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More than a quarter of NHS trusts have yet to start referring patients to community pharmacies through the discharge medicine service (DMS), an investigation by The Pharmaceutical Journal has found.
The DMS, which enables community pharmacy teams to check if any medicines awaiting collection by a patient recently discharged from hospital are still appropriate and set up a consultation if necessary, launched as an essential service on 15 February 2021 (see Box).
Guidance published by NHS England ahead of the rollout on 15 January 2021 said that NHS trusts should be “ready to implement the NHS Discharge Medicines Service in February 2021” and included suggested patient eligibility criteria.
However, responses to freedom of information (FOI) requests submitted by The Pharmaceutical Journal from 147 hospital trusts in England show that, as of July 2022, 39 trusts (27%) have not yet implemented the DMS.
Fourteen of these trusts said that plans to set up the service were in the pipeline and due to start in late 2022, while two trusts said that they refer patients to community pharmacy after discharge “through other means”.
Six trusts said the DMS did not apply to them as community providers or specialist hospitals.
Thorrun Govind, chair of the Royal Pharmaceutical Society’s English Pharmacy Board, said: “With continued pressure on the health service, there is a clear benefit for both patients and the NHS to reduce the potential harm from medicines at transfers of care and reduce the number of avoidable hospital admissions.
“The DMS highlights the key role of pharmacists working across the system to help patients with their medicines, but if we are to help reduce health inequalities, it is vital that new services are rolled out consistently across the country.”
But responses from the 102 NHS trusts that said they were using the DMS also revealed a wide variation in the types of patients being offered a referral, with some trusts offering a DMS referral to every discharged patient, while others limit the offer to one patient group, such as those using monitored dosage systems (MDS).
Commenting on the findings, Alistair Gray, clinical services lead pharmacist at East Lancashire Hospitals NHS Trust — which has referred at least 7,557 patients through the DMS since February 2021 — said that, where the DMS is not in place, when referring patients from secondary to primary care, “there’s a risk that the information might not be fully transcribed and that can finish up with an inappropriate prescription, which could then finish up with the patient taking it and having an [adverse] event … or they may not get the full health benefits if they’re missing new medicines”.
He added: “It adds a few seconds onto the patient’s care, but those few seconds can save a life.”
Clare Howard, medicines optimisation lead at Wessex Academic Health Science Network, which helped implement the similarly designed ‘Transfer of Care Around Medicines’ service in trusts between 2014 and 2021, said: “Trusts that broadened out their criteria had a much better chance of making it ‘business as usual’.
“So, places that just started with monitor dosage systems, for example, it tended to just get stuck a bit there,” she said.
“It’s about sitting down and thinking, what have we got going on in our patch, who do we absolutely want to make sure has got access to this service, rather than keeping it narrow to MDS patients, because you could miss some high-risk patients that could really benefit.”
According to the NHS guidance published in January 2021, patients on high-risk medicines, including anticoagulants, antiepileptics and opioids, as well as those newly started on respiratory medication and those with a learning disability, should all be considered for a DMS referral.
NHS England did not respond to requests for comment.
Box: How does the discharge medicine service work?
Once the referral is received from the discharging hospital, community pharmacies can claim £12 to check and compare the medicines that the patient has been discharged with to those that were prescribed before admission, ensuring that medicines awaiting collection are still appropriate.
Contractors are then paid £11 to check the first prescription received post discharge, taking account of the changes made while the patient was in the hospital.
A further payment of £12 is made once the pharmacist or pharmacy technician carries out a consultation to check that the patient understands their new medicines regimen.
Guidance for NHS trusts, published by NHS England on 12 January 2022, said that patients “who receive this service are less likely to be readmitted (5.8% vs. 16% 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”.
In July 2021, an analysis of referral data by NHS England suggested that the discharge medicines service could have helped avoid 17,238 hospital bed days in three months.
