Medication Review and Optimisation To discuss medication issues with patients as needed and appropriate. To carry out medication reviews. To review and continue repeat medications for new patients who have just registered with the practice and PCN, and suggest GP medication review where appropriate. To discuss medication issues with patients as needed and appropriate by telephone, e.g. adverse effects/interactions, overdose/inadvertent ingestion, OTC remedies, queries from practice and PCN dispensary, queries from care homes. To respond to dispensary queries to include, re-authorise repeats where there are queries, clarify doses, clarify products, give appropriate alternatives when availability issues. To discuss specific patient and prescribing issues (e.g. complicated regimes/polypharmacy, compliance difficulties, multiple adverse effects, medication reduction regimes) with other clinicians as necessary. To support the completion of medication administration forms for district nurses for GPs to sign. Care Home Medication Reviews: Undertake clinical medication reviews with patients with multi-morbidity and poly-pharmacy and implement own prescribing changes (as an independent prescriber) and order relevant monitoring tests. Work with care home staff to improve safety of medicines ordering and administration. Long Term Condition Clinics According to experience and training. Hypertension (lifestyle advice and medication initiation and optimisation) Diabetes (joint clinic with practice nurse, with referral to GP/community diabetes nurse specialist/secondary care diabetes advice line) CHD (medicines optimisation, with referral to GP where necessary) Respiratory (advise practice nurse, including interpretation of spirometry) Chronic pain management (responding to patient or GP requests for review). Medicines Reconciliation To review secondary care requests for new medication (as communicated by discharge summaries, outpatient letters, etc.) and raise any queries with relevant GP, and discuss how to respond when inappropriate prescribing requests arise. To deal with anticoagulant start/stop requests from secondary care and contact patients who have defaulted on INRs. Unplanned Admission Prevention Devise and implement practice/PCN searches to identify cohorts of patients most likely to be at risk of an unplanned admission and readmissions from medicines. Work with case managers, multidisciplinary (health and social care) review teams, hospital colleagues and virtual ward teams to manage medicines. Put in place changes to reduce the prescribing of these medicines to high-risk patient groups.