Discharge Medicines Review Service Frequently Asked Questions Q: Can I repeat the service if the patient is admitted and discharged more than once in a 12-month period? A: Yes if in your professional opinion the patient would benefit from the service, the patient meets the eligibility criteria and you have not exceeded your annual DMR allowance. Q: How is the cost of preparing for the service covered? A: In 2011/12 only, any pharmacy that initiates 10 DMS interventions before March 31, 2012 and goes on to complete those interventions will receive an implementation payment of 1,400. The one off payment is the same for all pharmacies and should be used to meet any set up costs incurred in implementing the service (this may include, amongst other things, undertaking MUR accreditation, changes to premises and printing DMR forms). Q: Is the patient required to register with the pharmacy to receive the service? A: No, while it is expected that patients will nominate their regular pharmacy, there is no need for the patient to register to provide the service. When you explain the service to the patient and obtain their consent it is important to remind them that they need to ensure that they obtain their first two prescriptions following discharge from your pharmacy so that you are able to complete the service. Q: Can I provide the service if I do not have a consultation room? If you do not have an approved consultation area for the provision of MURs you will not be able to undertake a face to face consultation with a patient during times when the pharmacy is open to the public. You will however be able to provide a face to face consultation with a patient at times when the pharmacy is closed to the public. If you provide the DMR service in this way you should give due consideration to appropriate security and chaperone arrangements. If you do not have a consultation area you will still be in a position to provide the intervention by telephone provided the patient consents to a telephone intervention and the discussion takes place in an area where it cannot be overheard by members of the public or pharmacy staff. When completing the Premises Listing Form you should tick the second box on the Premises Listing Form as when the pharmacy is closed you are able to meet this requirement. The NHS Wales Shared Services Partnership has been informed that if a contractor is able to tick either the first or second box on the form they will be listed as providing the service. Q: Why do I need to be MUR accredited to provide the service? A: There was a desire by both CPW and the Welsh Government to avoid unnecessary additional accreditation to provide the service while at the same time providing the Health Boards and the Welsh Government that the pharmacist had the necessary skills to carry out an effective consultation of the nature required by the DMR service. As MUR accreditation contains within it elements of consultation skills, it was agreed that if a pharmacist is MUR accredited and has lodged
their certificate with the NHS Wales Shared Services Partnership (formally the NHS Wales Business Services Centre) this would be sufficient to provide the DMR service. Q: Why do pharmacists need to complete a DMR Self Assessment Form when I hold MUR accreditation? A: The MUR accreditation provides assurance that you have the skills to deliver the service. The declaration form is intended to provide assurance to the pharmacy contractor that you are able to provide the DMR service and that claims made by the contractor for services provided are appropriate. Q: Will the service be withdrawn in April 2013? A: Funding for the service is guaranteed until the end of March 2013. CPW will arrange for a formal independent evaluation of the service to be conducted. If the evaluation identifies that the service provides value to both patients and NHS Wales, this will provide CPW with the evidence to negotiate an extension of the service. Q: How has the service been communicated to GP practices? A: The Welsh Government has written to BMA Wales and the General Practitioners Committee Wales to inform them about the launch of the service. GPC Wales will have communicated to Local Medical Committees. Contractors are encouraged to meet with their local GP practices to brief them on the service and discuss the operation of the service at a local level. Q: Have social services and the carer network been made aware of the service? A: CPW will be communicating to all Social Services Departments across Wales. Q: How will I receive a copy of the Discharge Advice Letter (DAL) from the hospital? A: This will depend to some extent on the processes in place in the hospital concerned. Some hospitals may post the DAL to GP practices, others may fax the DAL to GP practices and some may give a copy of the letter to the patient or their representative for them to hand to their GP. It is likely that the same mechanism will therefore be used to provide the pharmacy with the information. LHBs and CPW Regional Directors will be liaising with hospitals on your behalf. Q: How will I know who to contact in the hospital if there is a query? A: LHBs will make CPW Regional Directors aware of the contacts for queries in each hospital. CPW Regional Directors will then arrange for this information to be communicated to contractors and posted on the CPW website. Q: How are patients going to find out about the service? A: Patients will be made aware of the service when they are discharged from hospital or other care settings. In addition the service will be promoted directly to patients by the pharmacy, thorough patient groups and by general word of mouth. Approved marketing material will be distributed to contractors by CPW.
