The NMS is a consultation service, which provides an initial interview and a follow-up review for patients newly started on medicines for the following long-term conditions/therapy areas:

• Asthma and COPD
• Type 2 diabetes
• Antiplatelet/anticoagulant therapy
• Hypertension.

The regulations state that if a patient is started on a course of treatment in hospital which is to continue after discharge, a community pharmacist may undertake a NMS consultation following referral from a hospitalbased healthcare professional involved in the patient's care. Hospital staff may use a referral form to facilitate communication around discharge medicines and some hospitals have included elements of the form in their standard electronic discharge letter, a copy of which is given to the patient on leaving hospital.

Some hospitals contact community pharmacists by telephone to provide a verbal referral and may offer to fax or email a copy of the discharge letter through secure routes. It is important to establish how the referral will be communicated within the pharmacy (e.g. through a note on the PMR) so that it can be followed up by any pharmacist in the patient's nominated pharmacy. In outpatient services, it is common for hospital prescribers to recommend initiation of medication to the patient's GP and this can include a medication suitable for the NMS.

There is an opportunity to work with hospital outpatient services to encourage the use of the NMS and it is hoped that systems will be developed to allow referrals for the NMS and MURs to be shared electronically with community pharmacists. The Care Quality Commission has concluded that improvements are needed to improve the quality and safety of patient care in relation to medicines management after discharge. The 'ideal' patient pathway in relation to medicines is described in Figure 2. Community pharmacists can contribute to Step 5: 'Support for adhering to medication' through MURs and the NMS.