Chronic Medication Service

The Right Medicine outlined the commitment to make better use of pharmacists’ skills and expertise to improve patient care. The Chronic Medication Service (CMS) is the final component in the changed contractual framework.

The Chronic Medication Service (CMS) merges two previous policy initiatives: serial dispensing and Pharmaceutical Care Model schemes (PCMS) and fits in with the Scottish Government’s (SG) Healthcare Quality Strategy.

Serial dispensing pilots previously identified the benefit of a pharmacist being involved with a patient’s repeat medicines. The pharmacist was able to identify medicines that were no longer being used and was able to intervene with patients who were struggling to comply with their medication.

The pharmaceutical care model schemes introduced in 1999 supported a patient-centred approach to pharmaceutical care. Areas covered by the schemes include older people, people with severe and enduring mental health, palliative care, diabetes, epilepsy, asthma and coronary heart disease. The evaluation of the pharmaceutical care model schemes identified that people with long term conditions had unmet pharmaceutical care needs which could be tackled by their pharmacist. Supporting these unmet needs was complementary to other work being carried out by the healthcare team. All of the above is central to the SG Quality Strategy with the Quality Ambitions of care being patient-centred, safe and effective.

The chronic medication service aims to encourage joint working between GPs and community pharmacists to improve patient care 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.

Contractors are encouraged to use the Reports function within the PCR to help manage their CMS/PCR activity. It may be particularly useful when managing NMIST and HRM interventions as these are fully detailed in this section.  Please refer to the PCR version 11 user guide and what’s new in PCR 11 guide for more information

Chronic Medication Service Outline

Chronic Medication Service 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 establishing a serial prescription for either 24 or 48 weeks and support for the patient using disease specific protocol