Background and objective There is limited published data on coordinated care models focusing on addressing suboptimal medicines use, which not only leads to poor patient outcomes but also represents an unprecedented economic challenge. This paper describes the key components of a system-wide coordinated care model adopted by, and integral to, the Lewisham Integrated Medicines Optimisation Service (LIMOS).

Methods and results LIMOS consists of specialist pharmacy team members who rotate geographically between primary and secondary care organisations, accepting referrals from health and social care professionals within both settings. LIMOS provide a formal pathway for the referral of patients with medicines-related problems for assessment, support and follow-up to review access, adherence and clinical issues. An integrated and deliverable pharmaceutical care plan is developed and agreed with the patient and all involved in their care. Regular follow-up, by either phone or further visits to the patient's home, is provided after initial review to ensure interventions continue to meet individual needs. Outcome measures are being collated for service evaluation. Enablers underpinning successful service delivery include the ability to share information and refer across traditional boundaries to ensure that patient-centred care is delivered together with the implementation of a joint health and social care medicines policy.

Conclusions An approach addressing an identified gap in meeting the medicine support needs of the local population has been described. The essential components underpinning LIMOS should be explored by other health and social care organisations considering the establishment of a new, or development of an existing, medicines optimisation model.