What Is a Medication Review? The Different NHS Reviews and Which One You Need

What is a medication review? It is a planned conversation with a pharmacist, GP or nurse about every medicine you take, to check that each one is still needed, still working, safe alongside the others and practical to take. The NHS runs several different kinds, for different situations, and all of them are free.

What is a medication review, and what does it check?

The phrase gets used loosely. A GP surgery, a hospital ward and your local chemist might all say "medication review" and mean quite different things. That causes a lot of confusion, especially for families trying to arrange one for an older relative.

What they share is a purpose. NICE, which writes the guidance the NHS follows, describes a medication review as a structured, critical look at a person's medicines, with the aim of reaching agreement with that person about their treatment, getting the most benefit from the medicines, cutting down medicine-related problems and reducing waste. The NHS name for that bigger goal is medicine optimisation: making sure each person takes the right medicines, in the right way, for the right reasons.

In practice, a good review works through a short set of questions for each medicine:

• What is it for, and do you still have that problem?
• Is it working, and how would anyone know?
• Is it causing side effects, or clashing with anything else you take?
• Are you actually taking it the way the label says, and if not, why not?
• Does it need a blood test or other check that has been missed?

NICE is clear that the review should cover everything, not just prescriptions. That means medicines you buy over the counter, vitamins, herbal remedies and supplements too, because those can interact with prescribed medicines just as easily. It should also take your own views seriously. If a tablet makes you feel worse and you are not sure it helps, that is exactly the kind of thing to raise.

A review does not always end with a change. A medicine might be stopped, a dose lowered or the timing moved. Or everything stays as it is, but now you know why, which is a good result too.

The different types of NHS medication review

This is the part most people have never had explained. Which review you need depends on your situation: whether you take lots of medicines, whether you have just started a new one, whether you have just come out of hospital, or whether your repeat prescription is simply due for its routine check. Each is run by different people and reached in a different way. Every one of them is free on the NHS.

Structured Medication Reviews are the most thorough kind. They are part of the contract GP practices work under as Primary Care Networks, and are normally carried out by a clinical pharmacist or doctor. The review looks at the whole person, and the benefits and risks of each medicine are weighed up with you, not decided for you. Practices are expected to focus them on higher-risk groups, and the number offered depends on how many clinical pharmacists the network has. NHS England's page on structured medication reviews sets out who they are aimed at.

The New Medicine Service is for the first few weeks after starting a medicine for certain long-term conditions, such as high blood pressure, asthma or type 2 diabetes. It is run by community pharmacies, including ours, and it looks only at the new medicine rather than everything you take. Our New Medicine Service page explains which conditions qualify and how it works.

The Discharge Medicines Service exists because leaving hospital is one of the riskiest moments for medicines. Tablets get stopped, doses change and new ones are added, and the GP practice and the pharmacy do not always hear about it in time. Since 15 February 2021 this has been an Essential Service, which means every community pharmacy in England must provide it. The hospital sends your pharmacy details of what changed. The pharmacy then checks your next prescription matches those changes and talks it through with you or your carer. You cannot book it yourself; it starts with a referral from the hospital.

The repeat prescription review is the one most people have come across. Your GP practice sets a date by which your repeat medicines need checking before they can keep being issued. It may be a face-to-face appointment, a phone call, or a questionnaire and a blood test, depending on what you take. If it lapses, practices sometimes issue a shorter supply until it is done, so it is worth answering promptly.

Medicines Use Reviews are the one people still ask us for by name. For years they were how community pharmacies reviewed people's medicines. The service was decommissioned in England on 31 March 2021, and no pharmacy in England can provide an NHS MUR today. If you have been told to get one, what you probably need now is one of the other reviews in the table, and we are happy to work out which.

Who should have a medication review?

Anyone who takes a regular medicine can benefit from having it checked. But some people have far more to gain than others, and the biggest single reason is simply taking a lot of medicines at once. The medical word for this is polypharmacy.

It is more common than people think. A national review of prescribing in England, published by the government in 2021, found that around 15% of people take five or more medicines a day, and 7% take eight or more. The same review reported that around 6.5% of hospital admissions are caused by the unwanted effects of medicines, rising to up to one in five in people over 65.

