Home > Core Services > Medicines Care and ReviewMedicines Care and Review
This service replaces the Chronic Medication Service but retains the aim of providing pharmaceutical care and support for those taking medication for long-term conditions.
Community pharmacy teams deliver both structured and opportunistic interventions to help people get the very best out of their prescribed medication as well as minimising the harm that medicines can do.
How the Service Works:
The key intervention within the medicines care and review service is the pharmaceutical care planning process. Pharmacists are expected to populate a patient profile for each person registered under MCR and to undertake a Care Needs Assessment for them within three months of registration.
Completing these gives you a more rounded view of the patient’s health and allows you to identify those patients who have sub-optimal therapeutic management, side effects, or poor compliance. Patients should be prioritised for further pharmaceutical care planning based on the identified care needs.
Individual care issues can be created within the patient profile and managed using the reports function on the PCR – effective use of this will allow for robust follow-up and closure of identified issues. There are also specific tools within the PCR which support pharmacists to deliver structured supportive interventions for newly prescribed medicines and therapies which are considered high-risk (Methotrexate, Lithium, and Warfarin). To facilitate communication with other healthcare professionals and care services, the PCR has a function that allows the generation of an SBAR, which is a standardised method of conveying information about the care of a patient in a clear and concise way by giving an overview of the presenting Situation, any relevant background information and your Assessment and Recommendation as to what action needs to be taken (if any).
Click here for more information on the PCR and access to the full guide:
Care Plan Steps
Step 1: Identifying Pharmaceutical Care Needs and Issues
This step supports:
Judging a patient’s understanding of their condition and if they know what each of their medicines are for
Identify any unresolved pharmaceutical care needs and issues which you wish to address
At the end of the process you will identify:
Product Specific Needs e.g. identifying the need for an additional or alternative medicine
Service Specific Needs e.g. providing patient counselling and advice
Patient Factors e.g. age or relevant medical problems
Medication Risk Factors e.g. reduced renal clearance
Step 2: Formulating the Pharmaceutical Care Plan
This step supports:
Prioritising Pharmaceutical Care Issues
Identify any desired outcomes
Propose any necessary actions required to address the issues
Document the issues, outcomes and actions in a pharmaceutical care plan
Any desired outcomes and proposed actions should be agreed with your patient and where appropriate supported by other practitioners. Documentation of the pharmaceutical care plan and patient profile will be done using the web-based Pharmacy Care Record (PCR). The care plan will form the basis of ongoing monitoring and review of the patient to ensure the issues identified are auctioned.
Step 3: Implementing, Monitoring and Reviewing the Pharmaceutical Care Plan
This step supports:
Implementation of the Care Plan for the patient
Monitoring Progress towards each of the outcomes identified
Reviewing the Care Plan
Pharmacists will be expected to monitor and review the care plan on an ongoing basis. Implementation might be counselling the patient, ensuring they have their medication monitored appropriately or referring to the GP due to a loss of symptom control if required. Pharmaceutical Care planning is a dynamic process and it is important that regular review of the care plan is undertaken.
NES Pharmacy Support
NES have a programme of resources that can be accessed to support frontline care in both community pharmacies and GP practices. These can be accessed by logging in to TURAS Learn and searching for “chronic”.
Registering for the Medicines Care Review
Who is eligible for the Medicines Care Review Service?
The patient must be registered on a permanent basis with a GP in Scotland, have one or more long-term conditions that requires medication e.g. Diabetes, Asthma and CHD and consent to data-sharing between their GP and Community Pharmacy.
Can a patient register with any community pharmacy for MCR?
Any patient who has a long term condition and is registered with a GP practice in Scotland can register with the community pharmacy of their choice.
Can a patient register with more than one pharmacy for MCR?
No, patients can only register with one pharmacy for MCR.
Does a patient have to register with the same pharmacy as they access MAS?
No, patients don’t have to register for the same pharmacy for MAS and MCR.
What are the rules around lapsing?
MCR registrations do not lapse.
How will a community pharmacist know if a patient is registered for MCR elsewhere?
A patient can only be registered with one pharmacy for MCR at any one time. If a patient tries to register with another pharmacy then the system will show the patient as already registered and the pharmacist will be asked if they wish to continue to register the patient. If they establish from the patient that they wish to move their registration from their current pharmacy then the pharmacist can proceed to register the patient. The Patient Registration System (PRS) will then withdraw the original registration and re-register them with the new pharmacy. Make sure to liaise with the patient, their current pharmacy and GP surgery if there are any live MCR serial prescriptions for the patient as these will not be transferred along with registration.
The GP will be notified of the change.
How do I register a patient for the Medicines Care Review Service?
Registration for Medicine Care Review is underpinned by ePharmacy. Registration is similar to the Minor Ailment Service. Contractors should use the combined CP3/CP4 form and their PMR system to perform this function.
Care must be taken to ensure the patient understands that information will be shared with their GP.
Contractors must ensure that the patient signs the registration form and complete the declarations on the reverse of the form fully.
When all the information is completed the pharmacist should detach the CP2 section leaving only the CP3 section to send to PSD.
How do I submit a completed CP3 form to PSD?
All CMS registration and withdrawal CP3 forms should be sent to PSD along with all other prescription forms.
As for MAS, the following information should be recorded on the exempt section of your GP34 form (PSD submission form).
You should count each CP3 as a form for example:
Scenario | Form | Item
One | Registration | 10
Ten | Registrations | 100
High Risk Medicines
Methotrexate, Warfarin and Lithium all continue to be considered high-risk medicines due to their narrow therapeutic range and the relative complexity of patient support that is required to minimise potential harm. Pharmacists can support patients taking these medicines using the High-risk tools within the PCR patient record.
These simple tools provide the basis for a simple, step-by-step conversation around medicines safety specific to each drug and allow the creation of any care issues identified. There are handy guidance points and reminders built into the tool to guide the conversation and ensure that the main areas of risk associated with use are addressed.
The high-risk tools are one of many functions within MCR which community pharmacy teams can use to record and demonstrate a tangible contribution to medicines safety and patient outcomes.
New Medicines Intervention Support Tool
What is the New Medicines Intervention Support Tool (NMIST)?
The aim of NMIST is to increase patient adherence to new medicines prescribed to treat long term conditions. The support tool has been built into the Pharmacy Care Record (PCR), in a similar way to the tool already available for high-risk medicines. Pharmacy contractors can use it to support the initiation of new medications and registration for MCR.
The tool is set up to provide guidance on interventions with a patient who has a new medicine and also offers related risk assessment information. The aim of the service is to provide tailored support to patients who are starting a new medication, from their first prescription through to their continued adherence, with follow-ups in between. Understanding their medication and the importance of taking it correctly supports patients to manage their own illness. Early intervention is known to improve the ability of patients to take their medicines as their doctor prescribed and helps reduce waste within the NHS.
The structure for intervention with patients receiving a new medicine differs slightly from the intervention for patients with a high-risk medicine and this has been reflected within the PCR.
The tool allows outcomes to be recorded and evidence gathered on the use of new medicines and the impact pharmacists have around adherence. Such information will demonstrate that by delivering effective pharmaceutical care, which is patient-centred, safe and effective, pharmacists can contribute through MCR in a positive manner to the SG Quality Strategy. NMIST also potentially offers a greater number of patient interactions than the high-risk support tools, which will aid contractors with continued MCR engagement.