What is the Discharge Medicines Service?
It is the essential service that connects a hospital discharge to the patient's community pharmacy. NHS England's guidance on the 2020 amendment regulations states: "Pharmacy contractors are required from 15 February 2021 to provide the NHS Discharge Medicines Service (DMS) as an essential service". NHS England's service page adds that it "must be provided by all community pharmacy contractors".
The purpose is safety at a known weak point. The guidance says "Discharge from hospital is associated with an increased risk of avoidable medication related harm". It cites NICE guideline NG5, which recommends medicines reconciliation "within a week of the patient being discharged". Before the DMS, the same idea ran as local Transfers of Care Around Medicines (TCAM) projects supported by the academic health science networks. The 2021 regulations made it national and compulsory.
NHS England summarises the service as ensuring "better communication of changes to a patient's medication when they leave hospital", to reduce "incidences of avoidable harm caused by medicines". In practice that means three things: reading what the hospital changed, checking that the next prescription matches, and making sure the patient understands the new regimen.
Who refers patients, and how?
NHS trusts, by secure electronic message, with the patient's consent. The guidance defines a referral as "any written patient information received by a community pharmacy via secure electronic message from an NHS trust" about the patient's discharge and their medicines. The toolkit is blunt about the route: "Referrals to the NHS Discharge Medicines Service must be made via secure electronic message". In practice that is a referral platform or NHSmail, and the toolkit points pharmacies to their NHSmail account for the purpose.
The trust decides who to refer. The toolkit gives hospital teams two lists to work from. Box 4.1 names high-risk medicines, including anticoagulants, antiepileptics, digoxin, opioids, methotrexate, antipsychotics, lithium, insulin and NSAIDs. Box 4.2 names high-risk patients.
| Toolkit priority group | Wording |
|---|---|
| Polypharmacy | "People taking more than five medications". |
| New medicines | "Those who have had new medicines prescribed while in hospital". |
| Changed medicines | "Those who have had medication change(s) while in hospital". |
| Support needs | Patients with a learning disability or who need help taking their medicines. |
General practice is a partner, not a referrer. The toolkit asks practices to "work collaboratively with community pharmacy to align the NHS Discharge Medicines Service to their current work". It also expects them to be "willing to provide this support" when the pharmacy needs clinical input. Discrepancies found at stage one or two go to the practice or the trust to resolve.
That referral flow is the whole game. The NHSBSA publishes monthly DMS summary reports by pharmacy and by integrated care board, with a national running total. The pattern is uneven. The service is national, but the referrals depend on each trust's discharge process. A pharmacy next to a hospital with a mature electronic referral route sees a steady flow. One whose trust never wired it up sees almost nothing.
What are the three stages?
A clinical check of the referral, a check of the first post-discharge prescription, and a conversation with the patient. The guidance sets them out in tables 8.1 to 8.3, and the timing rules are strict.
| Stage | Trigger | What happens |
|---|---|---|
| Stage 1 | Referral received | Check the referral's clinical information and actions. Compare discharge medicines with those taken before admission. Raise issues with the trust or practice. Note the record. Review prescriptions already ordered, in process or awaiting collection. Due within 72 hours of receipt. |
| Stage 2 | First post-discharge prescription received | Check the prescription against the discharge information. Make sure it reflects the hospital's changes. Raise discrepancies with the general practice. Update the record. |
| Stage 3 | Patient or carer available | A confidential discussion to check understanding of each medicine, when to take it and any advice. In the consultation room, or by telephone or video if the patient cannot attend. |
The 72-hour clock is the rule people miss. Stage one must be provided "within 72 hours of receipt of a referral (excluding hours of days on which the pharmacy premises are not open for business)". A referral that lands on Friday afternoon in a pharmacy closed at weekends is due by Tuesday afternoon, not Monday morning, but it is still due. The toolkit describes the task as "a pharmacist clinical check within 72 hours of receipt of a referral".
Stage two waits for the prescription. The guidance says the pharmacy provides it "once the first prescription is received by the contractor following patient's discharge". Community Pharmacy England (CPE) says this is "usually one week to one-month post-discharge". Stage three is best done when that prescription is handed over, so the patient conversation and the prescription check happen together.
