Chronic Medication Service

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The Chronic Medication Service aims to enable community pharmacy teams to support people with long-term conditions by:

  • Identifying and Prioritising risk from medicines
  • Minimising adverse drug reactions
  • Address existing and prevent potential problems with medicines
  • Provide structured follow-up and interventions where necessary

The Chronic Medication Service is underpinned by a framework for pharmaceutical care planning based on the Clinical Resource and Audit Group (CRAG) Framework document Clinical Pharmacy Practice in Primary Care.

The framework is described in more detail in Establishing Effective Therapeutic Partnerships, the CMS advisory group report produced under the chairmanship of Professor Lewis Ritchie.

Medication in pharmacy

Chronic Medication Service Outline

CMS requires voluntary patient opt-in prior to participation. The three stages of the CMS process are underpinned by e-Pharmacy:

  • Stage 1 - Registration of patients
  • Stage 2 - Pharmaceutical Care Planning and Patient Profiling
  • Stage 3 - Shared care with the patient’s GP, generating a serial prescription for appropriate patients which lasts for 24. 48 or 56 weeks. (Optional)

All patients will benefit from stages 1 and 2 of CMS, with those whose condition is stable and have few medication changes being more suitable for the option of having their medicines managed using a serial prescription.

In simple terms, Stages 1 and 2 are giving a structure to, and recording, all of the high-quality support that community pharmacies have always provided to their patients but is never captured. If used consistently, the community pharmacy network will be able to build an evidence base of their contribution to patient care and outcomes.

Throughout 2019, CMS will undergo a refresh to further enable pharmacy teams to support people with long-term conditions. Part of this work has been to change the way that serial prescribing works in that GP practice teams can now generate a serial prescription for patients who are not yet registered for CMS, with the pharmacy team carrying out a registration when a serial prescription is presented.

Further developments will be updated on this section of the website as and when they are agreed

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Chronic Medication Service (CMS) Poster & Patient Information Leaflet

The CMS Patient Information Leaflet and CMS Poster are available to download below.

Language Leaflet Poster
English Leaflet Poster
Polish Leaflet N/A
Punjabi Leaflet N/A
Urdu Leaflet N/A
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How the service works

The key intervention within the chronic medication service is the pharmaceutical care planning process. Pharmacists are expected to populate a patient profile for each person registered under CMS 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 in 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 which 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 taken (if any).

Click here for more information on the PCR and access to the full guide 

A general outline of how the care planning process should operate is given below.

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”.

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CMS Serial Prescription SOP

An example SOP for the management of CMS prescriptions has been developed and can be accessed. This can be amended for individual pharmacy requirements.

Chronic Medication Service Implementation Support

Pharmacy teams can refer to guidance available via the NES Turas platform. You will have to log in or create an account, then search “chronic” to bring up relevant resources including the original implementation pack.

PCR support

Pharmacy teams can read the full PCR guide along with other resources here. We would recommend that teams familiarise themselves with the reports functions on the PCR to make best use of the system.

Chronic Medication Service (CMS) Poster & Patient Information Leaflet

Download your CMS Patient Information Leaflet and CMS Poster now.

Copies of the leaflet are also available in Polish, Punjabi and Urdu.

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Who is eligible for the Chronic Medication 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. Patients in care homes are not eligible for CMS.

Can a patient register with any community pharmacy for CMS?

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 CMS?

No, patients can only register with one pharmacy for CMS.

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 CMS.

What are the rules around lapsing?

CMS registrations do not lapse.

How will a community pharmacist know if a patient is registered for CMS elsewhere?

A patient can only be registered with one pharmacy for CMS 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 CMS 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 Chronic Medication Service?

Registration for the Chronic Medication Service 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 1 0
Ten Registrations 10 0
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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 in to 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 CMS which community pharmacy teams can use to record and demonstrate a tangible contribution to medicines safety and patient outcomes.

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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 initiation of new medications and registration for CMS.

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. (Full guide can be found here)

The tool allows outcomes to be recorded and evidence gathered on 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 CMS 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 CMS engagement.

This staff guide will help your team to plan how they will get involved in supporting patients with prescriptions which are new for them. From speaking to pharmacy teams across the country, a whole-team approach is the best way to make a real difference to patient outcomes by helping people to manage their medicines and conditions as effectively as possible. Delivered consistently, this element of CMS has the potential to significantly reduce waste for the NHS and, more importantly, improve people’s health and wellbeing. 

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