Introduction

The Discharge Medicines Service (DMS) is a contractual service designed to improve the safety and efficacy of medicines’ use at transfer of care from hospital to community in England. 

The period after discharge from hospital is when many medicines misadventures occur, but having community pharmacy staff checking and reconciling medicines is known to reduce inadvertent errors with consequent positive effects on patient safety. 

The DMS aims to:

• Optimise the use of medicines while facilitating shared decision-making
• Reduce harm from medicines at transfers of care
• Improve patients’ understanding of their medicines and how to take them following discharge from hospital
• Reduce hospital readmissions
• Support the development of effective team working across hospital, community and PCN pharmacy teams and general practice teams, providing clarity about respective roles.

Community pharmacies providing DMS can have a powerful effect. NHS England has reported 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”.

In Wales, the Discharge Medicines Review service, supporting patients with transfer of care, has been in place since 2011. In England, the DMS was introduced in 2021.

Scotland and Northern Ireland will soon be introducing community pharmacy support for transfer of care, as part of the Scottish 2021-26 NHS Recovery Plan and the Northern Ireland and NI community pharmacy commissioning plan for 2022-25 respectively. 

In the first three months of the DMS, pharmacists in England conducted 13,265 patient consultations via 2,522 community pharmacies.

New service condition

The NHS has introduced a new service condition in the NHS Standard Contract for 2022/23, 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 DMS”.

The NHS Business Services Authority (NHS BSA) reports that there are huge variations between trusts in the number of patients referred. 

While this module focusses on remote DMS, the content is relevant to all community pharmacy remote consultations relating to transfers of care.

The DMS involves three stages as part of a pathway: 

• Stage one is receiving documents from the hospital and reconciling the hospital discharge list with the community pharmacy list, within 72 hours of discharge
• Stage two is reconciling the prescription from the GP with the hospital prescription to rectify inconsistencies
• Stage three is a conversation with the patient about any questions they may have and to discuss any changes.

This module focuses on stage three and the conversation with the patient (and/or their representative).