Making medication counselling count: practical tips for pharmacists and pharmacy technicians

Medicines counselling is a crucial part of pharmacy practice. It improves adherence, reduces medication-related harm and gives patients the confidence to manage their treatment effectively. The NHS long-term plan and the World Health Organization’s Global Patient Safety Challenge ‘Medication without harm’ highlight the importance of ensuring patients understand their medicines, especially when moving between care settings^​1,2​.

It is estimated that 30–50% of medicines for long-term conditions are not taken as prescribed^​3​. This non-adherence contributes to avoidable hospital admissions, disease progression and increased healthcare costs. In addition to non-adherence, medication-related harm arising from adverse drug reactions, medication errors or inappropriate use, remains a significant patient concern. Among older adults, medication-related harm following hospital discharge is estimated to cost the NHS about £400m each year^​4​.

Structured medication counselling that is specific to the patient’s needs has been shown to improve adherence and reduce the risk of medication-related harm^​5​. The General Pharmaceutical Council’s (GPhC) standards for pharmacy professionals require pharmacists and medicines-management pharmacy technicians (MMPTs) to provide counselling that is clear and easy for patients to understand, while adapting their approach to individual needs^​6​. MMPTs are qualified and registered pharmacy technicians, who have undertaken additional training and competency assessments in medication optimisation and patient counselling, enabling them to support safe and effective use of medicines at ward level. Similarly, National Institute for Health and Care Excellence (NICE) guidance on medicines adherence recommends collaborative discussions that address patients’ concerns, beliefs and preferences^​7​. 

Medication counselling improves patient experience. When patients understand their medication, they are more likely to feel confident in managing long-term conditions such as asthma, diabetes and hypertension. This reduces unplanned readmissions, improves disease management and raises overall quality of life. In primary care, the New Medicine Service has demonstrated improvements in adherence and patient satisfaction, further emphasising the value of structured counselling across the healthcare system^​8​. Medication counselling is particularly important for high-risk medicines. 

For example, patients newly prescribed direct oral anticoagulants for atrial fibrillation face significant risks if they do not understand dosing, what can happen with missed doses, or drug interactions. Structured counselling, supported by written materials and follow-up, can ensure patients manage their medicines safely and know when to seek help^​7​.

Medication counselling is an integral part of safe and effective patient care. It requires not only thorough knowledge of medicines, but also communication skills, empathy and the ability to adapt to diverse patient needs.

The role of the pharmacist in medication counselling

Pharmacists play a crucial role in medicines counselling, bridging the gap between prescribing and the safe, effective use of medicines. Their responsibilities include medicines reconciliation, clinical review, patient education and safety-netting advice to help patients know when and how to seek further support, ensuring that treatment is optimised and clearly understood by the patient before they are discharged^​9​.

Pharmacists’ responsibilities in counselling are underpinned by the GPhC Standards for Pharmacy Professionals, which emphasise providing information that is accurate, clear and tailored to individual patients^​6​. Additional guidance from professional bodies and NHS frameworks further supports patient-centred counselling, open dialogue and adapting communication to the individual^​10,11​.

NICE guidance on medicines adherence highlights the importance of two-way conversations that explore patients’ beliefs, preferences and lifestyle factors^​7​. This may require pharmacists to adapt their approach for patients with language barriers, supporting patients with cognitive impairment by involving carers or simplifying complex regimens. Pharmacists must adapt their counselling approach depending on the patient group. For example, for paediatric patients, age-appropriate communication, and involving parents or carers is essential in ensuring all information is understood. For older patients, visual aids and reminder charts may be used to support counselling discussions. 

Pharmacists are particularly important in counselling for high-risk medicines. For example, when counselling a patient on warfarin at discharge, pharmacists should cover dosing schedules, international-normalised-ratio monitoring, dietary considerations and recognition of bleeding signs, and ensure that the patient’s Yellow Book is updated.

Pharmacists also have a role in teaching counselling skills to trainee pharmacists to deliver safe and effective counselling as part of wider clinical training. By doing so, they incorporate medicines optimisation into daily practice. Pharmacists can act as educators within the multidisciplinary team, ensuring that consistent, evidence-based messages are communicated to all healthcare professionals. By working collaboratively with others, pharmacists can help integrate counselling into the wider discharge planning and continuity of care.

How a medicines management pharmacy technician can support medication counselling

MMPTs are a key part of the clinical pharmacy services, reflecting the NHS’s commitment to patient-centred care and multidisciplinary working^​12​. Their contribution to medication counselling extends beyond traditional dispensing duties, enabling pharmacists to focus on complex clinical decision-making. 

MMPTs can conduct medicines reconciliation on admission, gathering information from multiple sources (such as summary care records, care homes or community pharmacies) to compile an accurate medication history and identify potential discrepancies^​13​. This ensures pharmacists have a reliable basis for clinical review and discharge counselling.