Q: When will electronic forms be available and will paper forms be available simultaneously? As with the MUR service Welsh Government will neither print nor distribute forms to contractors. Copies of the forms are available as pdf documents which can be printed and filled in by hand. Template forms are also available as word documents which can be completed electronically and saved and printed. Welsh Government will discuss with the NHS Wales Informatics Service (NWIS) opportunities to make electronic forms available from IT system suppliers. Q: Can patients discharged from hospitals in England participate in the service? A: Yes. Any patient that is resident in Wales is entitled to access the service provided they meet the service criteria. Health Boards will be in a position to ensure that support is provided for the service from hospitals in Wales they do not however have the same jurisdiction over hospitals in England. Patients discharged from hospitals in England should be provided a copy of their discharge information which, if presented at a pharmacy, will satisfy the eligibility criteria for the service. Q: Can patients discharged from other care settings such as mental health clinics and prisons participate in the service? Yes the service is available for patients discharged from any care setting back into the community where there is likely to be a change in medication or the issue of new medication. However in order for the system to operate there needs to be in place a mechanism to communicate information regarding discharge medication to the pharmacy. Q: How do I claim payment for the services provided? When the DMR has been completed the pharmacy should complete the DMR Summary Form. At the end of the month the DMR Claim Form needs to be completed and copies of all of the DMR Summary Forms completed during the month should be attached to the DMR Claim Form. Claims should be made for completed DMRs (i.e. Part 1 and Part 2 completed) only. The summary forms together with the claim form should be sent to your regional NHS Wales Shared Services Partnership (formally the NHS Wales Business Services Centre) office to arrive by the fifth of the next month. Q: At the end of the financial year it is likely that I will have some DMR interventions where I have completed the Part 1 of the service and will be waiting for the next patient prescription in order to complete the service. How can I ensure that I am paid for these services? A: It is recognised that at the end of the year a number of contractors will have commenced the service as part of that financial year s DMR allowance but will not be in a position, due to the design of the service, to complete the service before the financial year end. To ensure that no contractor is financially disadvantaged contractors will be asked to complete a form at the end of March each year highlighting the number of partially completed DMRs at the financial year end. The completion of the form during March 2012 will also ensure that contractors can secure the one-off Implementation Payment should they have started and not completed the 10 qualifying interventions before the 31 st March 2012.
Q: What happens if I have completed Part 1 of the service and I am unable to contact the patient to complete Part 2 of the service? A: It is recognised that on rare occasions this situation could arise and that despite the best efforts of the pharmacist the patient is unable to be contacted. This could for example happen when the patient is readmitted to hospital part way through service provision. The Directions allow for this situation as they state:- Q: How will the service be evaluated? A: CPW will arrange for the service to be formally and independently evaluated. An element of the implementation payment ( 400 per pharmacy) is provided to meet the costs of a national evaluation of the service which CPW has been charged with procuring. The funding implications will need to be considered by the CPW Board. Q: Can the service be provided to a patient s carer or representative? A: Yes, it is recognised that some patients recently discharged from hospital may be too ill to attend the pharmacy. In this case the service can be provided to the patient s carer or representative if the pharmacist feels it is appropriate to do so and where the patient has provided their consent. You will still require the carer or representative to ask the patient to sign the consent form and return it to the pharmacy prior to the provision of the service. Q: Can the service be provided to minors? A: Yes, children are not excluded from the service. It is presumed that anyone aged 16 or over is competent to give consent for her/himself unless the opposite is demonstrated. If a child under the age of 16 has sufficient understanding and intelligence to enable him or her to understand fully what is proposed, then he or she will be competent to give consent for him/herself. Young people aged 16 and 17, and legally competent younger children, may therefore sign the consent form for themselves, but may like a parent to countersign as well. If a child is unable to give consent him/herself, person(s) with parental responsibility for the child may provide information about their wishes in relation to the child. Any decisions taken must be in the best interests of the child. Q: Can a different pharmacist deliver the Part 2 follow up intervention? A: Yes, provided this is acceptable to the patient and the pharmacist is eligible to provide the service in that they have completed the DMR Self Assessment Form and have registered their MUR Accreditation Certificate with Shared Services.
