Core Services
Medicines Care and Review (MCR) Service
This service aims to provide 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.
- Stage 1 review
- Within 3 months, then annually
- Recorded in
- Pharmacy Care Record (PCR)
- Registration
- One pharmacy per patient
The Pharmacy Care Record
Click here for more information on the PCR and access to the full guide:
PCR Guide (opens in a new tab)Access to the PCR is granted by your local NHS Health Board
How the Service Works
Pharmaceutical care planning and the Pharmacy Care Record
Care planning
Patient profiles and Stage 1 reviews
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 Stage 1 Medication review with them within three months of registration and then annually thereafter. The Scottish Government has provided the Pharmacy Care Record (PCR) to enable community Pharmacists and Pharmacy Technicians to create these patient profiles and record MCR interventions. Access to the PCR is granted by your local NHS Health Board, with details on how to do this found at www.communitypharmacy.scot.nhs.uk (opens in a new tab).
Completing PCR records and carrying out the mandatory Stage 1 medicines review 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.
Using the PCR
Care issues, reports and specialist tools
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). Stage 2 and 3 medication review tools are also included for use at the discretion of the named pharmacist responsible for ongoing care planning.
Click here for more information on the PCR and access to the full guide: PCR Guide (opens in a new tab)
Tools and prescribing
Select a topic to read more
- Methotrexate
- Warfarin
- Lithium
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.
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.
For some patients whose health and medication regime is stable, their GP practice team may initiate a Serial prescription, which authorises the pharmacy to dispense at regular intervals over a 24, 48 or 56-week period from a master paper prescription. This requires less administration at the GP practice, allows the pharmacy team to better plan workload and changes the patient journey to reduce the steps required in re-ordering repeat medication.
All serial prescription claims are completely electronic via the PMR system, and should be sent at the point of prescription collection. Ensuring correct remuneration and reimbursement requires good electronic housekeeping - refer to your PMR user guide or provider for more information.
Treatment Summary Report (TSR). After the last supply has been made from a Serial prescription, the Treatment Summary Report (TSR) should be submitted to the GP practice - this summarises the supplies made and allows the pharmacy team to add notes e.g. to ask for a review to be carried out before repeating the prescription. You should check locally as to whether the TSR also acts as a request for a new serial prescription or if you should follow other agreed processes.
Remuneration and support
Payment arrangements and learning resources for MCR
Remuneration
Remuneration for the MCR Service
Full details of remuneration arrangements for the MCR service can be found in our financial framework section, which is updated annually.
Learning
Public Services Delivery Scotland (PSDS, formerly NES) Pharmacy Support
PSDS 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".
FAQs
Eligibility, registration and CP3 forms
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 or Cardiovascular disease, and consent to data-sharing between their GP and Community Pharmacy.
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.
No, patients can only register with one pharmacy for MCR.
MCR registrations do not lapse, but registration counts will update based on patient movement and as patients pass away.
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.
Registration for Medicine Care Review is carried out via your PMR system - refer to user guides for specific instructions.
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 CP4 section leaving only the CP3 section to send to PSD.
All MCR registration and withdrawal CP3 forms should be sent to PSDS along with all other prescription forms - counting them each as one form and zero items when filling out your GP34 submission form.
Other core services
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