They can also provide structured information to patients, including clear instructions on dosing, side effects, and storage, delivered verbally, in writing or with visual aids, according to the patient’s needs^​14​. For example, a patient newly prescribed an inhaler may benefit from a demonstration with a dummy device alongside picture-based instruction. 

In preparation for discharge counselling, MMPTs can gather relevant resources, such as patient information leaflets, and arrange consultation times with patients^​7​. This approach supports a more efficient and patient-focused counselling process, ensuring they receive consistent, accessible information. 

By ensuring patients understand their medicines and addressing concerns, MMPTs play an essential role in medicines optimisation and patient safety. 

Practical counselling techniques and tips 

Research published in 2013 suggested that only 16% of patients starting a new medicine take it correctly, experience no problems and feel adequately informed^​15​. Pharmacy professionals must therefore approach counselling with both clinical knowledge and strong communication skills.

Effective medicines counselling is part of patient-centred care and usually begins by establishing rapport. Introducing oneself and obtaining consent sets a respectful tone, while actively listening and asking open-ended questions allows the patient’s priorities and concerns to surface^​16​. Avoid jargon, tailor information to cultural or educational needs, and invite patients to share their understanding. Before ending the consultation, make sure to confirm understanding – for example, by asking the patient to repeat key instructions in their own words. Increasingly, electronic resources, smartphone applications and video demonstrations are used to reinforce messages after the consultation. 

A structured approach to medicines counselling can enhance consistency. The first step is to explore the patient’s knowledge, understanding and concerns – for example, establishing whether the medicine is newly prescribed, if they are already on multiple therapies or if there are any known compliance issues^​17​. The next step is to assess individual factors that may influence adherence, including age, past medical history, diagnosis and social background. Finally, advice should be prioritised and communicated in a way that aligns with the patient’s specific needs and preferences.

Other strategies pharmacists should put into practice include:

• Being proactive in preparation and ensuring familiarity with the medicine before starting the consultation;
• For inhalers, adrenaline auto-injectors or other devices, using dummy devices to demonstrate correct technique and inviting the patient to repeat the demonstration;
• Reassuring patients who feel overwhelmed by the information being provided, highlighting the clear labelling on the medication packaging, patient information leaflets and other resources;
• Using written or bilingual materials, where appropriate, and signposting patients to reliable sources of information, such as the NHS website or information pages on official charity websites;
• Keeping the consultation interactive by encouraging questions and using open-ended dialogue; 
• Reassuring patients that they can return if they have any questions or concerns about their medicine.

Monitoring and improving counselling

To ensure medicines counselling is consistently delivered and effective, monitoring systems should be integrated into daily practice. 

Electronic patient record (EPR) systems allow pharmacists and MMPTs to record counselling interactions as part of the patient’s journey. At London North West University Healthcare Trust, pharmacy teams routinely document the date and time of counselling, the medicines discussed, and any key points covered in the patient’s records. This documentation is visible across the pharmacy team, prevents duplication, and ensures continuity and consistency. 

By auditing EPR data, the pharmacy team can identify gaps, variations and areas for improvement. NICE guidance on medicines optimisation advises organisations to evaluate the impact of providing patient information and use their findings to enhance services^​18​. Monitoring the delivery of medicines counselling in this way also demonstrates the impact of the pharmacy team and can support the development of business cases for continued service development. Quality improvement tools (such as Plan-Do-Study-Act cycles) can be applied to refine counselling processes and embed best practice^​19​. In addition, linking counselling metrics to broader patient-safety indicators, such as readmission rates or reporting adverse drug events through the Yellow Card system, strengthens the evidence base for investment in pharmacy-led services^​20​.

Patient feedback is an essential tool to assess impact. Structured surveys and post-discharge follow-up calls can determine whether patients recall key information, feel confident about medication management and know when to seek support. Peer review further strengthens quality improvement. Pharmacy staff can observe each other’s counselling using standardised assessment tools, providing constructive feedback and sharing good practice. This reflective approach aligns with Royal Pharmaceutical Society recommendations for maintaining consultation skills and supports continuous professional development^​21​.

By embedding documentation, patient feedback, peer review and monitoring into daily practice, pharmacy teams can demonstrate the impact of counselling on patient outcomes and drive continuous improvement.

Conclusion

Medicines counselling is integral to safe and effective patient care. It supports adherence, reduces medication-related harm and empowers patients to take an active role in their treatment. 

Using evidence-based counselling techniques – supported by structured monitoring and improvement processes – ensures that every consultation counts. Pharmacists and MMPTs must not only provide accurate information during consultations, but also ensure that counselling is consistently documented, monitored and improved over time.

As the NHS continues to prioritise medicines optimisation and patient safety, medicines counselling will remain central to improving outcomes and reducing preventable harm. Embedding counselling within the wider NHS priorities of medicines optimisation, patient empowerment and shared decision-making is critical in ensuring patients not only receive the right medicines, but have the knowledge and confidence to use them safely. Every counselling interaction – whether in hospital, community, or primary care – is therefore an opportunity to improve outcomes and reduce preventable harm.