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Uncertainty continues for NMS as NHS England awaits evaluation

Practice The new medicine service is expected to be extended temporarily for the fourth time at the end of the month while the results of a long-running Nottingham University study into the scheme are pending

NHS England will not grant the new medicine service (NMS) permanent status when the current interim position comes to an end in two weeks time, C+D has learned. Instead the service is expected to be extended on a temporary basis for the fourth time while NHS England awaits the results of a long-running study into the scheme. 

The NMS is expected to be extended temporarily for the fourth time at the end of the month

More on the future of the NMS

NMS interventions fall amid uncertainty over future

NMS granted third extension

Pharmacists must sell NMS beyond funding negotiations

NHS England has received the initial findings from the study, conducted by Nottingham University, but they would not be made public, it said. C+D understands that an announcement on whether the service will continue after March is due next Monday (March 17).

"Headline findings" had been sent to NHS England, with a full evaluation due to be submitted by the end of the month, University of Nottingham lecturer in pharmacy practice Matthew Boyd, who is leading the study, confirmed.

In March 2013, the deadline for the publication of the evaluation had been pushed back from summer last year because of difficulties recruiting patients. But since then the study had "stuck to target", with the last patient recruited in September, Mr Boyd told C+D.

"We have a deadline to report the evaluation by the end of March and then it goes out for academic review. Those academic reviewers may provide comments [or] disagree with what we've said, but the Department of Health thinks it will be ready for publication around the end of May," he added.

Mr Boyd was unable to indicate whether NHS England would wait for the study to be peer-reviewed before deciding whether to commission the service permanently.

In December, PSNC expressed concern that uncertainty about the long-term future of the service had resulted in a fall in interventions. There was a 13 per cent drop in payment claims between July and August following doubts over the future of the service, PSNC figures claimed.

PSNC told C+D last week it had been in discussions with NHS England about the future of the service based on initial findings from the evaluation and expected news "imminently". It continued to stress the need for contractors to have "clarity on the future of the service", it said. 

Do you think the NMS should be granted a temporary extension again?

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Meera Sharma, Community pharmacist

This service was a good concept, but poorly thought out & executed. Like the other readers I agree that it does not prove it's worth for patients. If we are looking for a service with substance, then patient outcomes has got to be a key measure.The current pharmacy framework does not have the scope to allow for this through capacity, process or joint-up working.The success stories are few and far between. Back to the drawing board and think it through considerably this time, to prevent exploitation of the service purely for targets and payments!

Darren Powell, Community pharmacist

I'm sure that if the outcomes of the service evaluation are poor then pharmacy will lose some face, but it will certainly lose the funding!

I was hoping that the service would be a stepping stone to its expansion or evolution in to more services, for example the inhaler technique service or the falls service in Doncaster.

I agree it has to have positive outcomes for the patient and the NHS, but once again, the engagement by some pharmacists has been poor and that will always set us up to fail.

I do hope that every pharmacist will contribute to the Call To Action and put their thoughts forward, regardless of your point of view, your contribution is needed.
Pharmacy needs to make itself heard

JINISH PATEL, Community pharmacist

NMS does work, if you get your whole team involved, I am not talking about just myself, we got area of 27 stores, all doing well with the service without any problems. It will be shame if we loose the service. NHS has moved lot of money from dispensing to services, if you want to keep your business running, we have to help ourself and get this service going.

Chris Pharmacist, Community pharmacist

Yes it is possible to do many NMS but the question is whether patients actually benefit from them. In my experience some do but the vast majority don't since they usually have follow-up appintments with their GP (for BP tests and monitoring)/asthma nurse for efficacy check.

We are merely duplicating work done by the surgery and in the main it is a waste of NHS resources. What we should be asking to do is for example the work that asthma nurses do, spirometry testing, routine inhaler technique monitoring. We are supposed to be experts in medicines yet asthma nurses do our job for us and get the money for it.

Having said that, anyone got time to do this? Not me.

JINISH PATEL, Community pharmacist

We tell our patients that, your appointment is after 1-2 weeks, if any problem in meanwhile get in touch with me, it does save my GP lot of time. We do intervention and follow up recording anyway for everything else that we don't get extra money for, trust me if you decide the work among your staff and you just do talking to patient , you can do more NMS in the same time as MUR. My patients and GP are
Impressed with us

Farmer Cyst, Community pharmacist

It sounds like you may be in a fortunate position where a G.P is happy to delegate some of his workload to you, and thus the service you provide is more useful. The NMS that most of us provide is merely a duplication of a consultation the patient will have in a week or two anyway. Except we're unable to change anything meaningful.

If Pharmacists WERE the follow up consultation I'm sure we'd all be embracing the opportunity. As it is we know the service as it stands isn't really helping anyone. We know we're wasting our time and doing it for the targets. It can't be any surprise the profession isn't enthused about it.

My local G.Ps seem to be very good at asking patients back for follow up appointments. So long as they continue to feel that they've got time to ask patients back in 3 weeks (often to hear everything is fine) I don't believe the NMS offers patients any benefit.

JINISH PATEL, Community pharmacist

Can we not support patients in case they have any problems for those three weeks before they can see the GP, trust me reassurance and extra information given to patients goes long way and I don't see GP having that much time, I did mention 26 other stores doing well so it has to do with individual pharmacist to get on with the service, forget the targets you talk about landing on moon, what did we get ?
Cure for chickenpox as they were determined to keep astronauts disease free in space !
There is lot of things you can do , help your GP to control cost, change in medicines, feedback about any costly prescribing alternative.
You can offer all the patients inhaler technique, stop smoking, healthy lifestyle list goes on...
We do more than 11000 items with just one pharmacist and no ACT open only for 5 days a week and I don't see any extra work, you just got to delegate it properly and stick to just what they can't do

London Locum, Locum pharmacist

Well done. You must feel really good getting a pat on the head from your friendly GP. Please! We need to get reid of this subservient attitude which afflicts Pharmacists as it is the main reason we are not respected by patients and other health professionals. And why Commissioners and our own representatives continually push for us to do more work for little or even nothing.

London Locum, Locum pharmacist

A tick box exercise already carried out by most GPs. A bone that was thrown to us to stop us yapping. Ridiculous payment system grudgingly amended

Clive Hodgson, Community pharmacist

If the NMS is discontinued after the next extension it will not look good for Pharmacy and any claim it may make to any further service provisions.

I don’t however think in this case Pharmacy should take the blame.

The individuals who designed the NMS and its original payment structure are the culprits methinks.

London Locum, Locum pharmacist

No it won't look good. But continuing with any poor, ill conceived service simply because it looks good is absolutely pathetic and demonstrates the dire straits we are in. Worse still is that this service led future as it stands is not financially viable hence why everyone is still prescription crazy because that is where the money is(dwindling I know). Our leaders simply need to grow some [email protected] and listen to independent contractors, employees and locums who can't afford to carry out some of these poorly thought out and badly renumerated loss leading services like the multiples.

Kevin Western, Community pharmacist

Pharmacy is continually refused services on the basis that we cannot demonstrate benefit. given the inability of NHSE etc to get any kind of result from this despite all the hoops we had to jump through to make it easier for them what hope does the profession have of ever proving a benefit from what we do

Clive Hodgson, Community pharmacist

I don’t think that the NMS was a particularly well conceived or designed service from its conception.

It launched with a crazy payment scheme (later amended) that more or less guaranteed Pharmacists would do work that they would not get paid for.

It also remains vulnerable to accusations that it merely duplicates the work done by GP/Surgery and even after all this time there is only anecdotal evidence of its worth to patients with the publication of evaluation results still pending.

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