Medication Reviews Falling Behind: How PCNs Can Tackle the SMR Backlog

• 21st January 2026

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• Why Medication Reviews Are Falling Behind
• The Risks of a Structured Medication Reviews Backlog
• Structured Medication Reviews, QOF, and Year-End Pressure
• How to Identify an SMR Backlog Early
• Practical Ways PCNs Can Clear the Backlog
• Avoiding the Same Problem Next Year
• How Core Prescribing Solutions Can Help

Medication reviews, particularly structured medication reviews (SMRs), are falling behind in many PCNs due to rising workload, competing priorities, and limited clinical pharmacist capacity. When reviews are delayed, the backlog increases clinical risk, places pressure on prescribing systems, and makes it harder to deliver planned activity later in the year. Addressing SMRs early helps reduce safety risk, supports smoother QOF delivery, and avoids last-minute pressure on already stretched teams.

Key takeaways

• SMR backlogs increase clinical risk and operational pressure
• Clearing reviews early supports safer prescribing and QOF delivery
• Targeted pharmacist capacity and prioritisation are key to recovery

Why Medication Reviews Are Falling Behind

Medication review backlogs usually develop due to capacity and prioritisation pressures rather than poor planning.

• Rising workload driven by patient complexity and long-term condition management.
• Competing priorities for clinical pharmacists, including access support and reactive prescribing tasks.
• Vacancy levels, sickness absence, and supervision constraints reducing available capacity.
• SMRs being deprioritised during periods of high access pressure.

The Risks of a Structured Medication Reviews Backlog

Allowing an SMR backlog to build creates both clinical and operational risks that become harder to manage over time.

• Increased medicines safety risk due to delayed review of high-risk or complex patients.
• Missed opportunities to optimise treatment, reduce polypharmacy, or deprescribe where appropriate.
• A shift toward reactive rather than proactive care, driven by time pressure.
• Growing pressure as QOF deadlines approach, limiting flexibility in delivery.
• A difficult year-end catch-up period when capacity is already stretched.

Structured Medication Reviews, QOF, and Year-End Pressure

Medication reviews play an important supporting role in delivering safe, well-documented care throughout the QOF year.

SMRs help ensure medicines are appropriate, monitored, and clearly recorded, which supports broader QOF activity linked to long-term condition management. When reviews are left until later in the year, capacity becomes compressed and teams are forced to complete large volumes of work in a short period.

This increases the risk of incomplete documentation, audit gaps, and missed safety issues, particularly when resources are already under pressure.

How to Identify an SMR Backlog Early

Early identification of an SMR backlog allows PCNs to act before clinical and operational risk escalates.

• Review the number of eligible patients compared with completed SMRs.
• Look specifically at overdue reviews within high-risk patient groups.
• Compare planned SMR capacity with actual delivery over recent months.
• Identify variation in SMR completion between practices within the PCN.

Practical Ways PCNs Can Clear the Backlog

A focused, structured approach allows PCNs to reduce SMR backlogs without disrupting day-to-day services.

• Prioritise high-risk patients first to address the greatest safety concerns early.
• Separate SMR delivery from reactive workload so reviews are protected and not repeatedly delayed.
• Use pharmacy technicians to support preparation, data gathering, and follow-up activity.
• Temporarily re-balance pharmacist roles to create dedicated time for clearing reviews.
• Consider additional or flexible pharmacist capacity to provide short-term recovery support where needed.

Avoiding the Same Problem Next Year

Preventing future SMR backlogs requires embedding reviews into routine practice rather than treating them as a one-off task.

• Build SMRs into standard workflows so reviews are delivered consistently throughout the year.
• Protect dedicated pharmacist time to prevent reviews being displaced by reactive work.
• Use rolling review plans instead of relying on year-end catch-up activity.
• Monitor progress on a quarterly basis to identify slippage early and adjust capacity as needed.