DMS: Frequently Asked Questions (1)
DMS: Frequently Asked Questions (1)
February 8, 2021
The Discharge Medicines Service (DMS) commences as a new Essential service which all pharmacies must provide next week (15th February 2021).
Pharmacy contractors and their teams will find information on the service and links to guidance and resources to help them prepare to provide it on our DMS webpage.
You will also find answers to frequently asked questions on the DMS via the DMS webpage and a selection of the questions posed to PSNC over the last few weeks are included below.
Q. Must pharmacies have a consultation room to provide the DMS?
Distinct from the DMS, all pharmacies must now have a consultation room meeting the set standards. The only exceptions to this are set out in the NHSE&I regulations guidance.
For DMS, the legal requirements for the service are set out in the Pharmaceutical Services regulations and they are expanded upon in the DMS chapter of the NHSE&I regulations guidance, which says:
8.4.2. Premises requirements
Paragraph 28A, Schedule 429 details the premises’ requirements in respect of consultation rooms for pharmacy contractors. As a prerequisite to the provision of the NHS DMS, all pharmacy contractors must ensure that they are compliant with these premises’ requirements, in particular ensuring that the duty of confidentiality is met (paragraph 22C(5)(a), Schedule 4). Further information is provided in Chapter 11 on premises’ requirements in respect of consultation rooms.
The DMS is an Essential service from 15th February 2021, so it must then be provided by all contractors. It is therefore necessary for DMS consultations to be undertaken in a consultation room compliant with the requirements or via telephone or video consultation, where those remote options are chosen to meet the need of the patient or because NHSE&I have agreed the pharmacy is too small for a consultation room to be fitted.
Q. Is there mandatory training required for pharmacists and pharmacy technicians providing the service?
Pharmacists and pharmacy technicians providing the service need to be trained on how the service will operate and their role in providing it. There is no requirement to undertake a specific training programme, but reading the NHS England and NHS Improvement regulations guidance and the DMS Toolkit will provide key information that professionals need to understand. The CPPE DMS training programme will also support professionals to understand the service and their role within it. All pharmacists and pharmacy technicians that will provide all or part of the service need to complete the DMS Declaration of Competence to demonstrate that they have the necessary knowledge and competence to provide the service. A copy of the completed Declaration of Competence should be given to the pharmacy contractor.
Q. Which types of patients will be offered a referral to the DMS?
The DMS Toolkit contains advice for Trusts on which patients would benefit most from referrals, which has been derived from the experience of Academic Health Science Networks and hospitals implementing transfer of care around medicines schemes across England. Patients that may benefit the most from the service include those taking high-risk medicines, those who have had changes made to their medicines regimen while in hospital and those who have been prescribed new medicines.
Q. How will the hospital pharmacy team know which pharmacy to refer a patient to?
When patients are asked to consent to the referral being made, the hospital pharmacy team will ask which is their chosen pharmacy.
Q. How will referrals be received at the pharmacy?
Trusts must make referrals using a secure electronic message. This may be via systems such as PharmOutcomes and Refer to Pharmacy or it may be via NHSmail. Your Local Pharmaceutical Committee will be able to advise on what approach individual hospitals in your area are taking to making referrals.
Q. How do I provide the service to a patient if they are housebound?
The third stage of the service involves a discussion 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. 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 another way which meets the patient’s/carer’s needs, e.g. by telephone or video consultation.
Q. Do I need to obtain consent to provide the Discharge Medicines Service?
NHS trusts are required to develop a system of consent to ensure that patients are fully involved in decisions about their care following discharge and have agreed to the whole DMS pathway. Where the referral is for a patient who regularly uses the pharmacy, the receipt of a referral can be accepted as implied consent by the patient agreeing to have the referral made to the pharmacy.
Where a referral is received for a patient who is new or unknown to the pharmacy, the pharmacist or pharmacy technician may need to contact the NHS trust and/or the patient for more information; and to check that the patient does wish to use this pharmacy for the DMS. In this scenario consent can be confirmed verbally and could then be recorded in the pharmacy clinical service record.
Patients, like in any other service, are free to withdraw their consent to receive the service at any point in the service.
Q. Do pharmacists or pharmacy technicians have to view the patient’s NHS Summary Care Record (SCR) when undertaking DMS?
The NHSE&I regulations guidance says that within stage 1 of the DMS, the pharmacist or pharmacy technician should:
Compare the medicines the patient has been discharged on with those they were taking at admission. This should include all medicines and not just those that are taken orally. This will include reference to the patient’s medication record and may include reference to the patient’s summary care record (SCR).
If the patient regularly uses the pharmacy, it is likely that the PMR alone will provide an adequate information source to compare the pre-admission and post-discharge regimens. Viewing the patient’s SCR may be necessary where the patient has not used the pharmacy for some time or has never used the pharmacy before. The service requires pharmacists and pharmacy technicians to make a judgement on whether they need to access the SCR; there is no absolute requirement to review the SCR in all cases.
Q. When providing the DMS, do contractors need to obtain consent from the patient to look at their Summary Care Record (SCR), or is consent implied by the patient agreeing for the pharmacy to have their discharge summary for this service?
If access to SCR is necessary, consent would still be required from the patient.
Q. Do contractors need to obtain the patient’s consent to discuss any matters identified during provision of the service with the patient’s general practice or PCN clinical pharmacist?
Anything that arises during the provision of the DMS and then needs to be addressed with the general practice forms part of the service and the regulations place the contractor under a duty to act to seek to address the issue. Due to that contractual responsibility, there is no need for explicit patient consent prior to making contact with the general practice or the PCN clinical pharmacist. However, if the issues arise in a conversation with the patient, it would be practical and courteous to verbally seek consent from them at that time. This could occur in the flow of the conversation, where the professional identifies an issue and explains that they will need to speak to the practice to clarify the matter, after which they will revert to the patient. There would be no need for consent to be evidenced in writing.