Transfers of Care Around Medicines - now the NHS Discharge Medicines Service

Transfer of Care Around Medicines (TCAM) – ensuring support with medicines for patients leaving hospital

On this page you will find useful resources and learning from the TCAM work, previously led by Health Innovation Wessex and the Health Innovation Network. This work is now a nationally-commissioned service called the NHS Discharge Medicines Service.

The history of the DMS – Transfer of Care Around Medicines 

In 2016, a number of hospital trusts around the country were working with the Local Pharmaceutical Committees (LPC) to establish a medicines pathway for patients being discharged from a hospital inpatient stay. This interface has long been known to cause confusion for patients, particularly with their medicines and any changes to prescriptions. The World Health Organisation highlighted the problems as part of their third global challenge on medication safety.

The impact of this pioneering concept - to digitally transfer the pharmaceutical care of patients from hospital to community pharmacy - was first published by Newcastle Upon Tyne Hospitals NHS Foundation Trust, and showed that this type of clinical handover to community pharmacy could result in lower rates of readmission at 30, 60 and 90 days.

This initial study was the catalyst for many other trusts to show interest in the work; and in 2018, the 15 Academic Health Science Networks in England (now the Health Innovation Network) were commissioned to spread this innovation to 50% of acute trusts in their region.

At the end of the HIN national programme more than 160,000 patients had benefitted from additional support and 61% of acute trusts had adopted and embedded a TCAM pathway (figures from 2018-2021).

In February 2021, this service was established as the national NHS Discharge Medicines Service as an advanced service in the Community Pharmacy Contractual Framework.

What happened next

The DMS service built directly on the learning and reach that the HIN TCAM programme had already delivered. This service uses a digital platform to enable trusts to communicate with a patient’s usual community pharmacy about changes to their medication when they leave hospital. Through our successful roll out of TCAM, the AHSNs created a foundation for embedding the national DMS service. The legacy of resources created during the TCAM programme were made available for any new trust coming to this service. 

Two years later, government data has been released which shows community pharmacy has claimed for around 216,700 patient referrals from hospitals, through the DMS service, with more referrals for patients from deprived neighbourhoods. The original evidence base created by the TCAM work demonstrated a reduction in readmissions at 30, 60 and 90 days. This strong evidence base has continued under the DMS service with one 30-day readmission avoided for every 10-23 admissions, according to the latest government data. Extrapolating data to January 2023, the government estimates that between 9,420 and 21,667 readmissions have been avoided since the service started. 

The AHSN Network was keen to capture the learning from the early adopter sites to share with the remaining areas aiming to set up the DMS. We held a roundtable event with senior trust pharmacists and LPC officers, who had really got behind this work in its early stages to capture their experience.

We hope you will find the video of the event and the report summary helpful in learning the lessons of successful implementation of this very effective service, and how the areas which have embedded this work describe the benefits to the NHS and local patients alike.

Listed here are the timings to each section:

• 00:31     Why did you get involved?
• 08:47     Getting Started
• 19:33     What were the main barriers to implementing?  What about IT and IG?
• 33:52     What was the role of data?
• 41:43     How do you engage the disengaged?
• 48:20     If you were starting now, what would you do?

Previous TCAM information:

TCAM during Covid-19 pandemic

As we move into uncharted territory in the NHS, it is important that we focus on what is important and what is manageable for the system. Following a conversation about TCAM in Wessex, we have agreed that medicine safety is still of vital importance and recognise that as we discharge large numbers of patients more quickly than usual, medicines information can get lost. 

Our TCAM work can be a solution to this by ensuring that community pharmacy has an up to date list of medicines for the patient on discharge. However both the hospital pharmacy capacity to make the referrals and community pharmacy capacity to act on them is greatly affected by the current pandemic. 

We therefore propose that we move to a "for information" system whereby referrals can be made automatically by the Trust Pharmacy team but recognising that the usual face to face discussion with the patient is not currently possible so issues about adherence or problems may not be picked up. Similarly for Community Pharmacy, the expectation is that the referral information is there to help  ensure the next prescription after discharge is correct but there is no expectation that patients will be contacted unless there are issues that need to be resolved. 

Why did we do it?
The transfer of care process is associated with an increased risk of adverse effects. 30-70% of patients experience unintentional changes to their treatment or an error is made because of a miscommunication. When some patients leave hospital, they can need extra support taking their prescribed medicines. 

Original work in the North East showed that patients who see their community pharmacist after they’ve been in hospital are less likely to be readmitted and, if they are, will experience a shorter stay.

Patients tell us they don't always remember everything they are told in hospital, so it can be very helpful to have someone go through it again, discussing side effects and checking they understand.

Many HINs, including Wessex and the West of England, have worked with trusts and Local Pharmaceutical Committees to help set up a secure electronic interface between the hospital IT systems and PharmOutcomes, the community pharmacy system used in their area. This has further enhanced TCAM by providing patient data quickly and seamlessly to their community pharmacist.

What’s happened in Wessex?
The TCAM process helped patients manage their medicines across several trusts in Wessex. 

Our ambition was to ensure that this pathway is available to patients in all trusts across Wessex. 

We will continue to assist with implementation of the TCAM pathway, improving medication safety, when patients are transitioning from hospital to home.