‘Urgent’ need for community pharmacy to play a role in medicines homecare services, review says

There is an “urgent” need to develop and implement a role for community pharmacy in medicines homecare services in Scotland, a review of the system has said.

The independent review, published on 20 March 2025, was commissioned by the chief pharmaceutical officer for Scotland Alison Strath, following reports of poor standards of care in the sector, including delays, cancelled medicine deliveries, lack of continuity of supply and poor communication.

In one of five recommendations, the review, which was led by Benjamin Hannan, director of pharmacy for NHS Fife, said: “Scotland should take a key role in the development of medicines homecare key performance indicators (KPIs) at UK level, which focus on the quality of patient care and are linked to enhanced governance and stakeholder engagement and management.

“The current KPIs are widely viewed as not fit for purpose.

“Their development appears to have been based on data currently and relatively readily available, rather than what is required for modern, care-centric oversight of such a critical service. The sheer volume of them also speaks to an uncoordinated approach,” it added.

The review also sets out a requirement to “ensure that medicines homecare services are designed and selected to the benefit of patients and the NHS in Scotland”, and highlighted “a need to step back and holistically review current medicines homecare schemes”.

Additionally, it pinpointed “an urgent but highly complex need to develop and implement a role for community pharmacy, initially with low-technology medicines homecare services”, which it “linked to the importance of providing choice to patients in their care and the need to enhance the input of patients in the design of services”.

According to the review, the number of patients using homecare services in Scotland has increased by almost 50% since 2018, with over 41,000 patients using medicines homecare services in 2023 and around 206,000 medicines deliveries per year.

However, it said this growth “has not been matched with the systemic improvements required to sustain the scale of service”.

In 2022, the British Society for Rheumatology first raised concerns about homecare medicines delivery services after reports of patients experiencing delays in receiving medicines.

In November 2023, an investigation by The Pharmaceutical Journal revealed hundreds of patient safety incidents caused by problematic homecare medicines services, which led to calls for improved regulation and an overhaul of delivery models.

In January 2024, the government rejected recommendations, put forward by the House of Lords Public Services Committee in its report on homecare medicines services in England, that hospital chief pharmacists should be given powers and resources to “ensure high-quality homecare medicines services in their area”.

In February 2024, The Royal Pharmaceutical Society updated its ‘Professional standards for homecare services‘ to make them more relevant to teams involved in planning, commissioning and delivering homecare services across the UK.

In his introduction to the review, Hannan said: “Focusing across short, medium, and long-term developments, the recommendations in this report provide the foundations for improvements to facilitate the design and implementation of high-quality, integrated, patient-centred service that are efficient and sustainable.

“I believe the recommendations in this report provide the future direction for effective, efficient and sustainable models of secondary care-initiated medicines supply in Scotland, particularly medicines homecare services.”

Commenting on the review, a spokesperson for Community Pharmacy Scotland (CPS) said: “We welcome the recommendations set out in the review of medicines homecare in Scotland, which recognise the community pharmacy network as an alternative supply route for these medicines.

“Pharmacists are the experts in medicines, and we know that community pharmacies can add value to patient experience in this area. CPS looks forward to working with Scottish government colleagues in developing the community pharmacy model set out in the recommendations to support patients to live well in their community.”

Marianne Radcliffe, chief executive officer of Crohn’s & Colitis UK, said: “We know there are deep, systemic and long-standing problems with homecare medicines services. If people with Crohn’s [disease] or [ulcerative] colitis do not receive their medicines on time, they can experience serious complications, which may require emergency medical treatment or even surgery.

“Doctors and nurses have to spend hours chasing homecare companies for answers; time that could and should be spent supporting patients.  Therefore, we welcome this publication. We would like to see the four nations working together to bring about real change. Patients deserve better.”