Discharge medicines service: scaling success nationwide 

The discharge medicines service (DMS), which involves hospital, GP, primary care network (PCN) and community pharmacy teams, can prevent hospital readmissions and shift care closer to home. The service is aimed to ensure patients understand their medications, as well as how and when to take them. 

However, analysis by The Pharmaceutical Journal has revealed that the DMS in England is shockingly under-utilised. Nationally, only around 1% of patients admitted to hospital are referred to the service — less than one-fifth of those who could benefit^​1​ — and access depends on “postcode lottery”, with the service utilised much more in some areas than in others.

Under its ten-year health plan, the NHS wants to see healthcare shift ‘from hospital to community’ and ‘treatment to prevention’, which is enabled by a shift ‘from analogue to digital’. The DMS has the potential to unlock those benefits but, as high-performing service leads have told The Pharmaceutical Journal, integrated use of digital systems is crucial to its success.

Why the DMS is needed

Transition of care is a recognised risk factor for medication-related harm^​2​. According to the results of the  ‘Adult inpatient survey 2024’, conducted by the Care Quality Commission, 11% (n=6,848) of patients reported that they were given medication upon discharge with no information alongside it (see Figure 1^​3​).

Figure 1: Patients discharged from hospital are not always given sufficient information about medicines 

Similarly, study findings published in 2024 revealed that patients may not fully understand instructions given on discharge if they are distracted, overloaded with information and eager to leave for home^​4​.

Patients not fully understanding instructions can result in medication-related problems, adverse events and readmissions^{​5​​​}, with NHS costs for post-discharge medication harm in older adults of more than £396m each year, according to the results of a 2018 study^​6​.

However, helping patients and carers understand their medications post-discharge is effective in reducing harm and readmission. When the DMS was piloted in the North East of England in 2014, rates of hospital readmission were significantly reduced (see Figure 2^​7​).

Figure 2: Patients receiving a discharge medicines service consultation are less likely to be readmitted to hospital

How the service works 

The DMS is initiated by hospital teams, who can send a patient’s community pharmacy information about any medications that have been stopped, started or changed while in hospital (see Figure 3^​8​).

Figure 3: How does the discharge medicines service work?

Joined-up and patient-focused care

The DMS reduces medicines costs and wastage, avoids readmissions and ensures patients understand their medicines, says Lisa Ruddle, principal pharmacy technician for ward services at the Royal Chesterfield Hospital in Derbyshire.

“A lot of readmissions [happen] because patients are not in the right frame of mind when they do leave us, so you try to bombard them with everything, all the side effects, what time to take them. And sometimes they get home and they can’t remember that, and that could lead to a readmission. Whereas if we’ve referred them, that prevents that admission happening,” Ruddle explains.

The cross-sector collaboration between the hospitals and community pharmacies involved in the DMS also improves relationships and enables better communication — for instance, when there are supply issues with medications.

“Because we’ve got a better approach to communication with community pharmacies, we would contact them to discuss it, if needed. If it’s a critical medicine, a high-risk medicine, an expensive medicine, we would contact them to say, ‘What’s the supply situation?’” Ruddle adds.

“Instead of it just being our job and their job, it’s more of a together approach.” 

The growth of the DMS

According to NHS data, the number of complete and incomplete DMS interventions conducted by community pharmacies has more than doubled since the service was commissioned in 2021. In the first four years of the service, half a million DMS consultations were conducted across the three stages of the service, the data show. (see Figure 4).

Figure 4: The total number of discharge medicines service consultations has more than doubled since 2021

However, there is still room for improvement in referrals to the DMS. The authors of a 2023 study of the service concluded that “DMS implementation is currently variable and full implementation across all-ICS areas could increase the benefits five-fold”.^​1​

The findings of an analysis of the latest figures conducted by The Pharmaceutical Journal found that geographic variation is ongoing (see Figure 5^​1​).

Postcode lottery

In 2023/2024, acute hospital trusts were incentivised to refer between 0.5–1.5% of their non-maternity inpatients to the DMS^​9​.

Using this range as a frame of reference, DMS referrals remain inconsistent around the country, with rates of referral per acute admissions ranging from 0.06% in Birmingham and Solihull ICB to 9.82% in Cheshire and Merseyside (see Figure 5).

Outside of acute trusts, mental health trusts and community trusts also make referrals to the service — potentially because their patients are high-risk or are on higher-risk medications. The results of a study published in 2025 also revealed value in referring paediatric patients to DMS^​10​.

However, when other specialities are included, DMS referral rates are even lower.

Figure 5: Referrals of acute inpatients to discharge medicines service vary by integrated care board 

Enablers for DMS success

According to PharmOutcomes data shared with The Pharmaceutical Journal, around 170 of the approximately 200 trusts in England use an integrated PharmOutcomes referral system to refer patients to DMS^​11​.

Service leads at the Royal Chesterfield Hospital in Derbyshire and Dorset Healthcare University NHS Foundation Trust shared how DMS is integrated from the point of admission — with all staff members involved in identifying patients — and an integrated IT solution that automatically creates referrals upon discharge (see Figure 6). 

Figure 6: How two trusts embedded discharge medicines service

Cost savings for hospitals

Even with the cost of the digital infrastructure and staff time needed to make referrals, DMS referrals saved Dorset Healthcare University NHS Foundation Trust an estimated £1,394,571 in the 12 months leading up to March 2026 by avoiding readmissions.

In addition, Optum UK estimates that DMS referrals saved the health system approximately £471m in 2025–2026^​7​.

Supporting the DMS in the community

Compared to hospitals, the cost-benefit equation in community pharmacy is more complex. 

DMS is included in the core ‘Community pharmacy contractual framework’ (CPCF), which means that no additional money is available for the service, no matter how many consultations community pharmacies complete. The real-terms value of this overall funding has decreased since DMS was introduced (see Figure 7^​12​). 

Gareth Jones, director of external affairs at the National Pharmacy Association, comments: “The current CPCF does not leave adequate funding for the scheme to be scaled up and this must change if DMS is to realise its full potential.”

Meanwhile, Alima Batchelor, head of policy at the Pharmacists’ Defence Association, thinks a two-pharmacist model is needed, adding that “increasing numbers of services need appropriately staffed teams to deliver them safely and effectively”.

Figure 7: Discharge medicines service was introduced amid a flat multi-year funding deal

The funding mechanism also means individual pharmacies are not fully in control of the payment they receive from the service. Rather, their income is dependent on hospital referrals, which benefits pharmacies connected to high-referral hospitals and may benefit some types of pharmacy more than others. A pilot preceding the national service found completion of referrals was “highest for multiples and significantly higher than any other type of pharmacy”^​7​.

The future of the DMS

Tase Oputu, president of the Royal College of Pharmacy, says: “While the DMS is delivering clear benefits for patients, there is an opportunity to improve the consistency and completeness of referrals. 

“Making the referral process as simple and efficient as possible, supported by effective use of technology, skill mix and interoperable patient records, will help ensure critical information flows seamlessly between hospital and community pharmacy teams,” she adds. 

But increased hospital referrals to DMS are meaningless if community pharmacies are not able to keep up — which is why a funding mechanism that rewards pharmacies for their part in the shift from hospitals to home is also vital to make the most of this service’s potential.

Improved DMS services will “support closer collaboration across care settings and enable pharmacists to provide patients with the right support as they move from hospital to home”, Oputu concludes.