The Chronic Medication Service (CMS) allows patients with long-term conditions to register with a community pharmacy of their choice for the provision of pharmaceutical care as part of a shared agreement between the patient, community pharmacist and General Practitioner (GP). It introduces a more systematic way of working and formalises the role of community pharmacists in the management of individual patients with long term conditions in order to assist in improving the patient’s understanding of their medicines and optimising the clinical benefits from their therapy.
There are three stages to CMS:
Stage 1 involves the registration of patients for CMS. A patient with a long term condition/s registers with a community pharmacy of their choice to receive CMS. He/she can only register with one pharmacy at any one time for the service. Registration is voluntary and includes an explicit informed patient consent process. This consent is given to the registering pharmacist.
Stage 2 introduces a generic pharmaceutical care planning framework which is based on the systematic approach to the practice of pharmaceutical care as described in the Clinical Resource and Audit Group (CRAG) Framework document, Clinical Pharmacy Practice in Primary Care. Initially the pharmacist assesses registered patients to identify and prioritise individuals or patient groups with unmet pharmaceutical care needs in order to target patients most in need of their support. The pharmacist then undertakes to identify and record the patient’s pharmaceutical care needs, care issues, any desired outcomes and the actions required to deliver those outcomes. These are documented in a pharmaceutical care plan.
Stage 3 establishes the shared care element which allows a patient’s GP to produce a 24 or 48 week serial prescription for a patient which is dispensed at appropriate time intervals determined by the GP. Information detailing the date of a dispensing event for a CMS serial prescription item is automatically sent back to the GP practice electronically after each serial dispensing episode. This stage is supported by CMS disease specific protocols in order to determine any specific reporting or referral criteria for a number of pertinent disease conditions. A GP can cancel an item/s on a serial prescription electronically. Once cancelled, the pharmacist can no longer dispense any quantities that remain outstanding for that item. If there is a change of medication or dosage, then the GP can generate a new serial prescription if appropriate. Once the last instalment from the serial prescription has been dispensed the pharmacist electronically sends an end of care treatment summary, which includes a serial prescription renewal request to the GP practice. The renewal request acts as trigger to request a new serial prescription/s for the patient. The end of care treatment summary details any relevant data such as compliance reporting and any recommended action/s for the GP.
Like the Minor Ailment Service (MAS), a patient is registered electronically for CMS by the Patient Registration System (PRS). A CMS patient registration request is generated by the pharmacist’s Patient Medical Record (PMR) system and sent to PRS via the ePharmacy message store (ePMS). PRS will send back a message informing the pharmacist whether registration has been successful or not. The patient’s GP practice is also notified electronically once a patient is registered for CMS and the patient’s record is flagged. This acts as a trigger for the GP when they open the patient record so that they know that they can enter in Stage 3 of CMS and generate a serial prescription for that patient. Withdrawal is also electronically supported in the same way as registration. Again the GP practice is alerted to a registration withdrawal.
The care planning process will be supported electronically by the pharmacy PMR system. It will assist in documenting the care plan electronically, printing a paper copy for the patient and electronically generating the end of care treatment summary.
eCMS also builds on the Electronic Transfer of Prescriptions (ETP) and allows a GP to produce a “master” serial prescription which is transmitted by ETP to ePMS. When the paper form is scanned in the pharmacy this retrieves the electronic prescription. The pharmacist retains the serial prescription and scans it at the appropriate dispensing intervals to pull down the electronic prescription data. This also allows for a check for any cancellation messages that may have been sent by the GP. As with electronic Acute Medication Service (eAMS), each dispensing triggers the creation of an electronic claim message which the pharmacist sends to ePMS from where it is accessed by Practitioner Services for payment processing through ePay.
The GP practice receives feedback on the dispensing of serial prescriptions and the end of care period treatment summary electronically via the ePMS. When the serial prescription has been completely dispensed or is no longer valid the pharmacist sends the paper form to Practitioner Services. The end of care treatment summary and serial prescription renewal request are sent electronically to the patient’s GP practice via ePMS.
Establishing Effective Therapeutic Partnerships - A generic framework to underpin the Chronic Medication Service element of the Community Pharmacy Contract
The Chronic Medication Service (CMS) is underpinned by a generic framework as outlined in the report, Establishing Effective Therapeutic Partnerships. This report, produced by an Advisory Group under the chairmanship of Professor Lewis Ritchie, has provided a very solid foundation on which to build CMS based on the principle of improving patient care through the establishment of therapeutic partnerships between patients, General medical Practitioners (GPs) and Community Pharmacists.