When considering a MUR after a patient has been discharged from hospital, the emphasis should be on supporting adherence with the aim of trying to improve treatment outcomes by reducing both medication errors and adverse drug incidents. Community pharmacists don't yet have access to medical notes, have limited information on diagnosis and condition management (including rationale for choice of medicines, any tests done and their results), and may have difficulty influencing, instigating and following up changes in medication. These are issues that would be covered in a clinical medication review rather than a MUR.

NMS interventions

The NMS is an evidence-based service that allows pharmacists to provide continuity of care for patients on new medication. Through the initial interview and mandatory follow-up, the patient continues to be supported. The service is accessible to housebound patients (and others who choose to use it remotely) as it may be provided by telephone.

In any pharmacist-led consultation, it is important to give patients the opportunity to raise questions at the beginning as they will be more receptive to the pharmacist's advice if they have their questions addressed first. The NMS, as a structured consultation around specific questions, can lead to a variety of interventions. There are a number of suggested questions, which may be asked in a closed or open way.

Many practitioners find that the open (alternative) questions lead to a greater understanding of patient needs around medicines support, as suggested in Table 2.

Providing post-discharge MURs

There is plenty of scope to improve the support that patients get after discharge from hospital. Views differ as to the 'ideal' time to conduct a MUR after discharge. Factors to consider are:

• How many days' supply of medicines the patient is likely to have when discharged from hospital
• Whether the patient has been using his/her own medicines while in hospital.

Having the right information

Community pharmacies do not generally receive information about patients admitted to or discharged from hospital. This is relevant in light of the CQC report, which mentioned specifically the provision of medicines discharge information to community pharmacists and indicated that patient confidentiality need not be a barrier to information-sharing under the NHS Confidentiality Code of Practice.

A small number of pharmacies are linked with a GP practice electronically and have access to clinical information and discharge summaries. With the advent of web-based GP systems, there may be opportunities for community pharmacists to negotiate access to relevant patient records.