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Case Study Seven

Level 3 Clinical medication review by practice support pharmacists in East Elmbridge and Mid Surrey PCT

Publication of the National Service Framework (NSF) for Older People prompted the PCT to establish a clinical medication review service for people over 75 years of age.
A primary care incentive scheme ("Investing in primary care") was used to fund the initial service, which uses practice support pharmacists working in GP surgeries.


The scheme has a number of objectives. These include :
  • Improving health through better use of medicines
  • Rationalising medication on repeat prescription
  • Synchronising prescription items and supporting 28-day prescribing
  • Promoting concordance and encouraging improved compliance
  • Supporting the implementation of the NSF and guidance from the National Institute for Clinical Excellence (NICE)


The PCT launched the review process in August 2001 with the first reviews taking place during January 2002.
A number of focus groups informed the development of the scheme and helped with medication review materials (eg. forms and letters). Training is provided and includes workshops on therapeutics, communications skills, data analysis and IT.
Practice support pharmacists undertake the majority of the reviews within the surgery but GPs and practice nurses also provide this service for selected patients. Patients for review are identified and prioritised by a computer query using the MIQUEST system running on the GP clinical computer system as well as at the request of the patient or their carer themselves.
All reviews take place according to a protocol agreed by the practice with full access to the patient's clinical notes and relevant test results, where appropriate. Outcomes are documented using a special review form and a READ code is entered onto the GP clinical system.


In a recent audit of the scheme, 233 reviews undertaken by pharmacists during 28 practice sessions were analysed. 430 interventions were made (averaging 15 per session) and over 80% of recommendations were accepted by the patient's GP.
  • Key interventions include :
  • Stopping medicines no longer needed
  • Initiating medicines likely to be of benefit
  • Identifying side effects and reasons for non-compliance
  • Increasing patient's understanding of their medicines
In addition to the positive outcomes already identified, the scheme has led to a number of additional developments. These include plans for the appointment of a pharmacist for older people to work with social services and district nurses to develop a domiciliary scheme, a workshop package for care staff and a rapid response system for urgent medication problems.
Contact Information
Gabrielle Clezy, Pharmaceutical Adviser, East Elmbridge and Mid Surrey  PCT

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