Discharge Medicines Service: The Community Pharmacy Guide

About this service

The NHS Discharge Medicines Service (DMS) is an essential service within the Community Pharmacy Contractual Framework (CPCF), which means every pharmacy contractor in England must provide it. The service has been in operation since 15 February 2021.¹

Medicines changes at discharge are a known patient safety problem: between 30% and 70% of patients experience an error or unintentional change to their medicines when moving between care settings, and 60% of patients have three or more medicine changes on discharge.¹ The service ensures that when a patient leaves hospital, their community pharmacist is informed of those changes and can support them through the transition.

The service supports the World Health Organization's Medicines Without Harm goal of reducing serious avoidable harm from medicines by 50%, and is intended to reduce the risk of medicine-related harm and hospital readmissions after discharge.¹

Referrals are made only by NHS trusts. Patient-provided discharge summaries and GP practice referrals do not constitute a DMS referral and do not trigger the service.¹ The service is structured around three stages. Payment is made in accordance with the current Drug Tariff and NHSBSA arrangements.² Partial payment is available where only part of the service can be completed in the circumstances defined in the Drug Tariff.

Who to offer the service to

Include

• Pharmacists and pharmacy technicians delivering the service should complete the CPPE NHS Discharge Medicines Service learning and assessment and meet the competency requirements set out in the service specification.⁶
• Develop a standard operating procedure (SOP) for the service, covering how referrals are received, triaged, and acted upon within the required timeframes.
• Check for new referrals every working day. Referrals arrive via PharmOutcomes, Refer to Pharmacy, or NHSmail, depending on the referring NHS trust. Patient-provided discharge summaries and GP referrals do not trigger DMS.
• Brief all pharmacy team members who support the service on the DMS pathway and their specific role within it.
• Familiarise yourself with which NHS trusts in your area are actively sending DMS referrals. Referrals can arrive from any trust in England.
• Confirm that the referral contains sufficient information to complete Stage 1. SCR access may support medicines reconciliation where available and permitted by the pharmacy SOP, but the DMS referral, PMR, and other appropriate records should be used to complete the clinical review.

Exclude

• Stage 1 Step A (clinical review of the referral) must be completed by a pharmacist. It cannot be delegated to a pharmacy technician.
• Steps B, C, and D of Stage 1, and all of Stages 2 and 3, may be completed by a pharmacist or pharmacy technician.
• Step E of Stage 1 (checking queued prescriptions) may be completed by any suitably trained member of the pharmacy team.

Stages at a glance

* Payment values shown are indicative. Confirm current values against the Drug Tariff and NHSBSA guidance before claiming.

