Precision in Practice: Perfecting Medicines Ordering in Primary Care (2025)

NHS Shropshire, Telford & Wrekin ICB

Project summary

Medicines ordering in care settings - for example care homes and in some cases home care and supported living - presents significant challenges due to the complex collaboration required across multiple organisations.  Differences in understanding around the four-week ordering cycle, the need to order ad-hoc/out of cycle items and medicines reconcilliation, particularly between care setting staff, GP practices, and pharmacy teams, often lead to miscommunication, inefficiencies, and potential risks to patient care. 

We began our project by involving all parties who are involved in the ordering process to consider whether training on this issue may have value.  We conducted a study in the form of a questionnaire and sent out to 180 care settings, 50 GP practices and 80 pharmacies.  We took into account that we were sending this at a busy time while services were under considerable pressure, however were pleased that the questionnaire was completed by:

• 17 care home staff
• 13 staff from general practice
• 3 staff from community pharmacy
• 4 staff from a home care provider
• 1 other

Survey Results 

1. Do you feel an education package would support the understanding of the care setting ordering process in any of the following groups?

• Care setting staff
• General Practice administration staff
• GPs
• Pharmacy staff

2. Of the 46 responses, 22 felt it would be useful for care setting staff, 6 for general practice administration teams, 1 for GPs, 5 for pharmacy staff, 3 didn’t feel it would be useful and 9 were unsure.

Do you feel there needs to be improvement in communication between Care Settings, Primary Care/General Practice and Community Pharmacy to support effecive medicines ordering?
Of the 46 responses, 44 (96%) felt there did need to be improvement in communication, 1 did not and 1 was unsure.
The results of our survey confirmed that there was room for improvement and this could be driven by a comprehensive cross-sector training programme aimed at building a common understanding. We set about develipong training with the following learning outcomes:

• Describe the four-week medication cycle used in care homes
• State 3 circumstances for synchronising medicines for care home individuals
• Explain why it is important to have an effective communication process 
• Relate the “three-word” process necessary for medicines reconciliation 
• List the responsibilities of care homes to support an effective four-week medication cycle

We did this by by bringing together professionals from care homes, general practices, and pharmacies.  The training focused on clarifying roles, sharing perspectives, and addressing the practical challenges each setting faces. This collaborative approach has laid the foundation for safer, more efficient medicines management.
The project delivered a practical, innovative training package to clarify the complexities around how medicines are ordered in care homes; often missed as being a valuable driver of patient safety, prescribing quality, and a way of optimising valuable staff time.
Working in partnership with care home staff, pharmacy teams and GP practice teams, we developed and delivered a structured training programme that streamined understanding and provided clarity on the medicines ordering cycle with a view to reducing waste medicines and ensuring timely access to the right medication.
The training included real-life scenarios, visual tools and step-by-step instructions within its content to build confidence and accountability across primary care. By focusing on improving the understanding of the whole medicines cycle from ordering, prescribing, dispensing and administration, we improved knowledge and understanding and empowered staff as well as enhanced working relationships between care home staff, pharmacy teams and GP practice staff.  
This targeted, cross-sector training initiative has demonstrated a strong potential return on investment. By improving collaboration and clarity around the medicines cycle, the programme has the potential to reduce medication waste. Better understanding of the four-week prescribing and ordering process has also helped reduce confusion, last-minute prescription requests and unnecessary pressure on clinical and administrative teams. The training has promoted more consistent and proactive communication between care home staff, pharmacy teams, and GP practices by streamlining processes and reducing inefficiencies.  While formal evaluation is ongoing, the programme has clearly enhanced staff confidence, improved working relationships, and fostered a more collaborative approach to medicines management. These outcomes reflect the value of investing in practical training that not only supports safer prescribing and timely access to medicines but also maximises use of existing resources across sectors. The model offers a transferable, adaptable, cost-effective approach for other areas wishing to improve patient safety and operational efficiency in care home settings.