New Medicine Service (NMS)

New Medicine Service (NMS)

The New Medicine Service (NMS) was the fourth Advanced Service to be added to the Community Pharmacy Contractual Framework (CPCF); 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 focused on specific patient groups and conditions.


Changes to the service in September 2021 

Changes to the NMS service have been agreed as part of the Year 3 5-year CPCF deal. In September 2021, the following changes will be implemented: 

  • Additional eligible conditions will be added to the service – see the Patients eligible for the service and the NMS medicines list section below for the details. The rationale for selection of the conditions mirrors that used in identifying the original four therapy areas/conditions: firstly, that there is evidence from research that adherence to medication in this condition could be improved and secondly that reviews of available research suggest these are areas where community pharmacists are best able to support improvements in patient understanding and adherence to treatments; 
  • The Directions now permit contractors who have received an exemption from the requirement to have a consultation room (due to their premises size) from their regional NHSE&I team to provide the service remotely or at the patient’s home. All other contractors providing the service can similarly continue to provide the service remotely, where appropriate, and in the patient’s home.
  • The cap on the number of NMS which can be provided by contractors will be increased from 0.5 percent to one percent of monthly prescription volume and additional bandings included; 
  • The opportunity for the service to offered to support parents/guardians/carers of children and adults newly prescribed eligible medicines who could benefit from the service, but where the patient is not able to provide informed consent; and 
  • A catch-up NMS is being introduced for 2021/22 to provide support to patients who were prescribed a new medicine during the COVID-19 pandemic but who did not receive the NMS at that time. This catch-up NMS will also support patients identified through the Pharmacy Quality Scheme who have missed inhaler technique checks to optimise use of their inhaler. 

Read the updated service specification and the Directions for further information on these changes.

Additionally, further therapeutic areas will be piloted through the Pharmacy Integration Fund to inform future expansion of the service, as part of a service model fully integrated with the wider Primary Care Network team. 


Click on a heading below for more information

Introduction

The policy context for the service

In England, around 15 million people have a long-term condition (LTC) and the optimal use of appropriately prescribed medicines is vital to the management of most LTCs. However, reviews conducted across different disease states and different countries are consistent in estimating that between 30 and 50 per cent of prescribed medicines are not taken as recommended. This represents a failure to translate the technological benefits of new medicines into health gain for individuals. Sub-optimal medicines use can lead to inadequate management of the LTC and a cost to the patient, the NHS and society.

It is therefore clear that non-adherence to appropriately prescribed medicines is a global health problem of major relevance to the NHS. It has been suggested that increasing the effectiveness of adherence interventions may have a far greater impact on the health of the population than any improvement in specific medical treatments.

Non-adherence is often a hidden problem, undisclosed by patients and unrecognised by prescribers. People make decisions about the medicines they are prescribed and whether they are going to take them very soon after being prescribed the new medicine.

Research has shown that pharmacists can successfully intervene when a medicine is newly prescribed, with repeated follow up in the short term, to increase effective medicine taking for the treatment of a long-term condition.

Service description

The service provides support to people who are newly prescribed a medicine to manage a long-term condition, which will generally help them to appropriately improve their medication adherence and enhance self-management of the LTC. Specific conditions/medicines are covered by the service, which are detailed below.

The service is split into three stages, which are:

  1. patient engagement;
  2. intervention; and
  3. follow up.

Patient engagement – Following the prescribing of a new medicine for the management of a LTC, patients will be recruited to the service by prescriber referral (which could include referral for medicines prescribed to the patient as a hospital inpatient or outpatient) or opportunistically by the community pharmacy staff.

The new medicine will be dispensed as usual, with the provision of advice about its use  and the patient will be offered the opportunity to use the NMS. Where there is acceptance of the offer, the pharmacy staff and patient will agree a method and time for the Intervention stage, typically between seven and 14 days after patient engagement.

Intervention – The pharmacist and patient will have a discussion either face-to-face in the pharmacy’s consultation room or alternatively via telephone or video consultation. The pharmacist will assess the patient’s adherence to the medicine(s), identify problems and determine the patient’s need for further information and support. The NMS intervention interview schedule will normally be used to guide this conversation.

