New Medicines Service (NMS)

1. New Medicines Service(NMS)

2. Background • There are approximately 15million people with a Long Term Condition (LTC) living in England. • Research carried out in 2004 indicates that: • At ten days 18% of patients with a LTC were completely non–adherent to a new medicine • 66% of the patients reported at least one problem or issue with their new medicine • Main reasons for intentional or non-intentional non-adherence were: • Side effects (50%) • Concerns about the medication (43%) • Difficulties with taking the tablets (7%)

3. Background • In 2006 a randomised controlled trial was carried out - patients were divided in an intervention group and a control group - Patients in the intervention group received a phone call at 2 weeks - A semi structured interview was offered enquiring about the medicine and offering information, advice or reassurance in response to patients needs • At 4 weeks the results for patients’ self-reported non-adherence was: - Intervention group 9% - Control group 16%

4. NHS Community Pharmacy Contractual Framework • Based on the results of the study and with the implementation on 1st October 2011the changes aim to: • Improve medicines non-adherence thus reducing treatment failure • Better utilise community pharmacy expertise • Contribute to the Quality, Innovation, Productivity and Prevention (QIPP) agenda • Provide value for money for the NHS • Three key changes: • New Medicines Service (NMS) • National target patient groups for MURs • Changes to clinical governance requirements

5. New Medicines Service (NMS) • New Advanced Service • To be provided for people with LTC with a newly prescribed medicine • Runs from 1st October 2011 to 31st March 2013 • Outcome evidence will inform future commissioning • Ultimate aim of the service is to improve non-adherence

6. Aims of NMS • Help patients and carers manage and make shared decisions about LTCs • Improve health outcomes • Contribute to QIPP - reduce medicines wastage • Reduce medicines related hospital admissions • Promote and support self-care of LTCs • Promote healthy lifestyle changes in people with LTCs • Improved pharmacovigilance • Appropriate signposting and referral • Promote multidisciplinary working • Recognise importance of the role of pharmacists

7. Outline of the NMS Service • Three main stages: • Patient engagement • Intervention • Follow up • LTCs included in the NMS are: • Asthma and COPD • Diabetes (Type 2) • Antiplatelet / anticoagulant therapy • Hypertension • Pharmacist to offer advice in line with Essential Service 4 – Promotion of Healthy Lifestyles (Public Health) at all stages of the NMS

8. Stage 1. Patient Engagement • Patient with LTC referred by prescriber to pharmacist or recruited by pharmacy • New medicine/medicines dispensed according to NHS Terms of Service • Initial advice about new medicine given by pharmacist and may also offer healthy lifestyle advice • Patient and pharmacist to agree method and time for intervention • Patient given information about service, and consents for information to be shared with GP, PCT and NHS BSA

9. Stage 2. Intervention • Patient and pharmacist to have discussion either face to face (in consultation area) or via telephone (7-14 days after stage 1) • If discussion does not take place, pharmacist to make at least one attempt to follow up • Patient consents to be sought to share information with GP, PCT, NHS BSA • If no patient consent no intervention • Pharmacist uses semi-structured interview technique to obtain information from patient e.g. adherence, need for support etc.

10. Stage 2. Intervention (cont.) • Pharmacist to agree ONEof these next steps with patient: • Patient adhering to treatment • Agree method and time of follow up with patient (14-21 days) • Problem identified • Agree solution with patient (e.g. reminder charts) • Agree method and time of follow up with patient (14-21 days) • Problem identified • Exit patient from NMS; or • Explain any potential clinical risk to patient and refer to GP • NMS completed – submit records for payment

11. Stage 3. Follow up • Patient and pharmacist to have discussion - if not, pharmacist to make at least one additional attempt to follow up • If unable to contact patient – service completed • Pharmacist to give advice and further support • Agree next steps: • Patient adhering to treatment – exit from service – NMS completed • Problem identified – refer back to prescriber for review – NMS completed • Patient not usually eligible for MUR within SIX months of completing NMS, unless in pharmacist’s professional opinion patient will benefit from MUR

12. Record-keeping • Requirements defined nationally • Includes: • Method of entry into NMS (referral or pharmacy recruitment) • Patient’s demographic details • Registered GP surgery • Details of new medicine(s) • Method of intervention and follow up • Outcomes of interventions, follow up and reasons for referrals

13. Data Collection for PCTs • Total number of patients exited NMS • Numbers of: • adherent patients exiting NMS • non-adherent patients referred to prescriber • patients exiting NMS because treatment stopped • patients lost at engagement, intervention and follow up stages • Patients offered opportunistic healthy living advice at engagement, intervention or follow up stages • Details of interventions / solutions agreed with patients at interventions stage

14. Pharmacist Requirements • PSNC to work with expert stakeholders to determine and confirm knowledge and skills required by pharmacists • No formal training and/or accreditation process for pharmacists • Only registered pharmacists to provide NMS

15. NMS and the medicines pathway

16. What is the NPA doing? • Working collaboratively with other pharmacy organisations to avoid duplication of effort • Influencing agenda on behalf of our members • Meeting with British Medical Association (BMA) • Working with patient groups to communicate the NMS • Developing support to ensure appropriate skill-mix for pharmacy team • Contributing to expert panel being set up to ensure skills required for undertaking the NMS are addressed

17. How can the NPA help you? • Semi-structured interview process guidance • Producing factsheets for frequently prescribed medicines for LTCs • Support for engagement with GPs • NPA appointment cards for intervention and follow up • Patient care cards • Consent forms • Record books • Referral / interventions books

18. Thank you!