Questions or comments on this presentation can be addressed to alastair.buxton@psnc.org.uk

You can pick and choose the elements of the presentation that suit the needs of your event / training session

Documents summarising NMS can be downloaded from the PSNC website, to use as speaking notes or as briefing material for contractors/LPC members

Last updated: 3rd October 2012

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The New Medicine Service (NMS)

NHS Community Pharmacy Contractual Framework

• Estimates vary on the frequency of non-adherence:– Between 33% and 50% of medicines for LTCs are not used as

recommended– 20-30% don’t adhere to regimens that are curative or relieve symptoms– 30-40% fail to follow regimens designed to prevent health problems

• It has been suggested that increasing the effectiveness of adherence interventions may have a far greater impact on the health of the population than any improvement in specific medical treatments

Haynes R, McDonald H, Garg A, Montague P. (2002). Interventions for helping patients to follow prescriptions for medications. The Cochrane Database of Systematic Reviews, 2, CD000011.

Background – non-adherence

• Research published in 2004 showed that 10 days after starting a new medicine:– 7% of patients had completely stopped taking the medicine (completely non-

adherent)– 30% of patients still taking the medicine were non-adherent– 45% of non-adherence was intentional (the remainder was unintentional)– 61% of patients expressed a substantial and sustained need for further information– 66% of patients still taking their medicine reported at least one problem with it:

• Side effects (50%)• Concerns about the medication (43%)• Difficulties with the practical aspects of taking the medication (7%)

Patients’ problems with new medication for chronic conditions. Barber N et al. Qual Saf Health Care 2004;13:172-175

Non-adherence to newly prescribed medicines

• Research was published in 2006 reporting on a randomised controlled trial (n=500) on which the NMS is based

• At 4-week follow-up, non-adherence was significantly lower in the intervention group compared to control (9% versus 16%, P = 0.032)

• The number of patients reporting medicine-related problems was significantly lower in the intervention group compared to the control (23% vs. 34%, P = 0.021)

• Intervention group patients also had more positive beliefs about their new medicine, as shown by their higher score on the ‘‘necessity-concerns differential’’ (5.0 vs. 3.5, P = 0.007)

Patient-centred advice is effective in improving adherence to medicines. Clifford S et al. Pharm World Sci 2006;28:165-170

The cost effectiveness of a telephone-based pharmacy advisory service to improve adherence to newly prescribed medicines. Elliott R A et al. Pharm World Sci 2008;30:17-23

The ‘NMS’ research

• It’s all about helping patients to get the most from their newly prescribed medicine

• Based on proof of concept research• Advanced service (time limited to March 2013)• Service will continue if it has demonstrated

value to the NHS• Provision commenced 1st October 2011

New Medicine Service

• PSNC and NHS Employers envisage that the successful implementation of NMS will:– improve patient adherence– increase patient engagement with their condition and medicines– reduce medicines wastage– reduce hospital admissions due to adverse events from medicines– lead to increased Yellow Card reporting– receive positive assessment from patients– improve the evidence base on the effectiveness of the service– support the development of outcome and/or quality measures for

community pharmacy

Benefits

• Up to £55m in both 2011/12 and 2012/13• 2011/12 – implementation payment (£750)

and target payments• 2012/13 – target payments• Target payments depend on the achievement

of activity thresholds which are related to prescription volume

Funding

Under the new payment structure contractors will be paid for full service interventions as outlined below:•All full service interventions provided by a contractor that fall below the 20% target will paid at £20 each•Once a contractor reaches the 20% target all full service interventions (including those which fall below the 20% target) will be paid at £25 each•Once a contractor reaches the 40% target all full service interventions (including those which fall below the 40% target) will be paid at £26 each•Once a contractor reaches the 60% target all full service interventions (including those which fall below the 60% target) will be paid at £27 each•Once a contractor reaches the 80% target all full service interventions (including those which fall below the 80% target) will be paid at £28 each

