Medicines after a hospital stay: five questions for the pharmacist

After a hospital stay, several people should check a changed list of medicines. The ward gives the patient a discharge letter listing what was started, stopped or changed and why. The GP practice should check its records against that letter, ideally within a week of receiving it. With the patient’s agreement, the hospital can also refer them to their pharmacy for a free check of the first new prescription. Take the letter and the bag of medicines when you speak to either.

This guide is only about medicines, and only the first week (our discharge guide covers the rest of coming home). The problem is a paper bag of boxes, a letter in hospital shorthand, and a dosette box (a weekly pill organiser) filled before the stay that no longer matches.

Start with the discharge letter

The letter, or discharge summary, is the one document that explains what happened. NICE says it should give the current list of medicines and, for every change, what was started, stopped or altered and why. If no copy was handed over, ask the ward for one. Read it beside the bag, box by box: anything in one and not the other is a question for the pharmacist or GP practice.

How much medicine comes home varies. London North West University Healthcare NHS Trust, for example, says it usually supplies at least two weeks. Before leaving, ask the ward how long the supply will last and how the first repeat will be arranged.

The free NHS checks in the first weeks

The GP practice check. NICE recommends that the practice checks the discharge list against its own records as soon as practical, before a new prescription is issued, and within one week of receiving the discharge information. If the repeat list still shows a medicine the hospital stopped, ring the practice and ask for it to be checked.

The Discharge Medicines Service. Since 15 February 2021 this has been an essential service for community pharmacies in England. With the patient’s agreement, the hospital can send a referral to their nominated pharmacy. The pharmacy makes a first check within 72 hours of receiving it (not counting days it is closed), checks the first new prescription against the hospital’s changes, sorts out differences with the GP practice or hospital, and then talks the medicines through with the patient or carer. There is no published way for a family to refer themselves, so ask on the ward: “has a referral gone to Dad’s pharmacy?”

The New Medicine Service. If a newly prescribed medicine is for a condition on the NHS list, a participating pharmacy can offer free support, usually three conversations over several weeks, sometimes by phone. The list includes conditions such as high blood pressure, type 2 diabetes, asthma and COPD; the NHS page has the full list. Ask when collecting the medicine.

A structured medication review. GP practices offer these to people they prioritise, such as those on 10 or more medicines or with severe frailty who have recently been in hospital. There is no formal right to one, and it is unlikely to happen in the first week, but a stay that changed several medicines is a good reason to ask.

Five questions for the pharmacist

Take the letter, the bag and the old supply from the kitchen cupboard, and ask these in order.

• What has been stopped, and why? The old box is still in the cupboard and still looks like a medicine to take.
• What is new, what is it for, and how should it be taken? With food, at night, apart from another tablet. Is an unfamiliar name a brand of something already on the list?
• What has changed dose, and does the old strength go? Two strengths of one medicine side by side is how doubling up happens.
• Which medicines are current, and what do we do with the rest? Once the pharmacist or prescriber has confirmed a medicine is no longer needed, take it back to a pharmacy rather than putting it in the bin.
• When is the next review, and who does it? Pharmacy, GP practice or hospital clinic: write the date on the letter.

Blister packs: ask for an assessment, not a pack

Families often ask for a blister pack the week after discharge. NICE and CQC both say original packaging should usually come first, with a pack considered after a health professional has assessed a specific need. Some medicines are not stable out of their packaging, and a filled pack is hard to change when a dose changes, which is exactly what has just happened.

So ask for an assessment rather than a pack. A pharmacy must consider reasonable adjustments for a disabled person under the Equality Act 2010. Depending on the person, that might be a pack, a reminder chart, large-print labels, easy-open tops or an alarm.

Warning signs, and who to call

For new symptoms that are not an emergency, such as drowsiness, dizziness, sickness or a mild rash, call the GP practice or pharmacist the same day. A medicine change is one of several things they may consider. If the practice is closed, use NHS 111 by phone or online for urgent advice. If the person has run out of a regular repeat medicine, NHS 111 online can arrange an emergency supply; it is not the route for a new or unclear discharge medicine. Anyone, including a family carer, can report a suspected side effect to the MHRA’s Yellow Card scheme as well.

Some hospitals serving our five boroughs run medicines helplines for their own patients. Numbers were checked as published on each trust’s website.

Repeat prescriptions, costs and the NHS App

Ask the GP practice in good time to confirm the updated list and arrange the first repeat. Repeats usually need ordering up to 5 working days before they are due, and earlier before bank holidays, including Christmas and New Year.

Prescriptions in England are £9.90 an item. Many people get them free, including everyone aged 60 and over and people getting the guarantee part of Pension Credit; the NHS eligibility checker covers the rest. For people who pay, a prepayment certificate saves money at 4 or more items in 3 months (£32.05) or 12 or more in 12 months (£114.50).

A son or daughter can order and track repeats through the NHS App with family and carer access, provided both are registered at the same GP surgery; the surgery sets the level of access and asks for identification.

What a home care team adds in that first week

A carer who comes every morning sees the cupboard every day, which is often where discharge problems show first: the old blister pack with Tuesday still full, a new box with the seal unbroken, two strengths of the same tablet side by side. Marigold care workers are DBS-checked and trained to the Care Certificate standard, with unannounced spot checks by senior staff.

What a carer may do with medicines is set at the assessment and written in the care plan, as CQC expects: prompting (a reminder that it is time), assisting (opening a box or pack), or administering some or all of the medicines. We give only the support the plan describes and record it at each visit; families can see visit notes in the digital care record. If a dose is refused or a box does not match the letter, the carer reports it to the office and we contact the family. For a hospital discharge, call us and we visit within 2 hours.

Questions families ask

Can the pharmacist see what the hospital changed?

If the hospital sent a Discharge Medicines Service referral, the pharmacy receives the changes directly. Otherwise, bring the letter. With permission, the pharmacist may also be able to view GP records or ask the GP practice or hospital to clarify.

Who checks the list if no pharmacy referral was sent?

The GP practice. Once it has the discharge information, it should check the list against its own records. You can also take the letter to the pharmacy and ask them to look.

The GP’s repeat list still shows an old medicine. Who do I contact?

The GP practice. Ask for the list to be checked against the discharge letter before the next repeat is issued.

The new tablets do not match Mum’s dosette box. Who sorts that out?

The pharmacy that filled the box. Take the box, the bag and the letter in together and ask them to confirm which medicines are current and what to do with the existing pack. Do not refill it yourself from the hospital boxes.

Can a carer give Dad his tablets?

Yes, where that level of support is assessed and written into his care plan. A care worker may prompt, assist or administer, and records what they do each visit. They cannot change a dose or stop a medicine; that is for the prescriber responsible, such as the GP, a prescribing pharmacist or the hospital team.

What if a dose is missed in the first week?

Check the leaflet that came with that medicine, or ask the pharmacist. Do not take a double dose to catch up unless a prescriber says so.

Facts in this guide were checked against the sources below on 9 November 2026. It is general guidance, not advice about anyone’s own medicines; the pharmacist, GP practice or NHS 111 has the final word for an individual.