Medication reviews broadly fall into three types:
- A prescription review
- A concordance and compliance review
- A medication review
The first simply checks whether the prescriptions are correct. The second involves the patient and checks the pattern of medicine use, understanding and technical ability to comply. The third represents a full clinical review of medical conditions and adjustment of treatment.
I am sure that where the NHS believes they are paying for a full medication review, they are merely getting a prescription review. This was evident in some of the findings within an early report from the CQC.
Every patient prescribed a medicine should receive a full clinical medication review every year. This should be risk stratified so the GPs deal with the patients at highest risk and with the most co-morbidities. The remaining reviews can be completed by practice pharmacists, practice nurses and for certain conditions community pharmacists.
High risk patients, including those discharged from hospital for an un-planned admission or those admitted to a care home should be prioritised and receive earlier and more frequent reviews.
The NPC and other organisations have produced excellent guides on this issue.
The review should be systematic and fit within the control of repeat prescribing in the practice.
Every patient on a regular medicine should be offered a concordance and compliance review. These can be completed by the practice pharmacist or in a planned or opportunistic manner by the community pharmacist under MUR or directly commissioned services. Particular attention should be paid to devices such as inhalers for asthma and COPD.
Every patient should receive a prescription review completed by practice staff every time they put out a repeat prescription to be signed and as part of structured audit carried out by the practice pharmacist.
Many PCTs have worked hard to improve medicines safety and governance, but it is time that this responsibility was embedded into general practice and commissioned in a structured manner with community pharmacy.