Funding

Volume of prescription items per month

Number of NMS completions per month necessary to achieve 20% target payment

Number of NMS completions per month necessary to achieve 40% target payment

Number of NMS completions per month necessary to achieve 60% target payment

Number of NMS completions per month necessary to achieve 80% target payment

0-1500 1 2 3 4

1501-2500 2 4 6 8

2501-3500 3 6 9 12

3501-4500 4 8 12 16

4501-5500 5 10 15 20

5501-6500 6 12 18 24

6501-7500 7 14 21 28

7501-8500 8 16 24 32

8501-9500 9 18 27 36

9501-10500 10 20 30 40

+1000 (+1) (+2) (+3) (+4)

Funding – target payments

• Three stage process1. Patient engagement (day 0)2. Intervention (approx. day 14)3. Follow up (approx. day 28)

• Opportunity to provide healthy living advice at each stage

NMS – outline service spec

Make sure you read the service

spec before providing NMS!

• Follows the prescribing of a new medicine for:₋ Asthma or COPD₋ Diabetes (Type 2)₋ Antiplatelet / Anticoagulant therapy₋ Hypertension

• Apply professional discretion where a formulation change occurs

• Recruitment by pharmacy or via referral• Dispense script and provide advice (as part of

Dispensing service)

NMS – Patient engagement

List ofmedicines at

www.psnc.org.uk/nms

– Provide patient with information on the service– Patient leaflet text – use of

this text is not mandatory

– Collect written patient consent

– Agree a method and time for the intervention (in 7-14 days)

NMS – Patient engagement

• Intervention typically day 7 – 14– Face to face in a consultation area or

over the phone– Semi-structured interview

technique to:• assess adherence• identify problems• identify the patient’s need for

further information and support

NMS – Intervention

Make sure you are aware of the

limitations of telephone

consultations

– Pharmacist provides advice and support• agrees follow up• agrees solution(s)• refers to GP (only where absolutely

necessary)• Make a record of the discussion using

the standard dataset• An NMS worksheet has been published to

help you make notes during the discussion

NMS – Intervention

• Follow up typically between 14 and 21 days after the Intervention– Face to face in a consultation area

or over the phone– Semi-structured interview

technique to:• assess adherence• identify problems• identify the patient’s need for

further information and support

NMS – Follow up

The Interview Schedule has been

developed to prompt a thorough

conversation with the patient

– Pharmacist provides advice and support• Patient adherent• Patient non-adherent

• refer to GP (using nationally agreed NMS Feedback form)

• provide more advice and support

• Make a record of the discussion using the standard dataset• An NMS worksheet has been

published to help you make notes during the discussion

NMS – Follow up

Only refer to the GP where absolutely necessary

• Pharmacies must have a consultation area that meets the requirements for the MUR service in order to provide the NMS

Premises requirements

• Patients are not usually eligible for an MUR within 6 months of receiving the NMS, unless in the pharmacist’s professional opinion the patient will benefit from an MUR

• A note of the reason for carrying out an MUR within 6 months should be made on the patient’s record

• There is no limit on the number of NMS a patient can receive in a year

MURs and NMS

• If a patient – does not attend the intervention or follow up – cannot be contacted on the phone at the agreed

timeThe pharmacy must attempt to contact them to

rearrange the appointment• The NMS is only ‘completed’ in certain circumstances• Only competed NMS can be claimed for

DNAs and completed NMS

NMS stage Patient action Pharmacy action NMS complete?

Recruitment Patient refuses offer of service - No

Intervention Patient does not attend appointment Pharmacy tries to contact patient at least once, but fails

No

Intervention Patient cannot be reached on the telephone at the agreed time

Pharmacy tries to contact patient at least one further time, but fails

No

Intervention Patient attends appointment and is taking multiple new medicines

Patient has a problem with one medicine which requires referral to the GP practice, but other medicines do not necessitate a referral. Patient continues to follow up stage

No

Intervention Patient attends appointment and is taking multiple new medicines

Patient has a problem with all medicines which requires referral to the GP practice

Yes

DNAs and completed NMS

DNAs and completed NMS

NMS stage Patient action Pharmacy action NMS complete?

