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Industry perspectives

Healthy Wirral Partners: Primary care networks - digitally enhanced structured medication reviews

Optimising medicine reviews as part of a wider population health management approach.



Healthy Wirral Partners (HWP) are a place-based partnership of health and care organisations serving the population of Wirral, in Merseyside, northwest England, within the wider Cheshire and Merseyside Sustainability and Transformation Partnership (STP). Primary care networks (PCNs) are essential to supporting neighbourhood-level population health management within wider integrated care systems and have a key focus on structured medication reviews (SMRs) and medicines optimisation, amongst other areas.

HWP and local PCN clinical pharmacists have been working together with Cerner to co-develop and implement digital tools to enhance SMRs within local PCNs to support improved medicines management and safety through personalised interventions with residents. This has included using joined-up data from across primary, acute, community and mental healthcare settings, leveraging the Cerner HealtheIntent® population health platform and medicines optimisation framework, to identify and prioritise patients who would benefit from a structured medication review. This particularly includes those residents most at need in local care homes, with complex polypharmacy, on high-risk medications and with high frailty risk. Working in partnership with Imperial College London, the approach has included a full service evaluation quantifying the outcomes of these reviews with user feedback to support learning and continual improvement.

The 16-week co-development programme included:

  • Problem identification and requirement gathering for SMR prioritisation.
  • Identification of data sources, data quality issues and risks that may affect interpretation of data, identifying improvement opportunities, such as enhancing data quality relating to medication status, medication end dates and coding of SMRs.
  • Analytic development, validation, testing and clinical risk management from both HWP and Cerner clinical consulting stakeholders to ensure the product met expectations. 
  • Data analysis and visualisation using the Cerner HealtheAnalytics℠ product to support understanding SMR volume and outcomes over time, including a case-finding and care utilisation (theograph) view with health risk factors built in for clinical pharmacists to support SMR prioritisation and delivery. This included risk factors relating to individual age, conditions, polypharmacy, anti-cholinergic burden and falls risk. The care utilisation (theograph) view demonstrated individual health and care activity surrounding SMRs, such as recent GP visits, hospital attendance and attendances to community, mental health and other care services that may guide care delivery during the SMR: For example, helping to clarify the reasons for drugs prescribed post-discharge, or review medicines following a recent health and care event or visit. 
  • Implementation of the medicines optimisation and structured medication review tool was delivered in practice across two PCNs in the Wirral - Brighter Birkenhead PCN (c.70,000 population) and South Wirral PCN (c.50,000 population). 
  • Benefits measurement and service evaluation was included with support from Imperial College London, to understand the impact of the intervention and opportunities for learning and improvement.

The medicines optimisation framework allows system-to-person benchmarking on prescribing quality and patterns, with person-level case-finding to support SMR prioritisation.

The approach and delivery benefited from exceptional health and care professional leadership, including clinical pharmacist-led engagement and input to the design, development and use of new digital tools ensure the tools and approach delivered system-to-person-level improvement.

Figure 1: Casefinding tool

Figure 2: Patient theograph

Figure 3: Reviews Dashboard

SMR delivery in the Wirral has increased over time and coincided with the COVID-19 response, where SMRs have helped improve care for individuals who may be particularly vulnerable from the effects of the global pandemic. For example, in care homes, those with complex polypharmacy and those with severe frailty who are particularly isolated or housebound or who have had recent hospital admissions and/or falls.

Structured medication reviews to support those identified as most in need of review have increased over the 16-week development programme using new, standardised intervention coding to measure the increase in SMRs over time.

Using the HealtheIntent® tool to support SMRs with 30 residents over a seven-week period, several benefits have emerged. For example, patterns demonstrating reduced prescribing of high-risk medications and medications recommended for regular review in primary care settings.1

Drugs recommended for therapeutic monitoring in primary care are particularly important to review to reduce risk of polypharmacy and anticholinergic burden.1 During the use of the tool in practice for a group of 30 local residents, prescriptions for this group of drugs have decreased.

The total number of active prescriptions for drugs recommended for therapeutic monitoring in primary care were assessed one day prior to and 35 days after the delivery of the HealtheIntent-enabled SMRs. Active prescriptions included were identified from NHS Wirral CCG GP practices’ primary electronic health record source and Wirral University Teaching Hospital NHS Foundation Trust’s primary electronic health record. Full service evaluation completed by Imperial College London also indicated statistically significant reductions in all GP prescriptions at eight weeks post-intervention (see below).





Four weeks post-SMR

Eight weeks post-SMR

Mean (SD)

Mean (SD)



Effect size (CI)

Mean (SD)



Effect size (CI)

SMR medicines (+)


12.83 (8.09)

10.28 (6.06)



0.765 (0.66-0.84)

9.55 (4.80)



0.782 (0.68-0.85)


10.07 (3.23)

9.17 (3.60)



0.686 (0.55-0.79)

9.14 (3.62)



0.709 (0.58-0.81)


2.62 (5.98)

1.10 (3.84)



0.454 (0.26-0.58)

0.414 (2.23)



0.454 (0.26-0.61)



Wirral PCN clinical pharmacists have been central to the design, development and implementation of the SMR management and case-finding tool.

“I have found the tool to be extremely beneficial in practice – in a short space of time it has changed the way my team and I prioritise our medication review caseload and will continue to do so. The design, development and implementation has involved a lot of dedication, expertise and time from both Cerner and ourselves, but has been thoroughly worth it in seeing the finished product and how it has come to life.”

Michelle O’Neill, PCN clinical pharmacist (Wirral University Teaching Hospital NHS FT) working within Brighter Birkenhead PCN

“The SMR dashboard is very useful and makes it very easy to direct the attention to high-risk patients and takes the hassle out of building complicated searches.”

Rocco Hadland, PCN clinical pharmacist (Wirral University Teaching Hospital NHS FT) working within South Wirral PCN

To find out more about Cerner’s solutions and how we could support you, speak to your Cerner relationship owner, contact us here, or message us on Twitter.


1 NHS Specialist Pharmacy Service. Suggestions for Drug Monitoring in Adults in Primary Care. September 2020. Access online at on 29 June 2021.

With thanks to HWP, Pippa Roberts, Tori Young and the clinical pharmacists Michelle O’Neill and Rocco Hadland listed who have led and supported this work, together with Cerner and Imperial College London colleagues and those directly leading and delivering the co-development activities – Olivia Reed, Richard Betteridge, Gemma Kuczora, Miren Shah, Thomas Dudley, Esther Gathogo, Hannah Portugal, Nikolas Mastellos, Antonio Vallejo-Vaz, Kanika Dharmayat and Ryan Irwin.

Healthy Wirral Partners calculated their own findings.
Cerner has not validated the accuracy of these claims.
Client outcomes were achieved in respective settings and are not representative of benefits realised by all clients due to many variables, including solution scope, client capabilities and business and implementation models.