflecting that PCN recruitment. For a sense of the salary range for these posts, see our clinical pharmacist primary care guide and the related analysis of PCN pharmacist pay bands.
What to expect if you are invited
If your GP surgery writes, texts or calls to offer a medication review by the PCN pharmacist, it is worth accepting. Bring any over-the-counter products you take regularly, including supplements and herbal remedies, and a list of questions — side effects that bother you, medicines you have stopped taking on your own, or anything you have read about your condition online.
The service is free on the NHS, and the pharmacist is a qualified prescriber in most cases, which means agreed changes can often be actioned during or immediately after the consultation.
What SMRs are not
A structured medication review is not a prescription request appointment, and it is not a diagnosis clinic. If you need a new condition investigated, you still need a GP. The SMR starts with the medicines already on your record and works outwards from there.
It is also not a cost-cutting exercise in disguise. Where NICE evidence supports it, a review may add medicines as well as remove them — for example starting a statin or a bone-protection drug that was missed in the past.
Finding more information
To see which pharmacies in your area have NHS dispensing contracts and what services they offer, browse the PharmSee pharmacy directory. To understand how your pharmacy gets paid for the services it delivers, see how community pharmacies earn revenue.
Sources
- NHS England — Structured Medication Reviews guidance for primary care networks
- NICE guideline NG5 — Medicines optimisation
- PharmSee analysis of NHS Jobs clinical pharmacist listings, April 2026 snapshot (n = 1,693 active pharmacy vacancies across 11 tracked sources)
PharmSee publishes UK pharmacy market analysis based on public NHS data, our own pharmacy register, and live job-market tracking.