Discharge Medicine Service

Discharge Medicines Service

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 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. More details can be found here:


All community pharmacists are reminded that this Essential service is not optional and is to be provided by every pharmacy and pharmacist in England including Distance Selling Pharmacies.


The service seeks to ensure better communication of changes made to a patient’s medicines in hospital and its aims are to:

  • Optimise the use of medicines, whilst 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.

Contractors need to ensure that the pharmacists and technicians –

  1. Read the section on DMS within the NHSE&I guidance on the regulations; and
  2. Read the DMS toolkit.

Additionally, it is recommended that they also complete the CPPE NHS Discharge Medicines Service eLearning and assessment.

For information to provide to the GP surgeries and PCN’s 

DMS Communications to PCNs & General Practice– by Rachael Rees, Head of PCN Development, Nottinghamshire ICS

DMS-briefing-for-GPs-and-PCNs-v1– PSNC info

There are 3 stages of consultation – 

1) checking the referral for any clinical actions needed, compare medicines on the discharge sheet to those on the PMR, if there are changes liaise with the gp practice and also check that you haven’t got prescriptions waiting on the system or already dispensed waiting for collection.
2)When the first post-discharge prescription comes in then check this is the same as on the discharge summary  and if not contact and resolve with the practice.  Input details into the PMR system.
3)  When the first post-discharge prescription comes in check the patient’s understanding of their new medicine regime.


Stage 1:                £12
Stage 2                 £11
Stage 3:                £12

Contractors will need to make a monthly claim for completed DMS provisions via the NHSBSA’s Manage Your Service portal.

More detailed information can be found on the PSNC website – https://psnc.org.uk/services-commissioning/essential-services/discharge-medicines-service/

What is happening in Nottinghamshire and Bassetlaw

The LPC have been working closely with each local NHS Trust to support their plans to increase the number of discharge medicine referrals that are sent to community pharmacy.

Sherwood Trust will continue to refer patients using compliance aids only at present.

Bassetlaw Trust will be referring two groups of patients to community pharmacies listed in table 1.

  • Group 1 – Monitored dosage system
    • The patient is a regular MDS user and there have been changes to their medication
  • Group 2 – Clinical criteria
    • There have been three or more medication changes / additions to medicines on repeat
    • There has been one or more newly started, or changes to, high risk or problematic medicines
    • The patient or carers has expressed confusion / concern over medication on discharge
    • The patient has had multiple admissions during a significant period of time or have had a long inpatient stay
    • There has been an AKI (Acute Kidney injury) on admission or during inpatient stay leading to one or more medication change(s)
    • The patient was admitted due to a drug / disease interaction
    • Any other circumstances where the referring pharmacy professional has concerns about medication safety effectiveness that could addressed by the DMS


NUH have briefed their hospital teams and from 15th June contractors can expect to see an increased number of referrals coming through to community pharmacies via Pharmoutcomes.

The patient groups in table below can be referred to community pharmacies from NUH;

– Patients with MDS boxes

– Patients taking high risk medications eg. DOACs, antiepileptic’s, Parkinson’s disease meds

– Any patients who have been started on a new medication

– Patients who have had any doses changed whilst an inpatient

– Patients who have had their medications stopped and the reason for discontinuation

– Patients with learning disabilities

– Any patient at risk of readmission for any reason eg. frequent attender or non-compliance

Consenting patients from NUH that fall within the high-risk groups (table 3) will be referred to their nominated community pharmacy on discharge with the following information available:

  • The medicines being used by the patient at discharge. This INCLUDES over the counter, prescribed and specialist medicines. Any additional information will be put in the pharmacy comments section of the discharge
  • Any changes to medications (including stopped or started and changed doses) and documented reason for change.
  • New medications will have the indication for the drug in the ‘instructions/reason for medication section’
High Risk Medicines High Risk Patients
  • Multiple resources cite a risk of high-risk medicines. They include but are not limited to: anticoagulants (eg warfarin, dabigatran), antiepileptics, digoxin, opioids, methotrexate, antipsychotics, cardiovascular drugs (eg beta-blockers, diuretics), controlled drugs, valproate, amiodarone, lithium, insulin, methotrexate, non-steroidal anti-inflammatory drugs (NSAIDs) and aspirin among others.
  • Newly started respiratory medication, including inhalers
  • Medication requiring follow-up. Eg blood monitoring, dose titration
  • Patients prescribed medicines that have potential to case dependencies (eg opioids).
  • Those for which doses vary change, either increasing or decreasing over time.
  • People taking more than five medications, where the risk of harmful effective and drug interactions is increased.
  • Those who have had new medicines prescribed while in hospital
  • Those who have had medication change9s) while in hospital
  • Those who have experienced myocardial infarction or a stroke due to likelihood of new medications being prescribed
  • Those who appear confused about their medication on admission when getting ready for discharge and have already needed additional support from a healthcare professional
  • Those who have help at home to take their medications
  • Those patients who have a learning disability

Please be aware that there may be boundary issues at times where a pharmacy in the Nottinghamshire system may receive referrals from Trusts in adjacent counties.  If this is the case then please note that the relevant contact name and details will be on the end of the referral form from the Trust.


DMS workshop 14.07.22 – Making DMS work effectively slide deck

Sarah Partridge, Lead Senior Clinical PCN Pharmacist @ NCGPA – slides from presentation –  DMS benefits

The link for the recording of the workshop is https://youtu.be/8OV6CPT3Htg

Questions and Answers from the session – Questions and Answers from DMS workshop 14.07.22 amended 170822

List if contact numbers for the ward pharmacists can be found on the NUH website –QMC – visiting times and ward information | NUH

DMS workshop 14.07.22