Nick Thayer, Professional Healthcare and Policy Researcher for the Company Chemists’ Association (CCA), outlines how the new Discharge Medicines Service can transform the patient discharge process.

Over the past 12 months, hospital teams have been working tirelessly to ensure that ICU beds are available for those who really need them. The pandemic has increased pressure on an already strained discharge process, as systems attempt to ensure that people do not stay in hospital any longer than is necessary to increase efficiency and maximise patient safety.

It is estimated that around 60 per cent of patients have three or more changes made to their medicines during a hospital stay. One of the elements of a successful discharge process is ensuring that patients understand their medicines regime once they return home.

There is a substantial body of evidence to demonstrate that discharge from hospital is associated with an increased risk of avoidable medication related harm:

  • 30-70 per cent of patients experience unintentional changes to their treatment, or an error is made because of a lack of communication or miscommunication on discharge
  • 90 per cent of elderly patients will be discharged with a change to the medication that they were admitted to hospital on
  • 20 per cent of patients have been reported to experience adverse events within three weeks of discharge, 60 per cent of which could have been improved or avoided.[i]

Transforming patient discharge

Research on schemes implemented across the UK has demonstrated that patients who see their community pharmacist after they have been in hospital are less likely to be readmitted and will experience a shorter stay if they are. The National Institute for Health Research shows that people over 65 are less likely to be readmitted to hospital if they are given help with their medication after discharge.

Since 2011, community pharmacists in Wales have been commissioned to support patient transitions between care settings. A recent retrospective cohort evaluation of this service demonstrated up to a 26 per cent reduced probability of re-admission at 30, 60 and 90 days – a key measure for many trusts. ii

To support discharge in England, a new service has been commissioned by NHS England to help hospitals and community pharmacists work together more closely. Since 15 February 2021, all community pharmacies in England have been able to receive digital discharge information from hospital trusts. The Discharge Medicines Service (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, and
  • Support the development of effective team-working across hospital, community and primary care networks pharmacy teams and general practice teams and provide clarity about respective roles.[ii]

NHS trusts can refer patients who would benefit from extra support with their medicines after they are discharged to a community pharmacy. This service builds on the work that the Academic Health Science Networks (AHSN) have undertaken with trusts and community pharmacies over recent  years, as part of the Transfer of Care Around Medicines (TCAM) programme. Within this programme, the AHSNs have worked with many trusts to put in place processes and IT infrastructure to allow hospital clinicians to identify patients admitted to hospital that might benefit from being referred to their community pharmacy at discharge.

Upon receiving discharge summaries, community pharmacy teams will:

  • Clinically check the discharge and compare (and update) this to existing records
  • Check any medicines prescribed post-discharge to ensure changes have been captured, and
  • Check the patient’s understanding of their medicine’s regimen. This might be face-to-face or via the telephone/video consultation depending on individual patient circumstances.

The DMS provides a means of building on this previous good work, helping to reduce both the avoidable harm that can occur during the transfer of care process and hospital re-admissions. It is a secure, digital route for transferring patient information, building working relationships between community pharmacy and hospital teams. It provides a framework for hospital, general practice and community pharmacy to support patients, to their ultimate benefit.

The community pharmacy DMS service allows hospital clinicians to create an additional safety net for their patients. By identifying patients who would benefit most, vital interventions can be supported post-discharge. Various trusts have taken different approaches to selecting and prioritising patients. The discharge of elderly patients is a common priority area. Other successful patient groups include people with drug dependence, housebound patients, people in residential care and those with cardiovascular or respiratory conditions.

An integrated approach

Implementation of the DMS is to be driven locally, and success is likely to be dependent upon the engagement within local geographies. Local Pharmaceutical Committees (LPCs) are key leaders in this area, supporting community pharmacies and providing information to trusts. There is no strict guidance on the volume of referrals, and trusts should look for every opportunity where value can be added by community pharmacy teams. Where this service has not been trialled, LPCs can support trusts and pharmacies in the initial stages.

The pandemic has shown what can be achieved when healthcare professionals work together, and historic barriers are cast aside to achieve a common good. For this service to be a success, healthcare professionals in primary and secondary care need to continue to work together in this patient-centred way to support patients with their medicines. It is the interests of everyone – patients, hospital teams, GPs and community pharmacists – to minimise the risk of medicines related harm that being discharged from hospital can create.


ii Mantzourani E et al. Exploring the association of the discharge medicines review with patient hospital readmissions through national routine data linkage in Wales: a retrospective cohort study, BMJ Open, 2020 (10)