Talk to your local GPs about supporting patients after discharge from hospital and suggest that you trial the provision of post-discharge MURs with a small number of patients initially. Include the following points in your discussion:

• Potential benefits of MURs, scope of service, examples of issues that may be discussed
• Ask the GPs which patients they feel could benefit, how they might refer to you and how they would like information shared with them after a MUR
• Explain how your pharmacy meets NHS information governance requirements and what information the GP could provide to support you (e.g. discharge letter).

Discussions with the patient may include:

• Medicines reconciliation (hospital and post-discharge)
• The patient's perception of the need for and use of medicines, including identifying any medicines stopped
• Patient adherence, tolerability, side-effects
• Problem-solving regarding ordering, obtaining, taking and using medicines. Under the service specification for MURs, there are two criteria for reporting the findings of a MUR to the relevant GP:

Items within the action plan that need to be considered by the GP/practice

Within seven days of conducting a MUR, the pharmacist is required to forward the overview action plan page to the GP, and a professional judgement is required as to whether the consultation page is also required. The GP is able to request all paperwork of the completed MUR as required

No items within the action plan that need to be considered by the GP/practice

A completed form need not be sent to the GP/ practice, but they should still be notified that a MUR has been completed within a month of it being carried out.

Information governance arrangements

Post-discharge MURs need to be considered in light of information governance (IG) requirements:

Electronic discharge form

Where a discharge summary is faxed to a community pharmacy, the fax machine must be secure as there is patient identifiable information transmitted through it. The IG lead should identify the risks associated with this.

Consideration also needs to be given to storage of faxes, the visibility of the fax machine to members of staff and other patients, and the storage and disposal of faxes in a secure manner. This is relevant to both discharge MURs and hospital referrals for the NMS.

Computer MUR forms

Computer forms may be used to conduct the MUR and will require password protection, back-up facilities, secure printing facilities and consideration given for secure transport.

Paper-based MUR forms

Storage of completed MURs and partially and fully completed NMS forms and their safe disposal should be in line with IG arrangements. This should include the transfer of MUR or NMS forms in a secure manner to the GP practice. Where hospital referrers are contacted after a NMS consultation, IG arrangements are required for transfer.

Community pharmacy discharge MURs and NMS interventions improve care transfer