To provide a clinical pharmacy service to wards as part of ward-based pharmacy teams. To promote the safe, rational and cost-effective use of medicines in accordance with the local formulary, clinical guidelines, procedures and policies To evaluate the clinical appropriateness, safety and legality of prescriptions based upon the patients health and other medication and treatments taken, working with the prescriber and medical team to make optimisation, as appropriate To work as an integrated member of the multidisciplinary team to optimise the use of patients medication. To undertake the medicines reconciliation process for patients admitted to the Trust, especially providing clinical expertise and guidance on the reasons for discrepancies in patients medication. To counsel patients and respond to patient queries regarding the medication they are taking. To support with the efficient discharge of patients, ensuring a care plan has been agreed with the patient on discharge