There are three main roles for community pharmacies: providing post-review support for patients, including preventing inadvertent restarting of medicines; identifying patients at risk; and referral for prescribing review.

Providing post-review support

Decisions about medications and the outcomes of a review should have been made in partnership with the patient. Some patients may be reluctant to stop medications that they had been previously told they needed to take for life, especially if a specialist had initiated the treatment. 

A common reason for needing to stop a medication is because the evidence has changed or the patient is unable to take it as per evidence-based guidelines, so will not have all the benefits. Any changes should have been transcribed to the patient’s repeat prescription list and the outcomes shared with the patient’s pharmacy. Then, if a patient forgets or inadvertently orders a prescription, the pharmacy team can reinforce the outcome of the review – but such a role depends on effective communication between surgery and pharmacy.

Identifying patients at risk

The pharmacy team is well placed to have initial conversations with patients who are taking medications that are known to be high risk, medicines that cause harm (see polypharmacy.scot.nhs.uk), and combinations that can be flagged with the prescriber.
An example is the combination of a diuretic, an ACE inhibitor and a non-steroidal anti-inflammatory drug. 

The other area where interventions can be made is for medications that should not be taken long term, such as proton pump inhibitors or painkillers. 

Community pharmacies are often the first port of call for advice for symptoms such as sickness and diarrhoea, and staff are therefore well placed to advise patients on action that could be taken when they are ill. Polypharmacy guidance refers to this this as the “sick day rules”. An example would be for a patient taking metformin to stop taking this for the days that they have diarrhoea, vomiting or sickness. This is to prevent the potential development of acute kidney injury. 

Referral for a review

Many GP practices now have practice-based pharmacists. The community pharmacy is ideally placed to identify patients for a more in-depth review and refer these to the practice pharmacist. Many community pharmacies also provide medications and advice to care homes and are becoming more involved in the long-term prescribing of some medications and associated medication reviews in discussion with care home staff, the residents, and their carers.