Community pharmacist support for patients leaving hospital
When some patients leave hospital they might need extra support taking their prescribed medicines.
This may be because they’ve had changes to their medicines, have started something new, or just need a bit of help to ensure they are taking their medicines safely and effectively. Patients say they don’t always remember everything they are told in hospital so having someone go through it again, discussing side effects and checking that they understand is very helpful.
This is what the Transfers of Care Around Medicine (TCAM) initiative was set up to deliver. TCAM ensures that when patients in hospital are identified as needing this kind of support, they are referred through a safe and secure digital platform to their local community pharmacist when they are discharged.
The initiative has shown that patients who see their community pharmacist after they’ve been in hospital are less likely to be readmitted and, if they are, will have a shorter length of stay. So TCAM can lead to:
- Improved patient safety and experience
- Valuable bed space being freed up
- Savings for the NHS which can be reinvested elsewhere.
Guidance from the National Institute of Clinical Excellence (NICE) cites evidence that when people move from one care setting to another, between 30% and 70% of patients have an error or unintentional change to their medicines. This presents a significant risk to their safety.
Maintaining safe care as patients move across health and care services is a national priority for the NHS.
A study into the value of linking patients as they leave hospital to their local community pharmacist has demonstrated significant results. More patients are likely to continue to take their medication correctly because of support from a community pharmacist. This leads to improved health outcomes for patients and fewer admissions and re-admissions to hospital.
An independent study carried out by Durham University on two Newcastle hospitals found over £1.3m of NHS savings.
This was based on an electronic referral to community pharmacists for patients leaving Newcastle hospitals on a package of multiple medications. The pharmacy service followed up 36% of referrals and subsequent follow up rates have now exceeded 70%.
Leeds Teaching Hospitals NHS Trust, which has also implemented TCAM, is reporting follow up rates that regularly exceed 80%.
Improving the safe transfer of information about medicines also supports hospitals in meeting NICE’s Medicines Optimisation guidance that says “a consenting person’s medicines discharge information should be shared with their nominated community pharmacy where possible”.
How are we helping?
We are working with our member NHS Trusts, Local Pharmaceutical Committees and other organisations to implement TCAM. We aim to significantly increase the number of patients referred to community pharmacies and encourage those referrals to be acted upon.
To achieve this, we are:
- Actively coordinating, promoting and supporting implementation with Trusts and their partners
- Project managing adoption and spread in Trusts in Yorkshire and Humber
- Providing analysis of data for evidence of impact
- Creating opportunities for collaborative working to share best practice
From now until December 2018, our focus will be on developing an initial cohort of Trusts in the West Yorkshire and Harrogate Integrated Care System (ICS) that have implemented TCAM.
Building on the experience of this cohort we then aim, during 2019, to extend the spread of TCAM and work with Trusts to grow the number of referrals made and completed in the existing cohort.
Our impact to date
So far we have identified and met with several NHS Trusts who want to implement TCAM, one of which has firmly committed to implementation.
Leeds Teaching Hospitals NHS Trust, supported by Community Pharmacy West Yorkshire, has already successfully implemented TCAM through its Connect with Pharmacy programme. Between January 2017 and January 2018, 4,719 referrals were sent from the Trust to community pharmacies. 95% of those referrals have been accepted and 84% completed, which is much higher than expected. The Trust has identified subsequent reductions in both absolute numbers of readmissions and Emergency Department attendances.
Vale of York Clinical Commissioning Group, York Teaching Hospital NHS Foundation Hospital Trust and Community Pharmacy North Yorkshire have also established TCAM through their ‘Refer to Pharmacy’ initiative.
Nationally, with rapid adoption across all 15 AHSNs, TCAM has the potential to save £13.8 million, reduce length of stay by 56,704 days and achieve 1,004 fewer readmissions in 2018-19. In 2019-20, savings of £28.8 million are projected, based on a reduction in length of stay of 113,406 days and 2,007 fewer readmissions.
Our aim is to extend the spread of the TCAM programme by building on lessons learned and opportunities delivered through our work with the West Yorkshire and Harrogate ICS. We will work with partners to increase the number of patients referred to their community pharmacists for support resulting in safer patient care and quality improvement.
We also plan to:
- Publish key metrics on our website from June 2018 including the number of live sites, number of referrals to community pharmacies and the number of referrals accepted and actioned by community pharmacists
- Work with Leeds Teaching Hospitals NHS Trust to create and publish a case study to share best practice across the region
- Start to implement the TCAM programme in at least one other Trust by July 2018
For further information including if you are interested in implementing TCAM, contact Gareth Durling, TCAM Programme Manager, tel: 01924 664710 email: Gareth.firstname.lastname@example.org
Contact our project lead
NICE Guideline NG5: Medicines optimisation: the safe and effective use of medicines
Leeds Teaching Hospitals NHS Trust, Connect with Pharmacy
TCAM Case Study: Dorset and Newcastle
New transfer of care initiative of electronic referral from hospital to community pharmacy in England: a formative service evaluation published in BMJ Open