Transfer of care from hospitals to community pharmacies

Summary

Pharmacies in Cheshire and Merseyside are being notified by their local hospital when a patient is discharged who might need help with their medication. The initiative, called Transfer of Care Around Medicines, is improving patient safety and quality of care – and saved the NHS in Cheshire and Merseyside an estimated £9.5 million over the three years to Spring 2019.

All 635 community pharmacies in Cheshire and Merseyside are participating– helping to reduce the number of avoidable bed days in hospital in what is thought to be the most comprehensive roll-out of the programme in the country.  

The challenge

Some patients leaving hospital need advice and support to help them take their medicines correctly and safely. Around 60 per cent of patients have three or more changes made to their medicines during their stay in hospital, and only 10 per cent of older patients are discharged with the same medication they were taking before they went into hospital. 

In some cases, errors or unintentional changes to a patient’s medication can occur because of miscommunication. This can lead to patients becoming unwell and being readmitted to hospital, causing unnecessary distress to the patient and placing an avoidable burden on NHS resources. 

It is estimated that 6.5 per cent of emergency admissions are a result of adverse drug reactions, of which it is estimated that 72 per cent are avoidable. 

Actions taken

In 2016 NHS England in Cheshire and Merseyside in partnership with the Innovation Agency received funding from NHS England to support the implementation of systems enabling the transfer of care from hospitals to community pharmacies. Soon afterwards, the initiative was adopted nationally by all Academic Health Science Networks and is one of the AHSN Network’s key innovation programmes. 

A secure digital system enables a hospital’s pharmacy team to inform the patient’s local pharmacy of the patient’s medicines on discharge, so the pharmacist can follow up with advice and services. 

Impacts

Of all referrals from hospitals to community pharmacies through Transfer of Care Around Medicines, around 40 per cent require follow-up action from the pharmacist. It is estimated that for every 10 completed referrals, eight avoidable bed days are saved for the NHS. 

As of March 2019, Transfer of Care Around Medicines in Cheshire and Merseyside has been implemented in 10 trusts, including 11 hospitals, two mental health trusts and all 635 community pharmacies in the region – the fastest adoption and widest spread of the initiative in any region in England. 

There have been 14,853 referrals to community pharmacists at March 2019 of which 6,224 have been completed with further actions from the pharmacist, resulting in calculated savings of 5,103 bed days, or £9.5 million, to the NHS as well as improved patient safety and quality of care.

Testimonial

Una Harding, pharmacist at Day Lewis Pharmacy in Aintree, said: “We now get notifications on our system on a daily basis, it’s a platform we use every day. New discharges or referrals are the first thing you see when you log on. If we see a patient has recently been in hospital we can make a note to speak to them about their medication when they next come in.

“Patients now understand we can deliver more for them. There’s a culture now where people are realising that their GP doesn’t always have to be the first port of call. They know now that if they come into the pharmacy we can talk to them about the changes to their medication. 

“It’s fabulous. Finally we’re getting more information so we can make more clinical decisions without having to hunt for information from different sources.”

Hassan Argomandkhah, Chair of Pharmacy Local Professional Network NHS England Cheshire and Merseyside, said: “What started as an idea – we’ve managed to achieve it, and even if we’ve made just one small change in the quality of life of one patient in the past two years it’s been well worth it. None of this would have happened without the dedication of the pharmacists and their teams – whether in NHS England, in the community pharmacies, or in the hospital pharmacy teams – and all the other ancillary staff surrounding them. Without that support and encouragement we wouldn’t have achieved this.”