Not every referral reaches stage three, and the guidance plans for that in Box 8.4. If the patient cannot be contacted after stage one, the pharmacy makes "reasonable attempts to contact the patient" and shares any "findings of concern" with the general practice. If the patient moves to another pharmacy, the first pharmacy "should contact the second pharmacy contractor and offer to send them" the referral, with consent. If the pharmacy closes temporarily, it must try to reach the patient and pass the referral to another contractor.
Who can carry out each stage?
Pharmacists and pharmacy technicians, with one stage historically reserved. NHS England's 2020 guidance frames stage one as a pharmacist's clinical check, and its table 8.1 sets out what "a pharmacist" must do. Tables 8.2 and 8.3 give stages two and three to "a pharmacist/pharmacy technician". CPE's current service page lists all three stages as "Pharmacist/ Pharmacy technician" and asks owners to ensure that "relevant staff, including pharmacists and pharmacy technicians" are competent. Check the current guidance before delegating the stage-one check to a technician, and record who did what.
Competence is declared, not assumed. CPE says that once a pharmacist or technician has done the relevant learning, "they must complete the DMS Declaration of Competence". The CPPE transfer of care learning is the standard route, and NHS England links to it from its service page. A rota that names the DMS lead for each day is the simplest way to keep the 72-hour clock honest. Our onboarding guide covers how to build service responsibilities into the first month.
Stage three can be remote. The guidance says support and advice "can be provided by telephone or video consultation" where the patient cannot attend. That matters for housebound patients, who are often the ones with the most medicine changes.
How much does the DMS pay?
£35 for a completed episode. CPE's service page states that "Pharmacy owners providing the full service will be paid a fee of £35". Where the pharmacy can only complete some stages, the fees are £12 for stage one, £11 for stage two and £12 for stage three. A "setup fee of £400" was paid in 2021 to cover preparation. NHS England's guidance confirms that "information regarding payment for providing the NHS DMS can be found in Part VIA of the Drug Tariff".
| Payment | Amount | Source |
|---|---|---|
| All three stages completed | £35 | CPE service page; Drug Tariff Part VIA. |
| Stage 1 only | £12 | CPE service page. |
| Stage 2 only | £11 | CPE service page. |
| Stage 3 only | £12 | CPE service page. |
| Set-up fee | £400 | One-off, paid in 2021. |
Nothing changed for 2026/27. CPE's summary of the settlement agreed on 29 May 2026 says the single activity fee rises by 6p to £1.52 and "other dispensing and service-related fees will remain unchanged". The DMS is not mentioned in the settlement, and no cap applies to it. For what did change, see what the 2026/27 pharmacy contract actually pays.
How do you claim, and what must you record?
Monthly through the NHSBSA's Manage Your Service (MYS) portal, by the 5th of the month after the final stage. CPE's wording is precise. The claim "must be made via the MYS portal no later than the 5th day of the month following" the month in which the final stage the pharmacy could undertake was completed. Miss it and "later submissions will be accepted but only if made within three months of the date by which the claim should have been submitted".
The claim is also a data return. The guidance says contractors "will be required to report a standard dataset through the NHS Business Services Authority (NHSBSA) 'Manage your Service' (MYS) portal", monthly, "for payment, service evaluation and monitoring purposes". NHS England publishes a DMS data specification setting out the fields.
The clinical record sits on the PMR. The toolkit requires that "all relevant information must be recorded as a clinical record on the patient medication record or other appropriate record". At each stage that means the referral, what was compared, any discrepancy and who it was raised with, and what the patient was told. CPE provides DMS worksheets for pharmacies that want a structured template. If your notes are thin, our guide to recording patient notes on a PMR shows what a defensible entry looks like.
Does the DMS pay its way?
Only where referrals arrive in numbers, and only where the three stages are run as one workflow rather than three surprises. The fee is fixed at £35, so the economics are about time and volume.
