Pharmacists could abandon NMS over payments, experts warn

We have so far just missed "THE THRESHOLD" for being paid for NMS's every month in all of our branches. I know my team work hard to spot the right patients but we just don't seem to see enough of them. With out stating the obvious the contract was poorly negotiated with absolutely no foresight on the implications to those on the frontline. It's just another signature move by our negotiating team.

I have a dream that one day our PSNC Team will rise up and live out the true meaning of it's job role!!!

I think a Three step process is too time consuming, especially for patients. Therefore the NMS should be simplified to only two steps, an intervention and a follow up. Because from my experience two follow ups are regarded by patients as time consuming, tedious or simply makes some patients feel uncomfortable that you are trying to see them/ call them twice despite having already spoken to them once at the start.
However if the pharmacist feels that a third step is necessary ( which they may do in some instances) then an extra payment should be rewarded for a second follow up.

Sara (overdown pharmacy, tilehurst, reading)

Agreed, simplify the process by changing from three to two steps and also tier the payments to encourage more NMS deliveries whilst ensuring every single delivery is paid for. Don't take the figures literally but why not £20 for each NMS up to the 20% threshold, then £25 for each NMS from 21-40% threshold and £28 for 41% and over? Just a suggestion. This way even a few deliveries will garner a return for pharmacists making the effort whilst motivating pharmacies to really take the service to a higher level.

Has anyone else noted that the number of dispensed items being used to determine what NMS payments you receive is different to the total number of items that attracts a dispensing fee?
It seems that multiple fee items eg duopacks and methadone instalment scripts only count as one item for determining the NMS payments!
This caught me out and we slipped below to a lower threshold and consequently did not receive the full quota of fees we expected.
This cannot be allowed to go on, the lack of transparency and increasing beaurocracy ( have you sent your COC forms to the PCT yet stamped with prescriber and cost?) is compromising the service given to patients

Glyn

I certainly have worked hard to get more NMS done and only to find out that not quite sure what I am going to be paid. It is certainly making me think is it worth continuing as Salim said it like playing roulette not quite sure what we are going to be paid. I urge the PSNC to negotiate simpler payment structure and not complex once that has been agreed. If a new few structure is not agreed soon I will consider focusing on other areas of my business that will give a certainty in my return of my time invested providing support to my patients

Raj Radia

pharmacist sould be paid some amount as well for offering their time for MUR and NMS service.

On our already stressful day, including spending time chasing up medication shortages, the NMS is just NOT worth doing under the new guessing game payment structure. No other profession would settle for such a lousy deal!

More pressure, less money, can you imagine Nurses or Doctors, or ANY OTHER PROFESSION being put in this position. Our professional bodies give no value for money at all and as yet have not shown any work or results in our favour!! It may be a step forward in providing a clinical service, but should I be doubling my workload and stress levels and halving my income. What a load of rubbish!!! If I could afford to sell up and move into another profession, I would!

I was just thinking the same, unless payment is made more straight forward we will be concentrating on getting closer to our 400 target for MUR's and other services. NMS is a good idea just needs the rewards to be sorted.

As I have been emphasising, even before the NMS was implemented, we need absolute transparent system in order to make this system work for the betterment of all (specially the patients)

Why targets/ tiers, based on number of scripts being dispensed ?? Is it not a compromise/ cheating to refuse a patient the service just because you won't be able to acheive the target for payment. Also, it looks like PSNC and the DOH think we Pharmacists are some kind of mind readers, who can foresee how many new medicine scripts are going to come to them for a month. Ridiculous, can't they understand the basic ENGLISH meaning of NMS -- NEW MEDICINE SERVICE = a medicine being started for the first time = we don't know how many will have it in a month. Make it simple so we can provide the service to the fullest potential.

My suggestion -- Only 2 steps (as the consent signing can be clubbed as the intervention) with a gap of 7 - 14 days (thats when we know if the patient has any problem with the medicine) Devide the payment for each step and then award a single fee if both are acheived.

I was keen on this service at its outset, and I still think its an extremely valuable service that community pharmacy can deliver for the patients we serve.
But the structure and payment issues are going to undermine its delivery and if not addressed in the very near future, I can see the goodwill of the pharmacist evaporating and a minimalist approach being taken.

It will be interesting to see how the MUR performance of pharmacies changes in the light of this new service.

I think that the NMS will covert a lot of pharmacists to delivering the MUR service more actively.
Why do three times the amount of work, for an uncertain amount of pay, when your guaranteed £28 for a single MUR or tMUR?

Simples

i agree with Sara absolutely, 3 steps is one step too far,with the present 3-step process, patients have wondered why i shoul call them or speak with them a third time about the same thing especially when they have told you at intervention ie 7-14days after engagement, that they are doing fine. it's like we are pestering them. the present payment structure and process is like setting up pharmacist to fail in the first place, why didn't PSNC forsee this

...not to mention the time spent for finding best deal regarding specials, clarifying prescriber's intentions, endorsing certificates of compliance before sending them to appropriate PCTs, checking dossette boxes, challenging suppliers stock quotas and so on. And of course the end of month. I found it extremely ridiculous to segregate prescriptions according to doctors. Imagining how many more important things could be done instead.

I totally agree with this, we are really struggling to make the patient see the bennefit of the third visit. And has anyone else encountered the question of why we're duplicating what the GP is doing? Nearly every patient starting a BP med has wondered why they should come back to me in 14 days when the GP already has asked to see them then for exactly the same thing! We are struggling with the NMS and pushing for more MURs since we know what we're paid for them and that the effort is rewarded.

Sue Sharpe (PSNC) says '... To be clear, we need a simple payment structure that will motivate contractors to provide this valuable service to all eligible patients'.
Why was she not saying this when the NMS service was being developed during the negotiations???
Surely if she had sought the views or listened to the comments from grass-roots pharmacists she would have realsied what a mess the current payment structure is