How to deliver the service

1. Check for referrals daily. Referrals are sent electronically by NHS trusts, usually via PharmOutcomes, Refer to Pharmacy, or NHSmail. Checking daily is essential to meet the Stage 1 72-working-hour deadline. Referrals may arrive from any NHS trust in England, not only those in your immediate area.
   • The referral should include: patient demographic and contact details, NHS number, hospital medical record number, registered GP details, all medicines at discharge (name, strength, form, dose, frequency, duration, and reason), all changes made during admission, and contact details for the referring clinician.
   • If essential information is missing, contact the NHS trust to obtain it. Record any missing mandatory information as part of the claim.
2. Stage 1: Clinical review and medicines reconciliation (within 72 hours of receipt). This stage must be completed as soon as possible, and within 72 hours of receipt, excluding hours when the pharmacy premises are not open for business.
   • Step A (pharmacist only): Check the referral for clinical information and any actions that need to be taken. Assess whether any medicines changes require urgent follow-up. Pay particular attention to high-risk medicines changed at discharge: anticoagulants, insulin, opioids, methotrexate, lithium, antiepileptics, renally cleared or AKI-sensitive medicines (including antibiotics requiring renal-dose adjustment, ACE inhibitors/ARBs, diuretics, NSAIDs, metformin, and SGLT2 inhibitors), and any medicine stopped during admission that remains on a repeat prescription. If a discrepancy presents an immediate risk to patient safety, withhold or defer supply where supply may be unsafe, and urgently contact the referring trust or GP practice to resolve the discrepancy before dispensing proceeds.
   • Step B (pharmacist or pharmacy technician): Compare the medicines the patient has been discharged on with those they were taking before admission.
   • Step C (pharmacist or pharmacy technician): Raise any issues or discrepancies with the NHS trust or the patient's GP practice as appropriate.
   • Step D (pharmacist or pharmacy technician): Record on the patient medication record (PMR) and any other relevant records (including medicines dosette or compliance aid records). Note clearly that Stages 2 and 3 are still to be completed.
   • Step E (any suitably trained pharmacy team member): Check any prescriptions for the patient already queued, in the dispensing process, or awaiting collection, to confirm they are still appropriate. Pay particular attention to electronic repeat dispensing (eRD) prescriptions, which may have been automatically pulled down before or after discharge. Where a discharge change makes a queued item unsafe to supply, intervention or cancellation may be needed before dispensing proceeds.
   • If the service cannot be completed, record the reason and check the current Drug Tariff/NHSBSA criteria before claiming a partially completed service. Partial claims are limited to defined circumstances, such as the patient becoming uncontactable or withdrawing consent after Stage 1, changing pharmacy after Stage 1, or temporary pharmacy closure preventing completion.
3. Stage 2: First post-discharge prescription check. This stage is triggered when the first prescription is received after discharge. This is usually between one week and one month after discharge, depending on the quantity of medicines supplied by the hospital.
   • Check that the medicines prescribed post-discharge reflect the changes made during the hospital admission.
   • If discrepancies or issues are identified, attempt to resolve them with the GP practice using usual communication channels.
   • Complex clinical issues may need referral to the GP practice or PCN pharmacist for consideration of a Structured Medication Review.
   • Record the outcome on the PMR and any other relevant records.
4. Stage 3: Patient consultation. This stage is completed when the first post-discharge prescription is received, or earlier if the patient and/or their carer attends the pharmacy before their first prescription and it is clinically appropriate to consult at that point. DMS consultations must protect patient confidentiality and should be undertaken in a suitable consultation room or remotely by telephone or video where appropriate.⁵
   • Check the patient's and/or carer's understanding of what medicines should now be taken, when to take them, and how to use them. Pay particular attention to medicines that have been started, stopped, or had their dose changed during the admission.
   • Provide appropriate advice to the patient and/or carer to support correct use of new or changed medicines.
   • Communicate any information of value to the patient's GP or primary care network (PCN) clinical pharmacist to support ongoing care.
   • Offer to dispose of any medicines that are no longer required, to avoid confusion and reduce the risk of an adverse event.
   • Consider whether the patient would benefit from the New Medicine Service or another service within the CPCF.
   • Record the consultation on the PMR and any other relevant records.
5. Record and claim. Retain a clinical record of each DMS provision. Submit claims via the NHSBSA MYS portal once all DMS stages that can be provided have been completed.² Claims should normally be submitted by the 5th day of the month following service delivery. Late claims are accepted within three months of the original submission deadline, in line with Drug Tariff requirements.² From 6 July 2025, the shortened MYS journey allows claims for all three DMS stages, individually or in combination, according to what has been completed and is claimable.⁴ Flag outstanding stages on the PMR (for example via a task or alert) when the first post-discharge prescription arrives, to trigger completion of Stages 2 and 3.

Recording and submission

• Record Stage 1 actions on the patient's PMR at the time of completion. Note clearly that Stages 2 and 3 remain outstanding.
• Record Stage 2 and Stage 3 outcomes on the PMR when the first post-discharge prescription is received.
• Retain records for at least three years in line with current NHSBSA guidance for DMS MYS evidence and post-payment verification.
• Submit claims via the NHSBSA MYS portal once all stages that can be provided are completed. Claims should normally be submitted by the 5th of the following month. Late claims are accepted within three months of the original submission deadline.²
• From 6 July 2025, use the shortened MYS journey for all three DMS stages, individually or in combination.
• Partial payment is claimable where only part of the service can be completed, in the circumstances defined in the Drug Tariff.
• Keep evidence of service-specification compliance and clinical records available for post-payment verification for a minimum of three years.

Key takeaways

• DMS is an Essential Service within the CPCF. Pharmacy owners are required to provide the service and must act on eligible referrals received.
• Stage 1 must be completed within 72 working hours; Step A of Stage 1 must be done by a pharmacist.
• Flag Stages 2 and 3 clearly on the PMR at Stage 1. The pharmacy must actively identify the patient's first post-discharge prescription and complete the remaining stages.
• Claims should normally be submitted by the 5th of the following month via MYS; late claims are accepted within three months of the original deadline. Retain records for three years for post-payment verification.

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