Our working assumption, not an official figure, is that a straightforward episode takes about 45 minutes of professional time across the three stages. That covers reading and reconciling the referral, checking the first prescription, and a ten-minute conversation. At that pace £35 is about £47 an hour. It is below Pharmacy First at threshold and below an ambulatory blood pressure monitoring episode, but it is comparable with the New Medicine Service and it needs no consultation booking. The comparison across services is in which NHS pharmacy services actually pay in 2026.
Two things push the return up. First, the patient is already yours: the referral names your pharmacy, so there is no recruitment cost and no competition. Second, the work overlaps with dispensing you would do anyway. Stage two is a check on a prescription you are about to dispense, and stage three is the handover conversation done properly. A pharmacy that treats the DMS as an add-on will find it slow; one that folds it into dispensing will find the £35 is mostly for structure and record-keeping.
Two things push it down. Partial episodes pay £11 or £12, and a referral for a patient who never returns will not reach £35. And a referral that misses the 72-hour window is a governance failure as well as a lost fee, because the service is essential and the terms of service require it.
You cannot opt out of the DMS, so the only decision is whether it earns £35 an episode or costs you time. Put one person in charge of the inbox each day. Do the stage-one check the day the referral lands. Flag the patient's record so stage two triggers when the prescription arrives, and hold the stage-three conversation at handover. Then claim by the 5th. Everything else is about persuading the hospital to send more.
How do you get more referrals?
By becoming the pharmacy the hospital team trusts to close the loop. Trusts refer where they see referrals acted on, and they stop where messages go unanswered.
- Confirm the NHSmail shared mailbox and any referral platform used by your local trust are set up, and that someone checks them every working day.
- Introduce the pharmacy to the trust's medicines team and the integrated care board's community pharmacy lead, with the DMS contact details they should hold.
- Ask patients before planned admissions to name your pharmacy as their nominated pharmacy, so the discharge team can find you.
- Act on every referral within 72 hours and reply to the trust when you raise an issue, so the hospital sees the service working.
- Tell local GP practices you are receiving DMS referrals and agree how discrepancies will be resolved at stage two.
- Track referrals received, stages completed and the month's claim; the NHSBSA's monthly reports let you compare your volume with neighbouring pharmacies.
The DMS also feeds other services. A patient discharged on a new medicine in an eligible therapeutic area can be offered the New Medicine Service. A patient whose discharge medicine is short can be steered through the shortage process without a return trip to the hospital. Handled well, the referral is the start of a relationship with a patient who has just had the most disruptive medicines event of their year. That is worth more than £35.
Key takeaways
- The DMS has been an essential service since 15 February 2021, so every community pharmacy must provide it and there is no registration or opt-in.
- Referrals come only from NHS trusts, by secure electronic message with the patient's consent; GP practices resolve discrepancies but do not refer.
- Stage one is due within 72 hours of receipt, excluding closed hours; stage two follows the first post-discharge prescription; stage three is a conversation with the patient or carer.
- It pays £35 for all three stages, or £12, £11 and £12 for stages completed alone, unchanged by the 2026/27 settlement.
- Claims go through MYS by the 5th of the month after the final stage, with late claims accepted for three months.
- On our 45-minute assumption the service returns about £47 an hour, with no recruitment cost because the referral names your pharmacy.
- Volume depends on the local trust's referral process, so the work is building that flow and responding fast enough to keep it.
Sources and further reading
- Discharge Medicines Service (Community Pharmacy England)
- NHS Discharge Medicines Service (NHS England)
- Guidance on the NHS (Charges and Pharmaceutical and Local Pharmaceutical Services) (Amendment) Regulations 2020, chapter 8 (NHS England, December 2020)
- NHS Discharge Medicines Service: toolkit for pharmacy staff in community, primary and secondary care (NHS England, 2021)
- NHS Discharge Medicines Service data (NHSBSA)
- CPCF settlement 2026/27 (Community Pharmacy England)
- Community pharmacy (NHS England)
FAQs
Three stages, one record, no missed claim.
A DMS referral is only worth £35 if the 72-hour check, the prescription check and the patient conversation are all done and all recorded. Dataforge PMR tracks each referral through its stages, prompts the follow-up when the first prescription arrives, and builds the monthly claim.
See Dataforge PMR