Pharmaceutical Services Negotiating Committee

NMS

The New Medicine Service (NMS) was the fourth Advanced Service to be added to the NHS community pharmacy contract; it commenced on 1st October 2011.

The service provides support for people with long-term conditions newly prescribed a medicine to help improve medicines adherence; it is initially focused on particular patient groups and conditions. The service is supported by a maximum investment of £55 million per annum in 2011/12 and 2012/13. The NMS is a time-limited service commissioned until March 2013; it will continue beyond this time if all parties agree that the service has provided demonstrable value to the NHS. PSNC and NHS Employers envisage that the successful implementation of NMS will:

improve patient adherence which will generally lead to better health outcomes
increase patient engagement with their condition and medicines, supporting patients in making decisions about their treatment and self-management
reduce medicines wastage
reduce hospital admissions due to adverse events from medicines
lead to increased Yellow Card reporting of adverse reactions to medicines by pharmacists and patients, thereby supporting improved pharmacovigilance
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.

Quick Links

Directions, Guidance and Service Specification	NMS PowerPoint presentation
Pharmacist self-assessment	Learning materials
Funding and claiming payment	PCT notification form
NMS Medicines List	Standard Operating Procedure
Interview schedules	Patient consent
Information for patients	Data requirements
NMS worksheets	NMS PharmaBase module
Communicating with GPs and referring patients	Relationship between NMS and MURs
Evaluation of the service	Underpinning research for NMS
Further resources (including FAQs)

Directions, Guidance and Service Specification

The legal basis for the service is provided by the Secretary of State Directions. The service specification provides a 'plain English' version of the Directions.

The Pharmaceutical Services (Advanced and Enhanced Services) (England) Directions 2011

Service specification for the NMS

PSNC and NHS Employers have produced detailed official Guidance on the NMS for pharmacy contractors, their staff and PCTs.

ESPLPS pharmacies and the NMS

Department of Health impact assessment on the introduction of the NMS

NMS PowerPoint presentation

PSNC has produced a PowerPoint presentation which may be used as part of training on the service or at local meetings arranged by LPCs and other organisations.

PSNC PowerPoint presentation on the NMS (27th November 2011)

PDF version of the presentation

Pharmacist knowledge and skills requirements

Before they are able to deliver the NMS, pharmacists must have the necessary skills and knowledge and are required to sign the NMS self-assessment form to declare this. The completed form should be kept as a record by the pharmacy contractor.

NMS self-assessment form (PDF version to be completed by hand)

NMS self-assessment form (Microsoft Word version to be completed electronically)

Learning materials

CPPE have developed a portfolio of learning opportunities for the NMS and other organisations are developing learning programmes and workshops to support pharmacists and their teams to implement the changes to the community pharmacy contract; click on the link below for more information.

Many LPCs are organising local training events - contact your LPC to ask them if they are providing any training opportunities.

NMS learning and training opportunities

Funding and claiming payment

Up to £55m will be made available for the NMS in both 2011/12 and 2012/13. In 2011/12, the funding structure for NMS is made up of a combination of a fixed implementation payment and target payments. The £750 implementation payment will help with set up, training associated with delivering the service, data collection and publicity costs. In 2012/13, the funding structure will comprise target payments only. The level of the target payments will depend on the achievement of activity thresholds which will be related to the prescription volume of the individual pharmacy.

Further details on the funding for the NMS

NMS funding structure - Concerns were raised with NHS Employers and PSNC about the payment structure that supports the recently introduced New Medicine Service in late November 2011. At that time PSNC obtained agreement from NHS Employers to look into the concerns raised as a matter of urgency. PSNC is continuing to press NHS Employers and the Department of Health to find a resolution to the problems contractors are experiencing. Commenting on the discussions, Sue Sharpe, CEO, PSNC said:

“We know that this needs to be resolved as quickly as possible to avoid tarnishing the success of the NMS; clearly it’s not acceptable for contractors to provide the service without being paid. We are in active discussions with NHS Employers and are pushing hard for an early and satisfactory resolution to the problem.”

In the meantime we would encourage contractors to deliver the NMS in order to support the development of the service and maximise the benefit to patients.

When is the NMS complete (and payment can be claimed)?

The implementation payment can be claimed by pharmacy contractors once they have met certain conditions. The claim must be made to the NHS Business Services Authority (NHS BSA) using the NMS Implementation Payment Claim Form. The final date for submitting this claim to the NHS BSA is 5 April 2012.

NMS Implementation Payment Claim Form (Microsoft Word)

NMS Implementation Payment Claim Form (PDF)

The NHS BSA will make target payments to pharmacy contractors based on their declaration of the number of completed NMS in a month. The FP34C submission document was revised by the NHS BSA and from October 2011 it contained a section where the number of NMS completed in the month can be declared. Pharmacy contractors should only declare the number of NMS completed in that submission month.

Notifying the PCT prior to providing the NMS

Before community pharmacies can begin providing the NMS they must inform the PCT of their intention to do so; this notification must be made using the NMS Pharmacy Contractor Declaration Form.

NMS Pharmacy Contractor Declaration Form (Microsoft Word e-form)

NMS Pharmacy Contractor Declaration Form (PDF)

Medicines List

Four conditions/therapy areas were selected to be included in the initial rollout of the NMS. These are:

asthma and COPD
type 2 diabetes
antiplatelet/anticoagulant therapy
hypertension

The rationale for selection of the therapy areas/conditions was twofold: first, the evidence from the original proof of concept research, and secondly on the basis that these are areas where community pharmacists are best able to demonstrate the value of the service.

