Professor Smith has been head of the Regional department of Urogynaecology at St Mary's Hospital, Manchester for the last 18 years. During this time he has continued with his research and clinical interest in the causes and treatment of pelvic organ prolapse and urinary incontinence in women. He has published his research and surgical experience in journals and textbooks. Professor Smith pioneered laparoscopic techniques (key hole surgery) for the treatment of stress incontinence and prolapse and has demonstrated and lectured on this surgery in many countires. Professor Smith has written over thirty chapters in gynaecology textbooks particularly concerning laparascopic techniques in urogynaecology. Professor Smith has been President of the British Society of Gynaecological Endoscopy .
Professor Smith runs regular NHS clinics (St Mary's Hospital), and Private sessions (Anson Medical Centre) for women who have pelvic floor problems (prolapse and urinary incontinence) and at the Spire Regency Hospital in Macclesfield.