The Health Innovation Network has published a new report sharing insights and lessons from its initiative to improve access to Structured Medication Reviews for patients in seldom-heard communities, particularly those living in areas of high deprivation and from ethnic minority groups. 

The report, based on pilots delivered in 27 Primary Care Networks (PCNs) across England including two from the East MIdlands, demonstrates how targeted approaches and dedicated patient resources can increase engagement and attendance at these crucial appointments. 

The pilots served as a valuable catalyst for PCNs to refine or establish new SMR pathways. Patient feedback suggests the resources enhance understanding and preparation for reviews, while health and care professionals describe their value in engaging vulnerable populations and improving the quality of consultations, despite challenges related to digital exclusion. 

In England, the NHS primary care system dispenses over 1 billion prescription items every year. As people live longer with multiple long-term health conditions, they often take an increasing number of medicines, which can create a significant burden and, in some cases, cause harm. Evidence shows that people in areas of higher deprivation and from Black, Asian, and Minority Ethnic communities are more likely to be taking multiple medicines and experience overprescribing. 

Structured Medication Reviews (SMRs) are recognised as the best tested intervention for reducing problematic polypharmacy. They have been shown to help reduce the number of problematic or unnecessary medicines a patient is taking. However, studies indicate that most patients do not understand what an SMR is and receive limited information to help them understand or prepare. 

In response to this challenge, and building on the success of previous pilots, the Health Innovation Network opened a call in the summer of 2024. PCNs in areas of high deprivation were invited to apply for central funding of up to £1,500 to deliver a quality improvement pilot project using the Health Innovation Network’s SMR patient resources to specifically target seldom-heard patient groups at risk of polypharmacy and not engaging regularly with their GP practice. 

The response to the call was so significant that additional local funding was found in several areas, enabling a total of 27 PCNs across England to participate in this initiative, all with a significant patient population living in areas of high deprivation.  

The two PCNs in the East Midlands to receive the funding were Leicester City and University PCN (Victoria Park Health Centre, Leicester) and Larwood and Bawtry PCN (Bassetlaw, Nottinghamshire). Links to case studies of each of their projects are below.

Key findings from the pilots: 

• Increased SMR activity: While direct comparison was challenging due to varying study periods, all participating PCNs saw an increase in SMRs completed. Across 27 PCNs, a total of 2,587 SMRs were completed during the study period. 

• Reduced Did Not Attend (DNA) rates: Most areas were able to demonstrate a clear reduction in DNA rates for SMR appointments. 

• Improved engagement with seldom-heard communities: 85% of PCN teams agreed that the Health Innovation Network patient-facing resources helped them engage with target communities. Specific examples include improved engagement with veterans, people with a learning disability, and those with English as a second language. 

• Enhanced patient understanding and preparation: Half of respondents felt the materials helped patients better understand and prepare for their SMR, leading to improved quality of the review and increased likelihood of patients asking questions. Patient feedback confirmed that the materials helped them understand the reason for the SMR (67%), prepare for the appointment (58%), and share what was important to them (66%).  

• Catalyst for pathway improvement: The project provided a structured opportunity for PCNs to review their SMR processes, including patient identification, screening, pre-SMR work, and time allocation. Some PCNs designed new SMR pathways or moved from reactive to proactive approaches. 

• Value of patient resources: The Health Innovation Network SMR resources were appreciated by both patients and healthcare professionals, particularly the improved quality of conversations and shared decision making. The availability of resources in 12 community languages and easy-read versions was particularly helpful in engaging diverse patient groups. 

• Empowering patients: Patient feedback highlighted feelings of empowerment, valuing time for preparation, and appreciating receiving resources in their own language. Patients reported feeling more confident talking to their GP or pharmacist after reading the materials. 

• The role of pharmacists: The initiative reinforced the value of the clinical pharmacist’s role in multidisciplinary teams and their knowledge. Pharmacists carried out SMRs in almost all participating PCNs, often with dedicated time allocations. 

• Funding as an enabler: Although small, the funding, was seen as a significant enabler, creating dedicated time for PCNs to think about and deliver SMRs. 

Professor Tony Avery, National Clinical Director for Prescribing for NHS England, said:  

“I am delighted that this targeted engagement in seldom-heard communities, piloted in 27 PCNs across the country, has resulted in such positive feedback and improved patient care for people from areas of higher deprivation.   

“Structured medication reviews (SMRs) can play an important role to ensure the medicines that people are taking continue to deliver the benefit they should, and this report underscores how empowering people by providing accessible information can really help them get the most from their SMR.” 

The Health Innovation Network launched the patient resources as part of its national Polypharmacy programme, which began in April 2022 and is funded by NHS England. The materials were co-designed, tested and evaluated with patients and Leeds and Bradford Universities. The resources were later translated into 12 community languages and launched for national testing in September 2023.   

Find out more:

Register for the webinar: A shared learning webinar showcasing the report findings, including presentations from three of the PCNs involved in the study, will take place on Monday 14 July at 1pm. More information is available here. 

Read the East Midlands case study from Leicester City and University Primary Care Network.

Read the case study from Larwood and Bawtry Primary Care Network in Nottinghamshire.

Access resources relating to polypharmacy including translated materials to help patients to prepare for Structured medication reviews.