Primary care medicines support for people living in care homes

NHS England have developed the Enhanced Health in Care Homes (EHCH) model. This is a framework for more structured support to improve the safety and outcomes for people living in care homes when taking medicines.

Background

The NHS Long term plan states that the EHCH model will be rolled out across England by 2024. The model delivers proactive care, focused on the needs of individual people, their families and care home staff. This can only be achieved through a whole-system, joined-up approach.

A guide from the Care Provider Alliance provides advice for care home managers on how to support people to benefit from this service. It also provides information on how to work effectively with your primary care network (PCN). 

Pharmacy and medicines support to care homes

Pharmacy professionals can support care homes in different ways.

Community pharmacies can:

• supply prescribed medicines and over-the-counter medicines
• supply medicines administration record charts
• provide advice and support
• provide medicines and systems training
• undertake medicines audit.

Primary care or community pharmacists can:

• Provide support through a GP practice, primary care network, NHS community trust or NHS Medicines Optimisation in Care Homes (MOCH) programme, or from any other team from the integrated care system (ICS). Support includes:

• help with medicines supply, including with medicines for people at the end of their life
• delivering structured medication reviews
• supporting medication reviews of new residents or those recently discharged from hospital
• supporting care home staff and residents with medicines queries
• prescribing medicines for people living in care homes.

Terms you might hear

Medicines optimisation: a framework to help people take their medicines safely in a person-centred way

Polypharmacy: prescribing of many medicines to one individual person

Appropriate prescribing for a person:

• can be for complex conditions or for multiple conditions
• is prescribed following best evidence
• involves the person to achieve the best outcome.

Problematic prescribing for a person:

• involves inappropriate prescribing of multiple medicines
• is where the intended benefits of the medicines are not realised.

De-prescribing:

• a process of safe and effective reduction or stopping of inappropriate medicines
• reducing harm and the use of unnecessary medicines.

Medication review:

• a structured, critical examination of a person’s medicines by a healthcare professional
• includes the person’s views and understanding about their medicines
• where appropriate, includes family members or carers
• answers concerns, questions or problems with the medicines, including side effects or reactions
• should happen at least once a year but more often based on the person’s health and care needs.

Considerations for providers and staff

• When carrying out a medication review, involve the person and/or their family members. 
• Support people to make informed decisions about their medicines. Some people do not have the mental capacity to make decisions about their treatment and medicines, so relatives or advocates should be involved when making decisions.
• Use your knowledge and medicines records to inform a medication review.
• Care staff may be asked to monitor people before a clinical review, for example using pulse oximeters to measure blood oxygen levels. They must be trained and competent to do this.
• Promote safe and effective use of medicines by working with all healthcare professionals, including external healthcare professionals.
• Ask for a medication review when there are problems or changes in the way a person takes their medicines.