Prompting, assisting or administering: helping a client with medication

The Care Quality Commission's guidance for home care providers describes medicines support in three practical forms: prompting or reminding people to take their medicines, helping them remove medicines from the packaging, and administering some or all of their medicines. The first two keep your client in charge of their own medicine. They decide to take it, and you make that easier. Administering is different: you take the dose out of its container and give it, so you are the one making sure it is the right medicine at the right time.

The detailed practice comes from NICE guideline NG67, published in 2017 for adults receiving social care in the community, and NICE guideline SC1, published in 2014 for care homes, which you will know if you have worked in one. Both are written for care services: they are addressed to providers and commissioners, and NG67 defines a care worker as somebody employed to provide care. Neither is written for a self-employed carer, but they are the standard a GP, a pharmacist or a family will measure your practice against.

NG67 sets out six rights of administration. Before you give a dose, check that it is the right person, the right medicine, the right route, the right dose and the right time, and respect the person's right to decline. NG67 adds that you should only give a medicine when there is authorisation and clear instructions, usually on the dispensing label, when all six rights are met, and when you have been trained and assessed as competent to give it. Before any dose, ask your client whether they have already taken it and check the written record.

Two rules catch carers out. NG67 says doses should be given straight from the container they were supplied in, and not left out for a client to take later unless that has been agreed after a risk assessment and written into the care plan. And a medicine prescribed "when required", such as a painkiller, needs written directions saying what it is for, the dose, the minimum time between doses and the maximum in a day. Without those, you are guessing.

What families are told about the same subject is on can a private carer give medication?, which is worth reading before a first visit, because it is what a careful family will ask you about. The carer resources hub has the rest of the guides on working safely, pay and tax.

NG67 calls this a medicines administration record, usually shortened to a MAR, and says it should ideally be a printed sheet from the supplying pharmacy. Ask your client's pharmacy whether they will print one. If they will not, a sheet you draw up yourself works, as long as it carries the details above and is copied from the labels.

The record belongs with your client. Keep it in their home, where a relative, a district nurse or another carer covering a visit can read it, rather than in your phone or your car. Your contract with each client asks you to keep what you learn about them confidential, except where the law requires it, for emergency medical care, or to give a substitute carer what they need to carry on safely. PrimeCarers does not keep, check or update care plans or clinical information between you and your client, so the record you keep in the home is the only one there is.

Where a family member gives a dose between your visits, agree with them how they will write it down, or you will have no way of telling whether a dose was missed.

The contract between you and each client on PrimeCarers says you will provide services with reasonable skill and care appropriate to your experience and qualifications, and will not undertake work you feel unqualified to perform. Where it applies, you inform the client so that alternative arrangements can be made. The carer terms say the same thing from the other side: you must not accept a contract that involves duties beyond your level of competence. The same contract says the client must not pressure you into providing a service you feel unable to provide safely.

So say which part you can do and which you cannot, and suggest who can: the GP practice for a district nursing referral, or the pharmacy for help simplifying the routine. Put what you agreed in a message on PrimeCarers, so there is a written note of it. A family may never have been told the difference between prompting and administering, and a clear explanation from you helps them arrange the rest.

Hiding medicine in food, which guidance calls covert administration, needs a particular mention because families sometimes ask for it in good faith. NG67 says care workers must not give medicines covertly, or decide to, without clear authorisation and instructions in line with the Mental Capacity Act 2005, which means an assessment of your client's capacity for that decision and a best interests decision involving the prescriber. Mental capacity in care: MCA and DoLS explains how those decisions are made.

