Annie McGinley - Integrated Local Services - Specialist Pharmacist and Advanced Clinical Practitioner - GSTT @Home Team, Guys and St Thomas' NHS Foundation Trust, London, UK  -  13 May 2026

Hospital @Home sits at a unique junction of care — delivering acute, hospital-level treatment within a patient’s own home. It’s an exciting but complex setting, particularly when it comes to medicines management. I’m part of a small but dedicated pharmacy team within our @Home service, working with the wider multidisciplinary team to ensure medicines are managed safely and effectively throughout each patient's journey. 

Many of our patients are in that high-risk period following a recent hospital discharge. They’re often continuing their regular repeat prescriptions from their GP, but at the same time, they may be acutely unwell and need urgent changes to their medicines as part of their @Home care. The pharmacy team’s role is to bridge these transitions, not only by clinically reviewing medications as we would on a hospital ward, but also by anticipating the practical challenges that can arise when managing complex treatment regimens in a patient’s own home.

Much of my day involves virtual medication reviews; supporting the wider MDT with queries while they’re on home visits, screening charts for clinical appropriateness, identifying potential medication-related harm and opportunities for optimisation, and ensuring medicines are reconciled accurately. A significant part of this involves practical problem-solving: arranging supplies, advising on administration, liaising with community pharmacies, and helping patients safely manage medication changes.

Alongside this, I take part in nurse-led handovers and consultant-led MDMs, contributing to evidence-based prescribing decisions and supporting antimicrobial stewardship wherever possible. Most often I’m flagging that a patient has a blister pack — a recurring challenge in @Home. Many of our patients rely on blister packs, but adjusting these in response to acute illnesses such as an AKI or heart failure decompensation can be difficult. We're constantly considering how to facilitate safe, timely changes while also trying to minimise medicine waste. This is sometimes managed in liaison with community pharmacies, the patients or their families or directly by our team issuing a new prescription. Every patient’s setup is different, and often there’s no one-size-fits-all process. Needless to say, @Home pharmacists and blister packs have a complicated relationship!

As well as clinical responsibilities, I review drug expenditure, incident reports and safe and secure handling of medicines audit reports. We’re constantly striving to improve medicines safety within the service and working with the MDT to achieve this. I’m very lucky to have incredible pharmacists and medicines management pharmacy technicians to work alongside me in @Home and our wider integrated local services pharmacy team; all supporting each other and aware of the complexity and acuity of the patients we care for. 

When the workload allows, I also carry out home visits — an invaluable part of my role. These visits allow me to utilise my skills as a pharmacist and an advanced clinical practitioner. These visits are usually for specific patients from the caseload who have complex medication regimens or concerns about medication adherence and who also require a clinical assessment due to their acute illness. We’re in a very privileged position to visit patients in their own homes and truly understand how their medications fit into their lives and routines. 

The greatest joy of working in @Home is collaborating with the MDT, learning from the amazing professionals around me and solving problems together. Every decision we make reflects our shared priority of individualised, patient-centred care.