Beyond Cost Savings: Building a Skilled Care Home Medicines Service

Shropshire Community Health NHS Trust

Project summary

We developed a pharmacy led care home medicines optimisation service to address poor medication review coverage, high-risk prescribing, and variation in medicines management across care homes. The aim was not only to reduce inappropriate prescribing and improve safety, but also to build capability within care home teams so care could be delivered more safely and closer to home.

Over the 6-month pilot, the team engaged 12 care homes and reviewed medicines for 320 residents. Using targeted structured medication reviews, medicines reconciliation, ACB scoring, and clinical discussions with GPs and care home staff, we delivered 120+ pharmacist-led interventions, including deprescribing, dose reductions, medicines switches, and formulation changes. We focused on medicines linked to falls, sedation, anticholinergic burden, hypoglycaemia and hospital admissions.

A key feature of the project was partnership working. We worked closely with Keele University, community pharmacy teams, care home staff, PCN pharmacy teams and GPs to review complex cases, support implementation and evaluate impact. The project also delivered training and support to care home staff in medicines safety, diabetes management, insulin storage and administration, CGM use, EMIS Proxy ordering, falls prevention and safe deprescribing. This helped upskill staff, improve confidence, and strengthen their role in medicines management.

A major area of progress was diabetes care. We supported the introduction of CGM, improved insulin optimisation, and developed the case for care home staff to administer insulin safely with appropriate training and supervision. This reduces reliance on district nursing visits, releases district nurse time for more complex patients, and supports care closer to home.

The project also supported digital transformation through EMIS Proxy ordering, improving the safety and efficiency of medicine requests and reducing administrative burden. Patient outcomes were positive. We reduced anticholinergic burden in 10 residents, with all achieving ACB score improvement. We also addressed high-risk medicines in key groups including opioids, benzodiazepines, antihypertensives and insulin/sulphonylureas, reducing risks of falls, sedation, cognitive harm and hypoglycaemia.

This pilot demonstrates that pharmacy led care home support can improve patient safety, strengthen staff skills, enable digital working, support diabetes care, and provide a clear case for sustainable funding.