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NMS should follow MURs and be passed to GP pharmacists, academics say

Professor Elliott: The NMS should be expanded to include mental health medicines and statins
Professor Elliott: The NMS should be expanded to include mental health medicines and statins

The new medicine service (NMS) should follow medicines use reviews (MURs) and be “integrated” into “clinical” pharmacists’ roles, a group of academics has suggested.

As part of the funding contract for England, the Department of Health and Social Care (DH) announced that MURs will be phased out by April 2021 and replaced by “structured medication reviews” carried out by “clinical” pharmacists working in recently created primary care networks (PCNs).

In a study evaluating the NMS, published last month, academics from the Universities of Manchester, Nottingham, and University College London suggested this service should also be passed to GP pharmacists.

Rachel Elliott, professor of health economics at the University of Manchester and lead researcher of the study, said: “The NMS helps people when the medicine is started and some effect lasts for quite a long time. However, reviewing medicines-taking, for example every six months, is probably needed to continue the support patients need around taking medicines.

“We think clinical pharmacists, now often based in primary care doctor’s practices, may be able to integrate NMS and follow-up support into their role.”

As NHS England has proposed a “more appropriate clinical use of community pharmacy” as part of its long-term plan, it is “essential to examine how NMS integrates with these primary care service developments”, the academics added.

Expand NMS to cover mental health and statins

Professor Elliott suggested “mental health medicines, eyedrops and statins could be candidates for the NMS”, as these are “medicines which we know patients are less likely to adhere to”.

This is echoed the DH's own plans to expand the NMS as part of the five-year funding contract for England to include further conditions.

NMS saves NHS £651m

According to the academics’ analysis of the NMS since it was introduced in England in 2011, the NHS could save £651 million as a result of patients’ increased medicines adherence from using the advanced pharmacy service.

Pharmacies delivered around 5.7m NMS consultations between 2011 and 2018, with pharmacists following-up with patients taking a new medicine for: asthma and chronic obstructive pulmonary disease (COPD); type 2 diabetes; antiplatelet/anticoagulant therapy; and hypertension, the academics said.

“The cost to the NHS of paying community pharmacists to deliver NMS” – between £20 and £28 – “[is] absorbed by small reductions in other NHS contact-related costs”, the academics added.

Professor Elliott said: “The NMS workload had been absorbed into busy community pharmacists’ daily routines alongside existing responsibilities with no extra resources or evidence of reduction in other responsibilities.”

Professor Matthew Boyd, co-project lead from the University of Nottingham, said: “The way patients access healthcare is changing. [Our study] highlights the valuable contribution pharmacists make in protecting valuable NHS budget and improving outcomes for patients.”

20 Comments
Question: 
What conditions do you think should be included in the NMS?

Ben Merriman, Community pharmacist

If pharmacies are overworked/underfunded as implied by Prof. Elliot, why not pay them properly to do the services wanted, rather than a) slashing funding and b) adding more workload to an already creaking general practice sector?

Benie I, Locum pharmacist

Because curiously when they get given more money suddenly the workload becomes a lot more manageable and easier to cope with. Its amzaing really.

Oliver Staunton, Information Technology

So many angry pharmacists in the comments lol. This proposed change to NMS would be bad for pharmacy owners, but good for pharmacists and pharmacy in general. If you like doing clinical services and want a rewarding and well paid career, it looks like GP and PCN pharmacy is the way forward.

Independent Dave, Community pharmacist

Aha, one of the academics has appeared! How art thou squire? Yes, indeed, forcing the majority of family run independents down is good for everybody! How dare these owners get upset at what affects them and their patients directly. After all, working in a GP practice is always fun and roses, no stress at all. What’s that you say?.....a world where community and gp pharmacist co-exist to show their true worth and aim to reach the same/similar goals?...Fantasy I say, FANTASY! Divide and conquer, tis the best way....................no?

Oliver Staunton, Information Technology

Sadly I'm not an academic, but I am interested in patient care. Shifting NMS out of community pharmacy will likely be better for patients and more cost effective for the NHS. If anyone is to blame for that, it will be any unscrupulous contractors who decided that clinical services were actually revenue targets...

Ashley Cohen, Community pharmacist

GP QOF points, prescribing incentive schemes. I don't see the same argument when primary care tick box questionnaires to maximise "clinical / quality" payments.

Tom Kennedy, Pharmacy Area manager/ Operations Manager

Are you okay Dave?

Ashley Cohen, Community pharmacist

While your at it why don't we move the dispensing of medicines from community pharmacy to these new clinical GP pharmacist roles, followed by CPCS. This will give us sufficient time in our pharmacies to merchandise the shampoo and body wash sections.

Ben Merriman, Community pharmacist

You don't sell sandwiches? You're missing out there...

A B, Community pharmacist

Better still, get a Costa express machine installed and you'll have people queuing out of the door in no time 

C A, Community pharmacist

And they'll be happy when they are told it's only a 5 minute wait for their coffee 

Richard MacLeavy, Non Pharmacist Branch Manager

So much for the supposed service based contract! We will of lost 2 well funded and high volume services and in replacement got 1 service at half the funding which only comes into play on a saturday morning a couple of times a month.

Independent Dave, Community pharmacist

Is this a joke?? NMS is one of the most positive things I do in pharmacy. Probably about 70% of the time it genuinely makes a difference, and brings me closer to both patients and the community. Why would these guys suggest taking it away from us and further condemning our almost non-existent funding, not to mention, potentially further creating a divide between community and “clinical pharmacist” by taking from us and giving to them. Any funding should come from the GP budget. It’s just one thing after another, community pharmacy is silently and brutally being killed off, with little or no resistance. Things need to change, the system needs to change, we are worthless under the current conservatives!!

Rich S, Community pharmacist

Totally agree with this article...but funding should be provided as part of GP based budget and not taken from community pharmacy sector. Should also be a standardised way of determining 'value for money'. Would take away the target led initiatives seen in community pharmacy. 

C A, Community pharmacist

Great - lets take more money off community pharmacy, because Pharmacists love working with no support staff. 

Kevin Western, Community pharmacist

So someone please tell me, Are GP surgeries overworked or not? If they are this is madness, if they arent why are they whinging and being handed buckets of dosh? including the, if this goes ahead, money for a service that can be done just as well in community pharmacies, and if done properly actually saves them appointments? 

I wonder who sponsored the research, wouldnt be a GP organisation would it?

Oliver Staunton, Information Technology

Why do you think NMS can be done "just as well" in community pharmacy? Do you think most community pharmacists have undertaken postgrad pharmacy diplomas? Do you think they have better access to patient records and a better working relationship with the GPs responsible for the patients?

, Student

Then shouldn't there be a drive towards more funding towards:

1. Better information sharing between community pharmacy and GP

and

2. More funding for community pharmacists to have training (with adequate time)

A.S. Singh, Community pharmacist

The new medicine service (NMS) should follow medicines use reviews (MURs) and be “integrated” into “clinical” pharmacists’ roles.

Hold my tea!

D Change, Community pharmacist

Only if it's a masala tea. At which point you're at risk of having it drunk before you know it ! ...it's a dog eat dog world out there (as this article clearly hints)

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