For each therapy area/condition, a list of medicines has been agreed. If a patient is newly prescribed one of these medicines then they will be eligible to receive the service, subject to the pharmacist being able to determine that the medicine is being used to treat one of the above conditions in circumstances where a medicine can be used to treat multiple conditions.

New Medicine Service medicines list

Standard Operating Procedure

All pharmacies providing the NMS must have a Standard Operating Procedure (SOP) in place for the service. A template SOP can be downloaded from the NPA website.

Interview schedule

The group which developed the NMS self-assessment form also discussed the development of the NMS interview schedule. The interview schedule can be used by pharmacists to help shape the conversation they have with patients at the intervention and follow up stages of the service. The interview is based on the approach used in the proof of concept research and members of the original research team have helped to design it. It has been tested with other stakeholders.

Interview schedule with notes

Interview schedule without notes

Obtaining patient consent

The outline service specification for the NMS says that written consent needs to be obtained from patients. The wording of a consent declaration which must be used in any consent forms is detailed in the document below.

NMS and MUR patient consent requirements

PSNC template NMS and MUR consent form (to which a pharmacy address can be added) (Microsoft Word)

PSNC template NMS and MUR consent form (PDF)

Alternative consent form which allows the patient's ethnicity to be recorded:

PSNC template NMS and MUR consent form with ethnicity data collection (to which a pharmacy address can be added) (Microsoft Word)

PSNC template NMS amd MUR consent form with ethnicity data collection (PDF)

Information for patients on NMS

The outline service specification requires information on NMS to be given to the patient; this requirement may be fulfilled by providing a leaflet to the patient. PSNC and NHS Employers have developed text for use in a patient leaflet on NMS; its use is not a mandatory service requirement.

NMS patient leaflet (Microsoft Word)

NMS patient leaflet (PDF)

Royal Pharmaceutical Society NMS video for patients

Data requirements

The NMS data requirements have been determined along with the requirements for reporting information to PCTs; the requirements can be downloaded via the link below.

NMS record keeping requirements (updated 23rd September 2011)

NMS reporting template (for electronic submission to PCTs) (Microsoft Excel)

NMS reporting template (for electronic submission to PCTs) (OpenDocument spreadsheet)

This may be opened using the freely available OpenOffice software. To download this file, right click on the link and select 'Save target as...'. When the 'Save as' dialogue box opens choose a location to save the file to and ensure the documents name ends with the '.ods' suffix.

National standard codes to be used to record the ethnic group of patients

NMS Worksheets

The NMS PharmaBase module (see below) will allow you to record the mandatory NMS data for each patient. If you do not have access to a computer in the consultation area, or do not wish to use it during your discussion with the patient, the following NMS Worksheets can be used to record notes during the Intervention and Follow up stages of the service and code the discussion with the patient; the coded data can then be recorded on PharmaBase.

NMS Intervention Worksheet

NMS Follow Up Worksheet

NMS PharmaBase module

The NMS module in PharmaBase gives support to contractors in providing 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

The use of the module can also create a large dataset on the NMS which may be used as part of the academic evaluation of the service. Collation of this data is essential if community pharmacy is to be able to make the case for the ongoing commissioning of the service.

Communicating with GPs and referring patients

As part of delivering the NMS, pharmacy contractors or their representatives must contact local GP practices about the service. Local Pharmaceutical Committees (LPCs) and Local Medical Committees (LMCs) have a key role to play to make sure this process runs as smoothly as possible. PSNC has worked with NHS Employers and the GP Committee of the British Medical Association to develop a briefing document for GP practices on the changes to the pharmacy contract. This document can be used by LPCs and pharmacists/pharmacy contractors in local discussions with GPs and their teams.

Community Pharmacy Services - briefing for GP practices

PSNC PowerPoint presentation for briefing GP practices

PDF version of the presentation

CPPE NMS detailing card

Joint letter to LPCs and LMCs

There may be occasions during the provision of the NMS when pharmacists will need to refer patients to their GP, where an issue has arisen that cannot be solved by the pharmacist and patient. In these circumstances pharmacists can use the NMS Feedback form to communicate with the GP practice. The NMS module in PharmaBase allows pharmacists to produce completed NMS Feedback forms where appropriate.

NMS Feedback form (Microsoft Word e-form)

It is best practice to phone the GP practice where a referral is urgently required, following this up by sending a copy of the NMS Feedback form to the GP practice. Where the information to be fed back to the GP practice is less urgent, the form should be sent to the practice, with the patient being advised that the GP practice will contact them about the information in the NMS Feedback form where necessary.

Working with hospital colleagues

Guidance was published in January 2012 showing how NMS and post discharge Medicines Use Reviews (MURs) can be used to provide a seamless care pathway for patients who transfer from hospital to the community setting. It was developed and published by NHS Employers and PSNC working with a hospital and community pharmacy reference group. The guidance has been endorsed by the Royal Pharmaceutical Society.

Guidance for community pharmacy about engaging with hospital colleagues

Guidance for hospital colleagues about engaging with community pharmacy

Template national referral form

Template patient information leaflet

NHS Employers has produced a video about medicines reconciliation which follows the medicines pathway from a patient's point of view, demonstrating that both hospital and community pharmacists can work together to improve patients' understanding of their medicines:

NHS Employers video on medicines reconciliation

Relationship between the New Medicine Service and Medicines Use Reviews

NHS Employers and PSNC recognise it is important to explain the relationship between NMS and MURs. This is described in a document available below.

The relationship between the NMS and MURs

Evaluation of the service

The Department of Health has published an Invitation To Tender (ITT) in respect of evaluating the NMS. An announcement on which organisation has won the contract is expected shortly.

Download the ITT