Discharge Medicines Service (DMS)


Background and Overview

The Discharge Medicines Service (DMS) is now an Essential service within the Community Pharmacy Contractual Framework (CPCF) with NHS Trusts able to refer patients who would benefit from extra guidance around new prescribed medicines for provision of the DMS at their community pharmacy.

The service has been identified by NHS England and NHS Improvement’s (NHSE&I) Medicines Safety Improvement Programme to be a significant contributor to the safety of patients at transitions of care, by reducing readmissions to hospital.

Further information on the service can be found at the PSNC website here.


Greater Manchester DMS Webinar 

In March 2021 Bolton and GM LPCs supported by the GM Healthcare Academy delivered a DMS webinar for contractors.

The Webinar covered:

  • The different stages of the service
  • How and when to obtain consent from the patient
  • How and where to refer
  • The NHS Trusts currently offering this service
  • The steps you will need to take to deliver the service
  • How to claim for the service

DMS in Greater Manchester

The following trusts are now live:

Trust Current Status
Royal Bolton Live (June 2020)
Salford Royal Live (Feb 2019)
Tameside & Glossop Live (March 2020)
Stockport Live (May 2020)
Wigan Live (March 2021)
GMMH In progress
Pennine Care In progress
MFT (MRI/Wythenshawe/Trafford) TBC
Pennine Acute TBC

Referrals can be received from any locality in GM with the exception of Salford (Salford can currently only send DMS referrals to pharmacies in Salford). As an example, a referral could be sent from Royal Oldham Hospital to a contractor in Bolton.


PharmOutcomes

PharmOutcomes (Pinnacle) have produced two video guides, one for hospital colleagues and one for community pharmacies. These are available via the links below;


Funding

A setup fee of £400 has been agreed to cover the costs of preparing to provide the service, principally training staff and putting in place a standard operating procedure for the service. Any pharmacy on the pharmaceutical list on 1st February 2021 will automatically receive this payment on 1st April 2021, and it will be itemised in the Schedule of Payments.

Contractors providing all stages of the service will be paid a fee of £35.

Where only part of the service can be provided, in certain circumstances defined in the Drug Tariff, contractors will be paid a partial payment.

Stage Description of process Timescale Responsibility

1) A discharge referral is received by the pharmacy

Stage 1:  £12

The electronic referral is received by the pharmacy and the following actions are undertaken: As soon as possible, but within 72 hours of receipt (excluding hours of the days on which the pharmacy premises are not open for business). Section 8,7 of the NHSE&I guidance on the regulations provides more information on this timing requirement.
a)       check for clinical information and actions contained within the referral which need to be undertaken. Details of what to look for are outlined in the DMS toolkit;

Pharmacist

 

b)      compare the medicines the patient has been discharged on and those they were previously taking at admission; Pharmacist/ Pharmacy Technician
c)       where necessary, raise any issues identified with the NHS Trust or the patient’s general practice, as appropriate; Pharmacist/ Pharmacy Technician
d)      make appropriate notes on the PMR or other appropriate record, including to ensure pharmacy staff are alerted to the need to conduct stages 2 and 3 of the service, when the first prescription is received or at first contact with the patient/carer; and Pharmacist/ Pharmacy Technician
e)      check any prescriptions for the patient, previously ordered, in the dispensing process or awaiting collection to see if they are still appropriate. Particular attention should be paid to electronic repeat dispensing prescriptions as these could be pulled down from the system sometime after the patient has been discharged from hospital. All relevant members of the pharmacy team

2) The first prescription is received by the pharmacy following discharge (this may not be a repeat prescription)

Stage 2: £11

The pharmacist/pharmacy technician ensure medicines prescribed post-discharge take account of the appropriate changes made during the hospital admission.

If there are discrepancies or other issues, the pharmacy team will try to resolve them with the GP practice, utilising existing communication channels. Complex issues may need to be resolved by the general practice undertaking a Structured Medication Review; and

Make appropriate notes on the PMR and/or other appropriate record.

When the first post-discharge prescription is received, usually one week to one-month post-discharge, dependent on the quantity of medicines supplied by the hospital at discharge. Pharmacist/ Pharmacy Technician

3) Check of the patient’s understanding of their medicines regimen

Stage 3:  £12

This involves a confidential discussion, adopting a shared decision-making approach, with the patient and/or their carer to check their understanding of what medicines they should now be taking/using, when they should be taken/used and any other relevant advice to support medicines taking/use.

When this takes place on the pharmacy premises, the consultation room should be used*.

Where the patient and/or their carer cannot attend the pharmacy for this discussion, e.g. if they are housebound or convalescing following surgery, this can be provided in a manner which meets the patient’s/carer’s needs, e.g. by telephone or video consultation.

Information that would be of value to the patient’s general practice or Primary Care Network clinical pharmacist, to support the ongoing care of the patient, should be communicated appropriately.

Where appropriate, there should also be an offer to dispose of any medicines that are no longer required, to avoid potential confusion and prevent an adverse event.

Make appropriate notes on the PMR and/or other appropriate record.

Where appropriate, other services which form part of the CPCF can also be provided. For example, the New Medicine Service could be offered if clinically appropriate and if the patient would get additional benefit from provision of the service.

When the first post-discharge prescription is received.

 

Pharmacist/ Pharmacy Technician

 


Supporting Information & Resources

DMS Contractor checklist
This checklist details the actions contractors need to take to get ready to provide the service.

Briefing sheet: Introduction to the DMS for general practice and PCN clinical pharmacy teams
This two-page briefing provides a short introduction to the service for GPs and clinical pharmacists.

DMS briefing for pharmacy teams
This document can be used in briefings on the DMS provided for pharmacy team members.

Appropriate clinical records must be kept by the contractor, within the patient medication record (PMR) system or other appropriate record, for all stages of the service provided. While maintaining records in an electronic system is the ideal approach, it is possible to provide the service using a combination of annotation of the patient’s PMR and the use of paper records. PSNC has developed a DMS worksheet which can be used to maintain clinical records for the service, which can be used where pharmacy teams do not have access to an IT system to support the creation of electronic clinical records for the service.
DMS worksheet V1 (Microsoft Word)

DMS worksheet V1 (PDF)

DMS activity summary
This document summarises the actions to be taken at the three stages of the service.

NHSE&I guidance on the regulations

DMS Toolkit for pharmacy staff in community, primary and secondary care

DMS data specification – summary data on each DMS provided to be submitted to MYS

NHSE&I DMS webpage

DMS launch letter to pharmacy teams from Keith Ridge

DMS launch letter to NHS Trust chief pharmacists from Keith Ridge