Taking many medicines is a reason for a review in itself, for several reasons that build on each other:

• Every extra medicine adds chances of an interaction with the others, and the risk of side effects goes up with the number you take.
• Medicines get added by different people. A hospital consultant, a specialist clinic and the GP may each have started something without the full picture.
• Some medicines are prescribed to treat the side effects of others. Fixing the first problem can sometimes remove the need for the second medicine.
• Reasons change. A medicine that made sense ten years ago may not suit someone who is now older, lighter, or has kidneys that clear medicines more slowly.
• Managing it all gets harder. Several packets, different times of day and fiddly inhalers or eye drops make missed or doubled doses more likely.

Beyond the number of medicines, these are all good reasons to ask for a review for yourself or someone you look after: a recent stay in hospital; a fall, or feeling dizzy or unsteady; new confusion, drowsiness or low mood; trouble swallowing tablets or opening packs; a cupboard full of medicines that are not being used; regularly buying remedies over the counter on top of prescriptions; or living in a care home. Being on a medicine that can cause dependence, such as some strong painkillers or sleeping tablets, is another, and it is one the NHS specifically asks GP practices to prioritise.

How to ask for a medication review

Because the reviews are run by different people, the right place to ask depends on your situation. Here is the short version.

If you or a relative take lots of medicines, live with frailty or are in a care home, contact the GP practice and ask whether a structured medication review would be appropriate. It helps to say why: for example, that your mother takes eleven medicines, has had two falls this year and is struggling to keep track. The practice decides who is offered one, but explaining the situation clearly makes it much easier for them to see the need.

If you have just been started on a new medicine for a long-term condition, ask your pharmacist when you collect it whether it qualifies for the New Medicine Service.

If you are going home from hospital, tell the ward staff which pharmacy you use, so the referral goes to the right place. If your usual pharmacy is not the one your GP sends prescriptions to, it is worth sorting that out, because the discharge check works best when the same pharmacy sees your next prescription. You can choose where your prescriptions go through our NHS prescriptions service.

If your repeat prescription review is due, reply to the practice when it asks, and book it before you run low.

If you just have a question, you do not need to wait for any formal review. A pharmacist medication check at the counter costs nothing and needs no appointment. We can tell you whether something you have bought is safe with your prescriptions, or whether it is time to ask your practice for a fuller review.

If you are asking on behalf of someone else, it is best to have their agreement, and to go with them if you can. If they cannot make decisions for themselves, tell the practice or pharmacy, and they will explain how you can be involved.

What to bring to a medication review

The most useful thing you can do is bring the medicines themselves, not a list from memory. Put everything in a bag, in the original boxes, and take it along. What is written on the prescription and what is actually in the cupboard are often different, and that difference is usually where the problems are hiding.

That bag should include:

• Every prescribed tablet, capsule and liquid, including ones you only take now and then
• Inhalers, eye drops, creams, patches and injections, which are easily forgotten
• Anything bought from a shop or chemist, plus vitamins, supplements and herbal remedies
• Your repeat prescription slip, or the medicines list from the NHS App
• Any hospital discharge letter or clinic letter from the last year
• Home readings, such as blood pressure or blood sugar, if you keep them

Write your questions down before you go, because it is easy to forget them in the room. Note any side effects, when they started, and anything you find hard, like swallowing large tablets or remembering lunchtime doses.

Most of all, be honest about how the medicines are really being taken. If doses get missed, or a tablet was quietly stopped months ago, say so. Nobody will tell you off, and safe decisions need the real picture.

Medication reviews at our pharmacy in Harrow

At Garner Chemist we provide the reviews that community pharmacies deliver. We run the New Medicine Service for people starting a medicine for a qualifying long-term condition. And like every community pharmacy in England, we provide the Discharge Medicines Service, so when a hospital refers you to us after a stay, our pharmacist checks your new prescriptions against what changed and talks it through with you or your carer.

We cannot carry out a structured medication review, because those are run by GP practices and their networks. What we can do is help you work out whether one is worth asking for, and, with your consent, let your GP practice know when we spot something that needs their attention. Our superintendent pharmacist, Poonam Pankhania, is an independent prescriber, and our pharmacists are used to untangling long medicine lists for customers and their families.

Many of the people we help live a short walk away in West Harrow or North Harrow, and others come along Pinner Road from Harrow town centre, often carers collecting for a parent. If your prescriptions already come to us, we can see the medicine history, which makes those conversations quicker and more useful. You can also have repeats delivered to your door if getting to the pharmacy is difficult.

We have a private consultation room for anything you would rather not discuss at the counter. You will find us at 160 Pinner Road, Harrow HA1 4JJ, open Monday to Friday from 9am to 6pm and Saturday from 9am to 1pm, and closed on Sunday. Call us on 020 8863 6338, or simply come in and ask to speak to the pharmacist.