Introduction & module overview

The period after discharge from hospital is when many medicines misadventures happen for patients. Community pharmacist involvement in checking and reconciling medicines at this stage is known to reduce inadvertent errors with consequent enhancement of patient safety. Discharge medicines services are now recognised as a key part of integrated healthcare by the NHS across all four nations of the UK. 

Some patients on discharge are not able to attend a pharmacy in person, so remote consultations are an important part of the service. This module covers preparing for, conducting and completing such consultations.

DMS explained

The DMS is an essential contractual service to improve the safety and efficacy of medicines use at the transfer of care from hospital to community in England. In Wales, the Discharge Medicines Review service, supporting patients at the transfer of care, has been in place since 2011, while in England, the DMS was introduced in 2021. 

In the first three months of the DMS, pharmacists conducted 13,265 consultations from 2,522 community pharmacies. Scotland and Northern Ireland will soon be introducing community pharmacy support for discharge medicines as part of the Scottish 2021-2026 NHS Recovery Plan and the Northern Ireland Pharmacy Commissioning Plan for 2022-25. 

While this module focuses on remote consultations for the DMS in England,
the content is relevant to all community pharmacy remote consultations across the UK relating to medicines’ use at the transfer of care. 

The DMS involves a three-stage pathway:

• Stage one consists of an electronic discharge referral received by the pharmacy where the patient’s medicines on discharge are reconciled with those taken on admission
• Stage two is where the first prescription is received post-discharge and medicines checked to take account of changes made during admission
• Stage three is a conversation with the patient to discuss any issues they may have about their post-discharge medication regime. 

The NHS has introduced a new service condition in the NHS Standard Contract for 2022/2023, requiring acute services, mental health and learning disability services, and mental health and learning disability secure services, to “use all reasonable endeavours to refer service users, on discharge from inpatient care and where clinically appropriate, into the NHS Discharge Medicines Service”. 

Community pharmacists who provide the DMS can have a powerful positive effect on care, with NHS England reporting that patients “who receive this service are less likely to be readmitted (5.8 per cent versus 16 per cent at 30 days) and spend fewer days in hospital (7.2 days on average compared with 13.1 days for patients who did not receive the service) where they are readmitted”.

The NHS Business Services Authority has limited data but suggests there were 71,000 fee claims from contractors between March and December 2021 with huge variations between trusts regarding the number of patients referred.