Evolution of pharmaceutical care within general practice in England—a review

Background and objective: Medicines optimisation and pharmaceutical care are used across the UK to address the problems associated with sub-optimal use of medicines and adopt a patient-centred approach to improved outcomes. The changing medical model of prescribing in the UK and the increasing utilisation of clinical pharmacists in general practice in England, coupled with national policy change, has brought a renewed focus on medicines optimisation in pharmacist-led care in general practice. Reviewing and understanding the topic of medicines optimisation in the context of changing national policy can help advance primary care pharmacy practice. Design: We conducted a thorough search across multiple databases including PubMed/MEDLINE, Scopus, Embase, and Google Scholar within the timeframe of date of inception to 10/2022 using key words medicines optimisation, medicines management, medication review, pharmaceutical care, structured medication review, primary care, United Kingdom, England. Results: This review highlighted the classification and definition of medication review in the process of medicines optimisation and how national policy has evolved to focus on achieving its objectives and provided awareness on how medicines optimisation can be effectively implemented in general practice. Conclusion: The principles of medicine optimisation remain broad and multifaceted, and there is a lack of evidence to evaluate the impact of critical medicine optimisation principles in a general practice setting. Medication review remains an essential part of the medicines optimisation process, with a greater emphasis on adopting a patient-centred approach aligned with shared-decision making principles, evolving from a medicines management approach focusing on systems and processes only. Defining medication review represents a challenge as there is overlap in the literature and different countries, and territories use variations of the term to describe similar services, with the definition of medication review adopted in England evolving over time. A targeted approach for medication review has been advocated in the most recent national policy, however, there appears to be variation in how and when medication reviews are carried out, regardless of which healthcare professional is undertaking the activity. Utilising a structured approach to medication review using support tools may help standardise this process and ensure equity of care for patients.