Discharge Medicines Service (DMS)


Background and Overview

The Discharge Medicines Service (DMS) became a new Essential service within the Community Pharmacy Contractual Framework (CPCF) on 15th February 2021.

This service, which all pharmacy contractors have to provide, was originally trialled in the 5 year CPCF agreement with a formal announcement regarding the service made by the Secretary of State for Health and Social Care in February 2020.

From 15th February 2021, NHS Trusts were 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. 


DMS Support Webinar for Contractors – Tuesday 16th March 2021 (please note: this date has now passed)

UPDATE! Video recording now available – please see details below.

Thank you to all who attended the GM Healthcare Academy DMS webinar on Tuesday 16th March.

This webinar was hosted by GMHCA to provide contractors with a better understanding of DMS in order to deliver the service effectively. Topics covered included:
  • The various 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

For those who couldn’t attend, a video recording of the webinar is now available to watch, as well as a PDF version of the Q&A session.

Watch the video recording here

Read the Q&A PDF here


DMS in Greater Manchester

Please see the below status of Trusts live with DMS local to GM

Trust Current Status
Royal Bolton Live (since June 2020)
Salford Royal Live (since Feb 2019)
Tameside & Glossop Live (since March 2020)
Stockport Live (since May 2020)
Wigan Live as of 29/03/21
GMMH In progress
Pennine Care In progress
MFT (MRI/Wythenshawe/Trafford) TBC
Pennine Acute TBC

GMLPC is currently working with stakeholders across the system to ensure that trusts that are not yet live will be mobilised imminently. GMLPC will keep you updated with information on when Trusts will be going live with DMS.

Please note: Referrals can be received from any locality in GM. As an example, a referral could be sent from Royal Oldham Hospital to a contractor in Wigan.

The PharmOutcomes DMS module is now live in all Trusts that were previously TCAM sites. Any sites that will go live in the future will be processed via the DMS module.

All Community Pharmacies have access to the national DMS templates including templates linked to existing hospital referrals using our solution plus one to be used to record nhs.net referrals and onward referrals that can be made as part of this service.

Referrals received can now be processed as per the following guidance

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

Funding

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 the full 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. 

See fees below in the table:

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

Claiming

Further information on the claiming process will be made available in due course as the system is currently being linked to MYS. In the mean time please refer to national guidance on the PSNC website. and ensure you collate data for submission to the NHSBSA as per the usual claims process.

 


How to prepare

The below actions must be completed, to ensure that all staff members who will be involved in providing the service -including pharmacists and pharmacy technicians- have the necessary knowledge and competence. A template can be printed here.

Action Required Where to access
Read the section on DMS within the NHSE/I regulations

DMS – Guidance on the NHSE&I Regulations

 

Read the DMS toolkit

DMS Toolkit

 

Complete the CPPE NHS DMS eLearning and assessment

CPPE NHS Discharge Medicines Service eLearning and assessment.

 

Once all of the above is completed, the DMS declaration of competence must be completed

DMS Declaration of Competence

 

Other members of staff that will play a part in supporting provision of the service should be briefed on the service using the DMS briefing document, with appropriate training provided for any roles they will play.

 

DMS briefing for pharmacy teams

 

Contractors must also have a Standard Operating Procedure (SOP) for the service, which all staff participating in the provision of the service must be familiar with and follow.

The SOP should include the process for checking, on a regular basis, for new DMS referrals.

 

DMS SOP Template

Useful Resources:

There are a number of useful resources to help contractors prepare to deliver this service. Access the resources by clicking on the links below:

Further information on the service and links to guidance and resources can be found here.


CPPE – Learning programmes and assessments

NHS Discharge Medicines Service: improving outcomes for patients transferring care – Click here


‘DMS: A Step Towards True Medicines Optimisation’ Article

In this Hospital Times article, Nick Thayer, Professional Healthcare and Policy Researcher for the Company Chemists’ Association (CCA), outlines the benefits of the new Discharge Medicines Service (DMS) and how it can transform the patient discharge process.

Read the full article here.