Driving SMRs in Seldom Heard Communities using the HIN SMR patient resources. Barriers and Enablers (2025)

Health Innovation Network

Project summary

Problematic polypharmacy causes avoidable patient harm, adds cost to the healthcare system and diminishes quality care for patients. Data shows an increased risk of polypharmacy with higher deprivation and a greater proportion than average of Black, Asian and Minority Ethnic patients experience overprescribing (ref1,2).

Structured Medication Reviews (SMRs) can reduce the number of problematic or unnecessary medicines a patient is taking (ref1,3). However, studies also show that many patients do not understand what an SMR is, and receive limited information to help them understand or prepare for their SMR (ref1).

In 2023, the HIN, working with Leeds University and patients developed a suite of translated resources4 to help patients prepare for their SMR appointment. Local pilots (ref 8,9,10) showed that deploying the resources increased engagement with patients and reduced “did not attend” rates when these patients were invited to attend an SMR.

To build upon this work, the HIN wanted to increase access to SMRs for seldom heard patient groups and understand the enablers and barriers that Primary Care Networks (PCNs) in areas of high deprivation experience when deploying the SMR resources. 27 PCNs participated in the study, conducted between November 2024 and March 2025. Patient groups included veterans, the housebound, care home residents, patients with learning difficulties and ethnic minority groups who do not read or speak English.

2,587 SMRs were completed. 85% of PCN teams agreed that the SMR resources enabled engagement with seldom heard communities, reduced ‘did not attend’ rates and increased the uptake and quality of SMRs compared to baseline (1,241 SMRs). The relatively small amount of funding (£1000-£1500) was a key enabler, providing PCN teams protected time to review existing processes for SMRs, identify and prioritise patients and carry out SMR appointments.

Digital exclusion was an issue in some sites. Some patients did not have a smartphone to open web links. Several PCNs subsequently posted the resources but this was not seen as a sustainable solution.

Out of 112 patients, 67% said the materials helped them understand the reason for the SMR. 58% said the resources helped them prepare for their SMR and 66% said the resources helped them share what was important to them with their prescriber.

The resources significantly improved engagement with seldom heard patients. PCNs acknowledged that there remains a cohort of patients at risk of health inequalities who do not engage with their GP practice. Further research is needed to address this gap in understanding.

The full evaluation report including 10 PCN case studies is available here