There is plenty of scope to improve the support that patients get after discharge from hospital. Views differ as to the 'ideal' time to conduct an MUR after discharge, but factors to consider are:

• The number of days' supply of medicines the patient is likely to have when they are discharged from hospital
• Whether the patient will have been using their own medicines in hospital.

Talk to your local GPs about supporting patients after discharge from hospital and suggest that you trial the provision of post-discharge MURs with a small number of patients initially. Include the following in your discussion:

• Potential benefits of MUR, scope of service, examples of issues that may be discussed
• Ask the GP which patients they feel could benefit, how they might refer to you and how they would like the information to be shared with them after an MUR
• Explain how the pharmacy meets NHS Information Governance requirements and what information the GP could provide to support you (e.g. discharge letter).

Discussions with the patient may include:

• Medicines reconciliation (hospital and post-discharge)
• Patient perception of their need for and use of medicines, including identifying any medicines stopped
• Patient adherence, tolerability, side effects
• Solving problems with ordering, obtaining, taking and using medicines.