A Practical Guide to Structured Medication Reviews (SMR) for Long-Term Conditions

• 9th January 2026

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Structured medication reviews (SMRs) are a core part of medicines optimisation in primary care. When delivered well, structured medication reviews for long term conditions move clinicians beyond routine prescription checks and towards meaningful, person-centred conversations focused on safety, outcomes and what matters most to patients.

What is a structured medication review?
Why reviews matter in long-term condition care
Who should be prioritised for an SMR?
The structured medication review checklist
Who delivers SMRs?

For people living with chronic illness, medicines often accumulate over time. Without a regular long-term condition medication review, treatment burden and medicines-related risk increase. SMRs provide a practical, repeatable framework to address this safely and consistently across Primary Care Networks (PCNs).

Key takeaways

• Structured medication reviews for long term conditions are not routine reviews – they are in-depth clinical consultations, not administrative checks
• Risk matters more than volume – patients with complex needs and polypharmacy benefit most
• Clear governance enables impact – pharmacist prescribers prevent work drifting back to GPs

What is a structured medication review?

A structured medication review is a comprehensive, evidence-based assessment of a patient’s medicines, carried out through shared decision-making. As outlined by NHS England, SMRs are designed to optimise medicines use and reduce harm, particularly for people at higher risk of medicines-related problems.

Unlike a standard repeat prescription check, an SMR reviews the full clinical picture, including indication, effectiveness, side effects, interactions and physical monitoring such as renal function or blood pressure.

Why reviews matter in long-term condition care

Structured medication reviews support effective long-term condition management in primary care by enabling safer prescribing for complex patients. People with chronic illness are more likely to experience prescribing cascades and cumulative side effects.

In practice, structured medication reviews for long term conditions provide a clinical framework for reviewing complex prescribing in people with multiple long-term conditions. A focused structured medication review LTC creates protected time to reassess treatment rather than continuing historic prescribing by default.

A structured medication review is only valuable if it leads to real clinical decisions. When reviews focus on risk, outcomes and patient priorities, they reduce harm and prevent work recycling back to already stretched GP teams.

Adeem Azhar, Co-Founder and Chief Executive Officer – Core Prescribing Solutions

Who should be prioritised for an SMR?

SMRs should be targeted based on clinical risk rather than age alone. A targeted polypharmacy medication review is most beneficial for patients who:

• Live with multiple long-term conditions
• Take several regular medicines with high treatment burden
• Are at increased risk of harm, such as falls or renal impairment
• Use high-risk medicines, including anticoagulants or lithium
• Have had a recent medicines-related hospital admission

This approach helps GP practices and PCNs focus capacity where it delivers the greatest population benefit.

The structured medication review checklist

To ensure safety and consistency, an SMR GP practice should follow a clear clinical pathway. Many teams use a structured medication review checklist to guide consultations:

• Patient priorities
• Indication and benefit
• Safety and monitoring
• Adherence
• Deprescribing opportunities

This aligns with NICE guidance on medicines optimisation and supports clear clinical decisions.

Safety and deprescribing in long-term conditions

Polypharmacy is common in chronic illness, but more medicines do not always mean better outcomes. A structured polypharmacy medication review helps reduce cumulative risk, simplify regimens and plan deprescribing safely, improving adherence and reducing avoidable harm.

Who delivers SMRs?

Structured medication reviews can be delivered by GPs or clinical pharmacists. In many practices, pharmacist prescribers add the greatest value by making real-time prescribing decisions without unnecessary hand-offs. Clear governance ensures reviews translate into action rather than additional GP workload.

FAQs