Optimizing Medication Reviews: The Role of Clinical Pharmacists in PCNs

In today’s complex healthcare environment, where patients often juggle multiple conditions and even more medications, the importance of accurate and regular medication reviews cannot be overstated. These reviews are the backbone of patient safety, ensuring that medicines are appropriate, effective, and safe for each individual. Within Primary Care Networks (PCNs), the responsibility of performing and optimizing these reviews is increasingly being shared with clinical pharmacists, who bring specialised knowledge and a fresh, patient-centric perspective to general practice.

What is a Medication Review and Why does it Matter

At its core, a medication review is a systematic evaluation of a patient’s entire list of prescribed medication. Its aim? To ensure that every medicine continues to serve a purpose, and that no drug is causing harm or unnecessary complications. While that may sound simple, it’s often far from it—especially for patients who are elderly, have chronic illnesses, or take multiple prescriptions.

An effective medication review can:

• Prevent adverse drug reactions
• Increase adherence by eliminating confusion or side effects
• Reduce unnecessary prescriptions and healthcare costs
• Improve patient outcomes and overall quality of life

In a busy general practice setting, however, GPs often lack the time for such in-depth assessments. This is where clinical pharmacists, and in particular, the structured approach to reviews,come into play.

The Rise of Structured Medication Reviews in PCNs

With the introduction of structured medication reviews (SMRs) as part of the NHS Long Term Plan, the game has changed. Unlike a quick review at a prescription renewal, an SMR is a thorough, planned, and face-to-face consultation conducted by a medication review pharmacist. It focuses on:

• Understanding the patient’s full medication regimen
• Exploring how they are coping with each drug
• Checking for duplication, interaction, or inefficiency
• Adjusting, discontinuing, or substituting medications where necessary

This is a collaborative conversation,not a one-sided checklist. It includes the patient in decision-making and helps them take ownership of their own health journey.

The Role of Clinical Pharmacists 

Pharmacists in PCNs are not simply “prescription checkers.” They are clinically trained professionals who possess deep pharmacological expertise and communication skills, making them ideal for conducting structured medication reviews.

Here’s how clinical pharmacists elevate medication reviews:

• Holistic Approach: They look beyond symptoms and examine all factors including lifestyle, adherence patterns, and social challenges that may influence medicine effectiveness.
• Identification of Risk: Pharmacists are trained to detect high-risk combinations, inappropriate prescribing for age groups, or issues related to kidney/liver function.
• Deprescribing Experts: They are skilled at safely tapering or stopping unnecessary medicines—a growing need as polypharmacy becomes more common.
• Time and Attention: Unlike rushed appointments, pharmacists dedicate more time to medication reviews, ensuring patients are heard and understood.

Read more: Role of a Community Pharmacy in UK Public Health

How Often Should Medication Reviews Take Place?

You might wonder, how often should medication reviews take place? While the NHS medication guidelines recommend annual reviews for people on multiple or long-term medicines, there’s no one-size-fits-all rule. The frequency should be tailored based on:

• The complexity of the medication regimen
• Changes in a patient’s health condition
• Hospital discharge or major life events
• Occurrence of side effects or suspected inefficacy

Some patients may benefit from quarterly or even monthly reviews, particularly if they are dealing with multiple prescribers, or transitioning between care settings.

Medication Review Protocols in General Practice

The GP medication review protocol forms the backbone of standardisation within primary care. These protocols outline who should be reviewed, when, and how, ensuring that reviews are not only consistent but also clinically meaningful. But again, it’s the medication review pharmacist who ensures these protocols are not treated as a box-ticking exercise.

Clinical pharmacists also document everything meticulously and feed insights back to the broader healthcare team, closing the loop and ensuring continuity of care.

Real-World Impact of Pharmacist-Led Medication Reviews

Let’s look at some real-world impact scenarios:

• Mr. Ahmed, a 70-year-old man taking 9 medications, was found to be on two blood pressure medications with overlapping effects. After an SMR by a clinical pharmacist, one was safely discontinued, and his dizziness vanished.
• Mrs. Thompson, recently discharged after surgery, was taking a cocktail of painkillers and anticoagulants. Her SMR helped uncover a dangerous interaction risk—and adjustments were made in time.
• Teenager Leo, who has ADHD and anxiety, was struggling with side effects from overlapping prescriptions from different specialists. A PCN pharmacist reviewed his regimen, facilitated communication between his healthcare providers, and improved his overall wellbeing.

These examples are not outliers—they represent the tangible value that structured medication reviews offer to communities.

Challenges in Optimising Medication Reviews

Despite the proven benefits, there are hurdles to overcome:

• Patient Reluctance: Many patients still don’t understand the role of clinical pharmacists and may hesitate to open up.
• GP Collaboration Gaps: In some PCNs, GPs and pharmacists may not yet have fully integrated workflows, limiting collaboration.
• Data Access: Incomplete access to patient records can hinder effective reviews.

What’s the Solution?

• Raise Awareness: Educate patients that they can trust their pharmacist just as they would trust their GP.
• Team-Based Approach: Foster a culture where GPs and pharmacists co-manage patient medication plans.
• Investment in IT Systems: Ensure pharmacists have seamless access to patient notes and prescriptions across platforms.

The Future of Medication Reviews in the NHS

The NHS is steadily moving towards a model where pharmacists are not optional, but essential in patient care. In fact, the NHS workforce plan includes expanding the number of PCN-employed pharmacists to improve the quality and reach of medical reviews.

This is great news—not just for the overburdened GP workforce, but for patients who deserve undivided attention and safe, effective medicines.

Conclusion: A Collaborative Future for Safer Prescribing

The traditional “doctor knows best” approach is giving way to a team-based, patient-first model, where medication review pharmacists are key players. As part of a PCN, they provide the time, skill, and attention that GPs may not always be able to offer.

Whether it’s improving medication adherence, deprescribing unnecessary treatments, or preventing drug interactions, their impact is clear and critical.

For every patient struggling with a complicated pill box or unsure about the prescribed medication they’re taking, a clinical pharmacist might just be the best ally they didn’t know they had.

FAQs

1. What is a medication review?

A medication review is a structured evaluation of all the medicines a patient is taking to ensure safety, effectiveness, and necessity.

2. What is a structured medication review (SMR)?

An SMR is a comprehensive, face-to-face consultation carried out by a clinical pharmacist to optimise a patient’s medication regimen.

How often should medication reviews take place?

Annually for most long-term patients, but frequency can vary based on clinical need.

4. What is the GP medication review protocol?

It’s a standardised NHS framework used by GPs and pharmacists to conduct consistent, effective medication reviews.