Government announces digital hospital-to-pharmacy referral service to cut hospital readmissions
Several new services have been announced as part of an update to the community pharmacy contractual framework to be piloted over the course of 2020.
Hospitals will be able to digitally refer recently discharged patients to community pharmacies across England for advice on new and updated prescriptions from July 2020.
The ‘discharge medicines service’ will be introduced to reduce the number of hospital readmissions caused by side effects or complications relating to medicines prescribed while a patient is in hospital.
The announcement was made in a joint letter from the Department of Health and Social Care (DHSC) and the Pharmaceutical Services Negotiating Committee (PSNC) published on 23 February 2020 as part of an update to the ‘Community pharmacy contractual framework for 2019/2020 to 2023/2024’.
When the five-year framework was first published in July 2019, it outlined a ‘medicines reconciliation service’ aimed to “ensure that changes in medicines made in secondary care are implemented appropriately when the patient is discharged back into the community”.
Now, as part of the new discharge service, hospitals will digitally notify community pharmacies when patients who have been recently discharged may require advice on taking new medicines and any changes to their prescriptions, the government said.
Community pharmacists will then be expected to contact the patient for a consultation. However, the IT system used to transfer the digital notifications was not set out in the update.
Frequently asked questions (FAQs) published by the PSNC alongside the contract update said the service “will have a fee attached to it”, which is still under negotiation.
The new service, which will be an ‘essential service’, will build on the ‘transfer of care around medicines’ (TCAM) scheme, which has been running in parts of the country since 2014.
An evaluation of Cornwall’s TCAM pilot, for example, was published on 4 February 2020 and revealed that patients followed up by a community pharmacist after being discharged from hospital were significantly less likely to be readmitted to hospital within 30 days.
Meanwhile, a University of Bradford study published on 19 February 2020 showed that patients aged 65 years and over are less likely to be readmitted to hospital if they are given help with their medication after discharge.
Simon Dukes, chief executive of the PSNC, said the new discharge service is “a welcome development”.
“We know that lots of people get confused by changes made to their medicines while in hospital and this new NHS discharge medicines service from community pharmacies will help people to understand which medicines they should be taking and why,” he said.
“Pharmacists will also be able to offer people advice on how to get the most benefit from their medicines.”
He added that by reducing the likelihood of patients being readmitted to hospital, the NHS will save “millions of pounds each year”.
The Academic Health Sciences Network, which initially led the rollout of TCAM in Newcastle in 2014, said the service saved the health economy more than £50m in 2018/2019 by reducing in the number of hospital readmissions.
Bruce Warner, deputy chief pharmaceutical officer at NHS England, said the new service will “help people most in need of support with their medication”, adding that over the next year pharmacies will also “begin to test a variety of new measures to identify people with undiagnosed conditions”.
“This will make even better use of the valuable and extensive clinical skills of community pharmacists so that people can walk in and get the health advice and help they need, providing an excellent foundation on which we can build for the future,” he said.
Also as part of the contract update, the DHSC and PSNC announced that four clinical services would be piloted “over the course of coming year”.
These include blood pressure testing; stop smoking support for patients discharged from hospital; point-of care testing for streptococcus A; and the extension of the community pharmacist consultation service to include referrals from GP practices and NHS 111 online.
The PSNC FAQ document added that the pilots are still in development but “most are expected to commence during the next two months”, adding that NHS England and NHS Improvement ”are working to identify appropriate pilot sites dependent on NHS priorities and they will be in touch with [Local Pharmaceutical Committees] and pharmacies in their chosen pilot sites”.
Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2020.20207732
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