Transfer of Care Around Medicines (TCAM) Pathway in selected south London and Kent trusts

The results

  • Across the three trusts, a total of 2,253 referrals have been made using the TCAM pathway since the introduction of the first pathway in September 2018. 
  • 64.8% of these referred patients have already received an intervention by their nominated community pharmacist with the remaining patients awaiting contact.
  • This is estimated to have accumulated a potential cost avoidance across the system by these providers of £1,783,446 to the local health economies.
  • All results data was taken from PharmOutcomes on 16 March 2021.

What is the TCAM pathway?

Research has repeatedly shown that patients often experience errors or unintentional changes to their medicines when they move between care providers, presenting a significant risk to patient safety1. Improving the safe transfer of information about medicines between hospital and community pharmacy reduces the incidence of avoidable harm to patients.

Evidence has demonstrated a corresponding reduction in unnecessary healthcare utilisation, with significant associated cost avoidance in terms of re-admissions and length of stay2 .

“Many patients experience errors or unintentional changes with their medicines upon discharge from hospital.”

The Transfer of Care Around Medicines pathway promotes patient safety through collaborative working across care boundaries. Inpatients who are considered to benefit from ongoing support and continuity of care after leaving hospital are identified by hospital pharmacists and referred to a local community pharmacist of their choosing. A web-based system called PharmOutcomes is employed to facilitate the transfer of information between the hospital and the patient’s nominated community pharmacy team to improve the coordination of care. This includes electronic transfer of discharge letters as part of the referral process. Community pharmacists provide follow-up services tailored to the individual patient’s needs within 2 weeks of receiving a referral.

“TCAM is the implementation of a safe and secure digital, clinical handover from the hospital to community pharmacists.”

What did we do?

The Health Innovation Network rolled out the TCAM pathway at 3 acute trusts in south London and Kent:

  • Lewisham and Greenwich NHS Trust
  • Kingston Hospital NHS Foundation Trust
  • Dartford and Gravesham NHS Trust

We supported the collaboration between acute hospital trusts, clinical commissioning groups and the respective local pharmaceutical committees to adopt and implement the pathway. We delivered training sessions on TCAM and how to use the digital platform PharmOutcomes to hospital and community pharmacists. Ongoing training, support and resources were provided to all key stakeholders at these locations.


What are the next steps?

In February 2021, NHS England and NHS Improvement established the NHS Discharge Medicines Service (DMS) as an essential service under the Community Pharmacy Contractual Framework. NHS Trusts which have already developed a referral process under the TCAM programme will continue to refer patients under the new DMS. The name TCAM has been phased out under this new service but the pathway remains the same.

The Health Innovation Network will continue to share learning to support our existing providers to transition to DMS from TCAM, and as members of a cross-system stakeholder group to lead on the implementation of the DMS across other areas in south London.

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If you would like to discuss this report or learn more about our work in patient safety please contact us.

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By Rita Mogaiji

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