Q: At what point is the DMR complete? A: The service will be complete for the purposes of generating a payment claim once the Part 2 intervention takes place and the DMR Summary Form is completed. From a professional perspective we would expect the pharmacist to continue to act as an advocate for the patient until all issues have been satisfactorily resolved. Q: What is the HSW Prescribing Services Unit Number asked for on the Premises Listing Form? A: This is the same number that you use at the end of the month to complete the WP34C to send off your prescriptions at the end of the month. Q: The guidance states that in Part 1 of the service any discrepancies need to be brought to the attention of the GP what does this entail? A: This will probably need to be via a telephone to the GP or other Practice Manager and is no different to the pharmacist being aware of a potential prescription error in the normal course of their business. The patient is likely to be waiting for the medication to be supplied and therefore the pharmacist cannot rely on raising immediate issues through DMR paperwork. It is important that the pharmacist discusses any discrepancies with the GP as the discrepancy may arise as a result of a positive decision by the patient s GP to change the medication and cannot be assumed to be an error. In addition the DMR 1 form asks if the issue has been resolved which of course the pharmacist may not know if they have not discussed the matter with the GP. Q: It may be more convenient for the patient for me to provide the DMR service in a care home or at the patient s home is this allowed? A: Yes, the DMR service could be provided in a patient s home or in a care home setting provided the pharmacist has the consent of the Health Board for the service to take place outside of the pharmacy. There will be no additional fee paid for DMR services provided outside the pharmacy. Consent of the Health Board will be required on each occasion that a domiciliary visit is required. In relation to the provision of the DMR service in a particular care home it has been agreed that the contractor can seek the consent of the Health Board to provide the service to the identified care home and once consent has been granted this will allow the contractor to provide services to patients of the identified care home on a future occasion without approaching the Health Board for further consent. Q: What form needs to be sent to the patient s GP? A: The DMR 2 form is the only form that may need to be sent to the patient s GP. As with MURs the DMR 2 Form does not routinely need to be sent to the GP and should only be sent when there is a recommendation to the GP to be made. Q: Can I undertake a DMR without access to patient s notes? A: Uncovering a clinical issue as a result of a DMR is no different to uncovering the same issue in the normal course of dispensing. Part 1 of the service is a reconciliation process and is designed to ensure that the medicines on the DAL reconciles with the medicines on the first prescription received post discharge. If a discrepancy is found the pharmacist will discuss the situation with the
patient, GP or hospital as appropriate, to seek to resolve the discrepancy. This is not a clinical check. If a clinical issue is spotted e.g. a regular dose of a NSAID without gastric protection and the pharmacist wishes to bring this to the attention of the GP then this should be recorded as a recommendation on the DMR2 form and the form sent to the patient s GP. Q: If I am providing the service by telephone how do I obtain patient consent? A: An endorsement should be made on the consent form that consent has been obtained verbally. The entry should be endorsed with the pharmacist s name, GPhC number and the date and time that consent was obtained. The signature of the patient should be obtained at the first available opportunity e.g. when the patient collects the medicine or the medicine is delivered to the patient. Q: Can I provide the service if the patient does not provide consent? A: If the patient does not consent to share appropriate information with the GP then the service cannot be provided to the patient. If the patient does not agree to share consent with the Health Board or Shared Services then the service would not normally be provided other than in exceptional circumstances. Exceptional circumstances may arise when the patient has declined to share information with the Health Board or Shared Services and the pharmacist believes that, following discussion with the patient, the benefit to the patient of the DMR outweighs the unwillingness of the patient to provide consent. In these rare circumstances the pharmacist will need to annotate the claim form accordingly. Q: Can I produce my own marketing materials to promote the service? A: CPW will be producing and distributing posters and patient leaflets to support the service launch and will be advising contractors of the arrangements for future supply of these materials. If a contractor chooses to produce their own materials they are reminded that there will be a new Clinical Governance requirement from April 1, 2012 that requires them that when promoting Essential or Advanced services they need to acknowledge that these services are funded by NHS Wales. In addition Welsh Government has asked that all promotional materials are passed to them for approval before printing.