When pharmacy leaders Graeme Richardson (Chief Pharmacist, South Tyneside and Sunderland NHS Foundation Trust) and Claire Curry (Clinical Services Lead Pharmacy Technician, Calderdale and Huddersfield NHS Foundation Trust) set out to increase referrals to the NHS Discharge Medicines Service (DMS), they focused on two objectives: make referrals easy for busy hospital teams and make them meaningful for community pharmacists. Their approaches, developed independently but with shared aims, are now helping more patients leave hospital safely, with better continuity of medicines support in the community.

What the Discharge Medicines Service is trying to achieve

The Discharge Medicines Service is an ‘Essential’ NHS service that has to be provided by all community pharmacies. It ensures changes to patients’ medicines in hospital are communicated to community pharmacy at discharge, so pharmacists can reconcile, counsel and support adherence – and in doing so, improve health outcomes and reduce re-admissions. It is a collaboration between hospital, primary care and community pharmacy teams.

Evidence shared with regional teams highlights the impact of the service: around one avoided readmission for each 10 DMS consultations completed (with more recent analyses suggesting a range of 10–23 consultations per readmission avoided), and for patients who are readmitted, shorter length of stay – 7.2 instead of 13.1 days on average

South Tyneside & Sunderland – reducing referral times

Early pilots asked ward pharmacists to enter patient demographics and discharge details directly into their online system. Each referral took 10–15 minutes – time the small clinical team simply did not have.

Graeme recalls:

“At the South Tyneside District Hospital site we had circa 14 pharmacists for circa 300 beds…Spending 10 minutes per referral was impossible.”

Rather than build an expensive interface, Graeme’s team used what already existed in the Trust’s hospital information system. As part of routine Integrated Medicines Management on the wards, pharmacists already generate a Pharmacy Discharge Letter containing demographics, the final list of discharge medicines, dose changes, medicines started/stopped, allergies, treatment recommendations for the GP, and, most importantly, a free‑text section “for the Community Pharmacy” where the DMS ask is recorded. Once saved, this letter is fed into the wider medical discharge letter and then auto‑sent via by secure NHSmail overnight to the patient’s nominated community pharmacy.

Using this process DMS referral became an additional step in the usual clinical documentation for hospital teams, not a separate task. For community pharmacy, the letter provides a concise medicines narrative (what changed and why), enabling targeted support such as inhaler technique checks or monitored dosage systems.

Graeme explains:

“The beauty of this approach is that the referral becomes a by‑product of good documentation. It’s seconds of extra work, not minutes.”

Next steps

There are known limitations to the system, and the team are already working on improvements based on feedback. Community pharmacists asked for a timestamp, named contact details for the completing pharmacist, and a way to prevent multiple versions when letters are edited before discharge. Some of these enhancements are lined up as part of the Trust’s upgrade to their system to avoid double‑building in two systems.

Said Graeme;

“Clinical realities need to be accounted for, for example antibiotics can be prescribed at the very point of discharge, which means discharge letters have to be updated and resent. Until timestamps are added, some duplication is unavoidable; so in the meantime we’re just encouraging community pharmacies to use the latest‑received version.”

Graeme and the team are also aware that the patient’s nominated pharmacy from the NHS App/summary records doesn’t always propagate into the hospital EPR consistently. Teams often have to still confirm with the patient and enter the nomination in the hospital system to ensure the automated send works.

Even with these improvements needed, about 5% of discharge letters appear to convert into completed DMS claims.

With 7–8,000 discharges a month, that is a meaningful percentage of patients receiving post‑discharge support with minimal additional extra workload for ward pharmacists.

Graeme notes this is likely to be a low estimate on the real activity taking place, as some pharmacies act on the information without completing the full claiming pathway.

“Even if only 5% show up in claims, that’s hundreds of patients getting extra support. And the real figure is likely to be even higher,” he adds.

Not every trust uses the online system used by the Trust, but the principle is universal: embed the DMS ask into the standard discharge medicines documentation, capture the nominated pharmacy once, and auto‑route to generic community pharmacy mailboxes to ensure continuity. Where hospital systems cannot add an additional field, a template email attaching the discharge medicines summary with a clear free‑text “ask” will still convey the necessary information.

Calderdale & Huddersfield: increasing referrals by targeting the right patients

When DMS launched nationally in February 2021, Calderdale and Huddersfield NHS Foundation Trust (CHFT) primarily used the platform to alert community pharmacy about the treatment needs of monitored dosage system patients, generating roughly 200 referrals per month. A monitored dosage system is a tray with days of the week that help patients / carers to remember to take their medicines so patients using these are usually those requiring a lot of medication and specific instruction on how they need to be taken.

Claire describes the early phase:

“Initially, it was all about monitored dosage systems. That was our comfort zone. But we knew we could do more.”

 Scaling what matters.

Claire led a systematic expansion by defining high‑value referral patient groups – for example, patients on critical medicines (DOACs, insulin, sodium valproate) and those with significant medicines changes (e.g., inhalers, antihypertensives). She aligned the process with dedicated ward pharmacy teams, embedded pharmacy technicians into discharge workflows, and extended DMS to virtual wards, all without compromising dispensing levels.

Claire explains the rationale:

“We asked: who benefits most from continuity? Patients on high‑risk medicines, or with big changes during admission. That’s where DMS makes the biggest difference.”

By June 2025, CHFT’s referrals had climbed to 372 in a single month, with the team realising that that every ten DMS notices can prevent one avoidable admission and shorten subsequent stays if readmission does occur. Next, they are exploring robotic process automation (RPA) to increase referrals further and safely, and to widen inclusion to larger patient cohorts (e.g., opioid-related discharges).

Claire adds:

“Automation is the next frontier. If we can take the manual steps out, we can scale without adding pressure to ward teams.”

Tips for pharmacy teams

Integrate, don’t duplicate. Make the DMS referral part of an existing process e.g., the pharmacy discharge summary), rather than adding a separate system. Where eReferral platforms are necessary, keep additional steps to an absolute minimum for busy hospital teams

• Define who benefits most. Start with high‑risk medicines and high‑change discharges to maximise impact and early buy‑in from ward teams, then broaden once the pathway is routine.
• Use generic inboxes and automate the send. Routing to shared NHSmail mailboxes reduces the risk of missed referrals when individuals are on leave and allows pharmacies to build internal standard operating procedures.
• Close the feedback loop. Claims data only shows what’s claimed. Trusts should seek qualitative feedback from Local Pharmaceutical Committees (LPCs) to understand actions taken off‑platform and prioritise improvements such as timestamps.
• Plan for digital evolution, but don’t hold off making improvements for it. Future system interoperability will help systems develop even further; however, simple email‑based workflows can still deliver value to patients and staff right now.

Why replication elsewhere would make a difference for patients and the system

Both trusts show that small process changes can unlock big improvements for patients. By embedding DMS in routine pharmacy practice, South Tyneside & Sunderland encourage a better response to this kind of referral, while Calderdale & Huddersfield ensure referrals are clinically targeted and operationally supported. Together, these strategies deliver what DMS set out to do: safer discharges, better adherence, and fewer avoidable returns to hospital – with colleagues reporting growing activity and strong potential to scale further through automation and digital improvements.  Both Graeme and Claire have realised that DMS referrals don’t require perfect interoperability on day one, but they do need clarity about who needs the service, smart use of the tools you already have, and continuous, practical dialogue with community pharmacy. The rewards -safer transitions of care and reduced demand for hospital bed- are well worth the effort.