Structured medicines review

December 2025

Developed in collaboration with the Medicines optimisation Special Interest Group of the RCGP.

Background

While medicines play an important role in improving health outcomes and saving lives, they can also cause harm, contributing to preventable hospital admissions,i inefficient use of resources and the growing threat of antimicrobial resistance.ii,iii These challenges are further exacerbated by health inequalities, particularly among minority ethnic communities and socioeconomically deprived populations,iv as well as among people living with frailty, autism and learning disabilities.v

As stated by the General Medical Council (GMC),vi when clinicians prescribe medications, they ‘must ensure that suitable arrangements are in place for monitoring, follow-up and review’, while carefully considering each patient’s individual needs and the potential risks associated with treatment. Regular, structured review is especially important given the increasing clinical complexity in general practice, the expanding number of professionals involved in an individual’s care, and the growing prevalence of polypharmacy.

The RCGP identifies medication review as a critical mechanism for ensuring the ongoing appropriateness and safety of prescribing. This includes responding to changes in an individual’s comorbidities, preferences and priorities as well as to developments in the evidence-base, potential drug-drug interactions and physiological changes that may affect pharmacokinetics, such as declining renal function. We have published a policy report, ‘Towards Greener Prescribing in General Practice’, recommending that “Governments and health system leaders should provide the support and resources needed for trained primary care teams to carry out ‘Comprehensive and Structured Medication Reviews’ (CMR & SMR) for every patient in need, improve quality of prescribing and improve patient safety and outcomes. This should help to ensure medications are effective and necessary, and that suitable alternatives or dosage reductions are considered where appropriate.”

GPs are uniquely and expertly trained to provide holistic, person-centred care. In the context of prescribing for individuals with multiple comorbidities, this involves integrating recommendations from multiple specialists, carefully weighing the cumulative risks and benefits of complex medication regimens, and reaching shared decisions with patients and those important to them. Shared decision-making, structured medication reviews and advanced care planning have been supported by the Chief Medical Officers in England and Scotland, who have highlighted the importance of practising realistic medicine, particularly for older populations.vii,viii

Prescribing is a core component of the GP’s role. The assessment of new symptoms or clinical presentations requires a thorough understanding of the potential adverse effects of medicines and the risks of the prescribing cascade. The GMC underscores this responsibility, stating: “Pharmacists can help improve safety, efficacy and adherence in medicine use, for example, by advising patients about their medicines and carrying out medicines’ reviews. This does not replace [a doctor’s] duty to make sure [they] are prescribing and managing medicines appropriately.”

Prescribing expertise and confidence in medication assessment are critical priorities for clinicians and are fundamental to both patient wellbeing and the long-term sustainability of the NHS. Supporting clinicians to optimise medicines safely and effectively requires strong GP leadership across practice, neighbourhood, integrated care board (ICB), and national levels, working in close collaboration with pharmacy colleagues.

However, despite the recognised importance of these activities, escalating demand and pressure within primary care have increasingly constrained opportunities for meaningful medication review. As of October 2025, the number of fully qualified, full-time equivalent GPs in England has risen by only 462 since the end of 2019, while the registered patient population has grown by more than 3.7 million, further widening the gap between capacity and need.

RCGP recommendations

  1. All holistic medication reviews should be undertaken by clinicians who have the training, competence and professional confidence to review the medications and to deprescribe safely where clinically indicated, with access to GP support for complex decision-making.
  2. To support a more proactive preventive medicine approach, shared decision makingix is essential alongside the appropriate use of structured medicationx reviews and advanced care planning.
  3. Support and resources should be provided at national and local levels for the implementation of medication reviews as part of person-centred care.
  4. NHSE and ICBs should embed GP clinical leadership within medicines optimisation structures at practice, neighbourhood, ICB and national levels, ensuring that GPs work collaboratively with pharmacy teams to strengthen clinical governance and support effective, safe medication optimisation.

Useful resources

Resources and tools to support GPs in managing repeat prescribing and polypharmacy include:

  • The mechanics of tackling overprescribing and problematic polypharmacy – developed by the ‘Health Innovation Network’
  • Repeat Prescribing Toolkit – Commissioned by NHS England and co-developed by the RCGP and The Royal Pharmaceutical Society, to help GP practices and primary care networks work with community pharmacies and patients to make repeat prescribing safer, more efficient, and less wasteful. It also includes practical guidance on improving communication with patients, supported by case studies, flow charts, action plans, and other helpful resources.
  • Royal Pharmaceutical Society position statement on Structured Medication Reviews.

Endnotes

  1. Osanlou, R., Walker, L., Hughes, D.A., Burnside, G. and Pirmohamed, M. (2022). Adverse drug reactions, multimorbidity and polypharmacy: a prospective analysis of 1 month of medical admissions. BMJ Open, 12(7), p.e055551. doi: https://doi.org/10.1136/bmjopen-2021-055551.
  2. Bevan Commission (2023). Reducing Medicines Waste in Care Homes. Accessed May 2025
  3. World Health Organization (2023), Antimicrobial resistance. Accessed May 2025
  4. Department of Health and Social Care (2021) Good for you, good for us, good for everybody: a plan to reduce overprescribing to make patient care better and safer, support the NHS, and reduce carbon emissions. Accessed May 2025
  5. Public Health England (2019). Psychotropic drugs and people with learning disabilities or autism: introduction. Accessed May 2025
  6. Reviewing medicines - professional standards - GMC. Accessed May 2025
  7. Scottish Government (2023). Realistic Medicine - Doing the right thing: Chief Medical Officer annual report 2022 to 2023. Accessed May 2025
  8. Department of Health and Social Care (2023). Chief Medical Officer’s annual report 2023: health in an ageing society. Accessed May 2025
  9. Academy of Medical Royal Colleges. (2020). Choosing Wisely. Accessed May 2025
  10. Royal College of General Practitioners: Towards Greener Prescribing in General Practice. Accessed May 2025