Follow up Patient does not attend appointment Pharmacy tries to contact patient at least once, but fails

Yes

Follow up Patient cannot be reached on the telephone at the agreed time

Pharmacy tries to contact patient at least one further time, but fails

Yes

Follow up Patient attends appointment / telephone consultation

Patient has no problems with their medicines or is provided with further advice by the pharmacist

Yes

Follow up Patient attends appointment / telephone consultation

Patient has a problem with one or more new medicines which requires referral to the GP practice

Yes

• Pharmacists must complete and sign the NMS – self-assessment of readiness for community pharmacists

• There is no absolute requirement for training before providing NMS…

• …but pharmacists must ensure they have the requisite knowledge

Knowledge & skills for NMS

Make sure you record your NMS

related learning in your GPhC CPD

record

CPPE learning materials

Comprehensive review of the service

See what the service looks like

Practise the skills for the service

www.cppe.ac.uk/nmsOther training resources are listed on the PSNC website

• Pharmacy contractors or their representative must communicate with local GP Practices before providing NMS

• LPCs may support contractors with this task and may work with the Local Medical Committee

• A briefing document for GP Practice teams is available from the PSNC website

Communicating with GP practices

Don’t forget to talk to Practice Nurses as well

as GPs!

Communicating with GP practices

Available at www.cppe.ac.uk

• A standard dataset has been developed for NMS

• This supports data capture in a standardised manner, to support evaluation of the service

• A standard report can be requested by the PCT on a quarterly basis

Data capture and reporting to the PCT

PharmaBase will collate your NMS data and produce the quarterly PCT

report

• You must notify your PCT prior to providing the NMS

• The £750 implementation payment could be claimed once you had completed 6 NMS

• The target payments will be made by NHS Prescription Services. The number of completed NMS will be recorded on the FP34(C) at the end of each month

Claiming NMS payments

PCT notification form and Implementation Payment claim form - links on the PSNC

website

• The NMS module in PharmOutcomes supports contractors to provide the NMS service, including the following functionality:– patient registration– printing consent forms– scheduling interventions and follow ups using a

pharmacy calendar (which can also be used to manage appointments for other pharmacy services)

– printing a patient information leaflet and appointment reminder

– creating a task list of patient reminders to be provided prior to appointments

– recording the mandatory dataset for the intervention and follow up

– creating NMS Feedback forms to refer patients back to their GP practice

– an ‘NMS dashboard’ to allow the pharmacy team to keep track of their NMS activity during the month

– creating the quarterly reports for PCTs

PharmOutcomes support

• NMS will only be re-commissioned after March 2013 if the benefits of the service can be demonstrated

• The data collected via the NMS module in PharmOutcomes will support the evaluation of the service

• The Department of Health have selected Nottingham and UCL SoPs to evaluate NMS

Evaluation of NMS

• Read the service specification and the Directions• Read the PSNC/NHS Employers guidance• Read the CPPE open learning programme• Use the other CPPE and alternative learning

resources as needed• Attend a local workshop on NMS (where

available)

What do you need to do now?

• Complete the pharmacist self-assessment form and a CPD record or two…

• Develop an SOP (templates are available)• Train your pharmacy team on the service• With your support team, plan how the service

will operate in your pharmacy• Familiarise yourself with the data recording

requirements and paperwork

What do you need to do now?

• Discuss the service with your local GP practice teams (working with your LPC where appropriate)

• Familiarise yourself with the PharmOutcomes module

• Notify your PCT when you are ready to start providing the NMS

What do you need to do now?

PCT notification form can be

downloaded from www.psnc.org.uk

/nms

www.psnc.org.uk/nms

Questions & comments