1. 1

   A registered clinician decides the task can be delegated

   The clinician

   Usually the district or specialist nurse. NHS England's guidance says the decision should be made by a registered practitioner competent in the task and accountable for that part of the person's care. A relative or another carer cannot delegate it to you.
2. 2

   Your client agrees to it

   Your client

   NICE says the person, or somebody holding lasting power of attorney for them, must consent, and that everybody's responsibilities are agreed and recorded.
3. 3

   You are trained on this client and this equipment

   Training

   Skills for Care says training must be specific to the task and to the person, and should include a practical assessment, ideally where you normally work. A certificate from a general course does not replace it.
4. 4

   The clinician signs you off by name, and you sign too

   In writing

   Ask for the delegation in writing: the task, the limits, who to ring with a question or out of hours, and when your competence will be reviewed. Keep your own copy.
5. 5

   You do only what you were signed off for

   Ongoing

   If something comes up the training did not cover, stop and ring the clinician. Ask for refresher training before the review date passes, not after.

The national guidance is built around an employer. The delegated healthcare activities guiding principles from Skills for Care and the Department of Health and Social Care, first published in May 2023 and updated in November 2024, are written for care providers and individual employers. NHS England's guidance on delegating healthcare tasks to personal assistants gives the employer the job of checking that training has been signed off and of arranging insurance, and makes the employer responsible for the personal assistant's actions within their competence. As a self-employed carer taking a private client, you have no employer doing any of that.

That does not rule the task out, but it means the paperwork has to come to you directly. Have the delegation in writing from the clinician, naming you, before you do the task. Skills for Care's February 2026 short guide for care workers and personal assistants mentions self-employed personal assistants in particular: it says insurance needs to be extended to cover the specific delegated activity, and to check with your insurer before you start. The same guide says care workers are not required to carry out a delegated activity unless contractually obliged, and have the right to refuse. Some community nursing teams will decline to delegate to a carer who is not employed by a provider, which is a clinical decision they are entitled to make.

NHS England also says who answers for what afterwards. The clinician remains accountable for the decision to delegate. You are accountable for accepting the task, and responsible for what you do in carrying it out. Delegated healthcare tasks is what families are told about the same process, including which clinicians may delegate, and is useful to share with a family who has not been through it before. If the delegated task is insulin, supporting a client with diabetes covers the rest of the day around it, from meal timing to spotting a hypo.

When you know which of these tasks you are trained and signed off to do, you can register as a carer on PrimeCarers and set it out on your profile, or see the carer jobs open near you to judge what families are asking for.

The CQC's guidance on controlled drugs in home care, updated in January 2025, is written for registered providers, but the points above describe the law and the practical position in a person's own home. Beyond that, keep a running count of what is left each time you give a dose of a controlled drug and write it on the record. If a number ever does not add up, you can show when it changed, and you have something to take to the family and the GP.

If you think somebody in the household is taking your client's medicines, NG67 counts that as a concern to raise, and it is a safeguarding matter for the council or the police.

1. 1

   Check your client, and ring 999 if they are seriously unwell

   Straight away

   Signs of a life-threatening illness mean 999, not a callback.
2. 2

   Get clinical advice on what to do next

   The same visit

   Ring the pharmacy that supplied the medicine or the GP practice in working hours, or NHS 111 at any time. Have the pack and the record in front of you when you call.
3. 3

   Tell your client and the family what happened

   The same day

   Say plainly what was given, when, and what the advice was. They need to know even if no harm came of it.
4. 4

   Write it down factually

   Before you leave

   On the medicines record and in a note of your own: the time, what happened, who you rang, what they said and who you told.
5. 5

   Report a side effect or a safeguarding concern

   Where it applies

   Report a suspected side effect through the MHRA Yellow Card scheme. If you think your client has been harmed through neglect or somebody else's actions, contact the council's adult safeguarding team.

NICE's guidance treats medication errors and near misses as concerns to raise, not to keep quiet about, and for services it asks for a "fair blame" culture that encourages people to report them. As a self-employed carer there is no manager to report to, so the people who need to know are your client, the family and the clinicians. PrimeCarers does not supervise care and is not responsible for safeguarding during it. Under the contract, safeguarding concerns are dealt with between you and the client or reported to the statutory bodies. Safeguarding for self-employed carers explains how to report to the council.

If the routine has become too complicated, suggest the family ask the GP practice for a medicines review. If the task was one you were not confident with, stop doing it until you have been trained, and tell the client so. If you hold insurance, follow the policy's instructions on reporting an incident.