If the proof is in the pudding, then the newly released payment figures for the new medicine service (NMS) suggest that the advanced service's dessert is more soggy sponge than decadent gateau.

In the first month after the service launched in October 2011, just 2,557 – or 23 per cent – of pharmacies in England claimed payments for it. This is some 73 per cent fewer than the number of pharmacies who claimed for medicines use reviews (MURs) in 2010-11, and suggests that uptake was a long way from being as rapid as expected – in November, PSNC estimated that 70 per cent of pharmacies were ready to deliver the service. NMS activity levels varied significantly across the country, with contractors in north-east Lincolnshire managing just four completed interventions between them, while those in Hampshire clocked up 240 last October.

North East Essex PCT had an impressive uptake rate, with more than half its pharmacies carrying out the service in its first month, but this was in stark contrast to Torbay, where only 3 per cent – or one pharmacy out of its 39 – claimed for NMS interventions.

Perhaps predictably, the data also reveals that the big multiples made up the majority of pharmacies carrying out NMS interventions, accounting for about two thirds of all payment claims. Boots had the highest number of pharmacies carrying out the service, with 791 of their branches claiming NMS payments, followed by Lloydspharmacy with 555.

But more concerning than the variable and low average activity levels is the remuneration – or lack of it – that contractors received for their efforts. Criticism of the NMS banding payment structure, which many had misgivings about well before the service was launched in October 2011, appears to have considerable grounding, as the NHS payment data reveals that pharmacy businesses were paid for less than half of the interventions they carried out in the first month following the service's launch.

The banding payment structure for the service means that unless contractors meet specific targets for NMS interventions depending on the size of their businesses, they will not be paid at all for the service or will be paid less than the maximum £25 per intervention fee. And in October last year, contractors said they had completed 10,121 NMS interventions – but they were paid just £109,450 for those.

Taking the maximum intervention payment fee of £25, this means just 4,378 interventions – or 43 per cent of the total claimed for – were paid for in full. Across 15 PCTs, 334 interventions were completed and no payments made at all.

The proportion of interventions paid for also shows major differences between PCTs.
In Milton Keynes almost 85 per cent of interventions were paid for, giving a payment of £1,075 for 51 interventions – the equivalent of £21.08 per NMS intervention on average.

However, in Telford and Wrekin just one intervention of the 19 completed was paid for, giving a payment rate of just 5 per cent and an equivalent payment of £1.32 paid per intervention completed.

Pharmacies paid for just 43 per cent of NMS interventions in first month

LPC demands action on NMS payment structure Pharmacies paid for just 43 per cent of NMS interventions in first month More on NMS...

That payment levels could vary so much, with 5,743 interventions not paid for at all – meaning the sector missed out on £143,575 worth of funding despite having done the work for it – is simply not acceptable, contractors are agreed. Posting on C+D's website, pharmacists have threatened to abandon the service altogether until a solution is reached.
Criticism has also come from local pharmacy leaders, as Lancashire contractors branded the payment system "very poor" and the LPC demanded that PSNC review the service.

The LPC has written a letter to the negotiator warning that contractors' concerns must be addressed "speedily" and asking the committee to give "an indication" as to when the problems will be resolved.

PSNC head of NHS services Alastair Buxton confirms that the committee is in discussions with NHS Employers on the matter and is "pushing hard" to secure a solution "as quickly as possible", but no timescale has been given for the completion of these negotiations.

"Clearly it's not acceptable for contractors to provide the service without being paid," Mr Buxton says.

Unfortunately for the NMS, contractors may well agree. And, although the payment figures only reflect the first month of action for the NMS, it's clear that things are going to have to pick up – most likely through the introduction of a revised payment structure – if the service is going to prove a truly useful tool for pharmacists, their patients and the NHS.

NMS: the first month in figures

Interventions – the primary care trusts (PCTs) in which pharmacies claimed for the most and the least NMS interventions

The front-runners:
Hampshire: 240 interventions
Devon: 224
Surrey: 211

Bringing up the rear:
North East Lincolnshire: 4 interventions
Herefordshire: 5
Calderdale: 7

Activity – the PCTs in which the most and least pharmacies claimed for NMS interventions
The best take-up:
North East Essex: 54 per cent (28 out of 52 pharmacies)    
Isle of Wight: 40 per cent (12 out of 30)    
Barking and Dagenham: 39 per cent (14 out of 36)    

The slowest start:
Torbay: 3 per cent (one out of 39 pharmacies)
North East Lincolnshire: 9 per cent (three out of 35)
Westminster: 9 per cent (eight out of 92)

NMS spends – the trusts that paid out the highest and lowest total amounts for the NMS
The big spenders:
Devon: £2,825
Hampshire: £2,500
Redbridge: £2,375

The lowest payouts:
15 PCTs spent nothing on the NMS. They were:
Bassetlaw, Blackpool, Calderdale, Darlington, Hartlepool, Herefordshire, Kensington and Chelsea, Newcastle, North East Lincolnshire, North Lincolnshire, Redcar and Cleveland, Southampton City, Stockton-on-Tees, Sunderland, and Tameside and Glossop

The best payment rates – the PCTs in which the highest and lowest fees were paid per intervention on average (excluding PCTs that paid nothing)
 The best payment rates:
Milton Keynes: £21.08 per intervention
Islington: £20.83
City and Hackney: £20.51

The worst underpayments:
1. Telford and Wrekin: £1.32 per intervention
2. Hull: £1.61
3. Bath and North East Somerset: £2.27

Source: NHS PS monthly payment data for the NMS; all figures are for October 2011

Your Shout

"Hardly surprising given the combination of a crazy payment structure and the fact that most pharmacies are already working to capacity with the essential dispensing service with no spare resources to devote to the NMS."
Clive Hodgson, community pharmacist

"I know it's early days, but if that figure remains, then the service will be unsustainable. I know we have to find efficiency savings across the NHS, but 43 per cent is ridiculous!"
Pillman UK, community pharmacist

"I have stopped doing the NMS until the farce over payments is sorted. No point stressing and wasting time to guess what, if any, payment will be made. I'm sure I'm not the only one!"
Anant Bhogaita, locum pharmacist

"The NMS is a brilliant service, but the payment structure is absolutely dreadful. PSNC and NHS Employers need to get this sorted out otherwise it will be a pointless service."
Raj Radia, superintendent,Spring Pharmacy

Comments posted on chemistanddruggist.co.uk

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