The pharmacist will provide advice and further support and where no problems have been identified, will agree a time for the follow up stage, typically between 14 and 21 days after the intervention stage. This is similarly the case, where problems have been identified, but the pharmacist and patient have agreed actions which may address the issues, without the need to discuss these with the patient’s prescriber.

If problems are identified and it is the clinical judgement of the pharmacist that intervention by the patient’s prescriber is required, the issue will be referred to them to consider.

Follow up – The pharmacist and patient will again have a discussion either face-to-face in the pharmacy’s consultation room or alternatively via telephone or video consultation. The pharmacist will assess the patient’s adherence to the medicine(s), identify problems and determine the patient’s need for further information and support. The NMS follow up interview schedule will normally be used to guide this conversation. The pharmacist will provide advice and further support where necessary. If a problem is identified, the pharmacist and patients will either agree a solution or, where necessary, the patient will be referred to their prescriber to consider the matter.

All stages of the service provide an opportunity for healthy living advice to be provided, as appropriate to the individual.

The Directions and service specification

Amendments to the Pharmaceutical Services (Advanced and Enhanced Services) (England) Directions 2013 (updated 1st September 2021)
The Secretary of State Directions provide the legal basis for the provision of the service.

NMS service specification (Updated 1st September 2021)
The service specification describes the requirements for provision of the service and it is essential reading for all pharmacists providing the service. Changes were made to the service specification in late August 2021 in readiness for the service expansion and catch-up service introduction on 1st September 2021.

Before providing the NMS...

There are several requirements a contractor must comply with prior to providing the service:

1) They must be satisfactorily complying with their obligations under the Terms of Service in respect of the provision of Essential services and an acceptable system of clinical governance.

2) They must have a Standard Operating Procedure (SOP) in place for the service. A template SOP can be downloaded from the NPA website.

3) Pharmacists that will provide the service must have the necessary knowledge and skills to do so, with them assessing and declaring their competence by completing the NHS self-assessment form (see the next section).

4) Contractors are required to notify general practices within their locality of their intention to provide the service. This is to encourage effective partnership working between practices and pharmacies to ensure the service delivers good outcomes for patients.

5) The pharmacy must have a consultation room which complies with the following requirements:

  • it must be clearly designated as an area for confidential consultations;
  • it must be distinct from the general public areas of the pharmacy premises; and
  • it must be a room where both the person receiving services and the pharmacist providing those services are able to sit down together and talk at normal speaking volumes without being overheard by any other person (including pharmacy staff), other than a person whose presence the patient requests or consents to (such as a carer or chaperone).

Where pharmacy premises are too small for a consultation room to be included, the contractor must apply to their NHSE&I regional team to request an exemption from this requirement using the published form (NHS England – Pharmacy regulations guidance forms). NHSE&I will consider the information provided by the contractor and where it is of the opinion that the pharmacy is too small for a consultation room, it will confirm this with the contractor and grant an exemption.

The contractor must then ensure that they put arrangements in place at the pharmacy which enable staff and patients to communicate confidentially by telephone or another live audio link and a live video link.

Where NHSE&I have agreed an exemption from the requirement of a consultation room and the contractors has met the additional arrangements to facilitates confidential conversations with patients, then the contractor can instead provide the service remotely or in the patient’s home.

Contractors are advised to keep a copy of the NHSE&I decision confirming that the contractor is exempt from the requirement of having a consultation room on the premises.

Where NHSE&I are of the opinion that the pharmacy is not too small for a consultation room, the contractor will be advised of this and they will need to install a consultation room if they intend to provide the service.

6) Having met the above requirements, contractors must then inform their regional NHS England and NHS Improvement (NHSE&I) team of their intention to provide the service; this notification must be made using the NMS Pharmacy Contractor Declaration Form, which should be emailed to the regional NHSE&I team:

NMS Pharmacy Contractor Declaration Form (Microsoft Word)

NMS Pharmacy Contractor Declaration Form (PDF)

Pharmacist knowledge and skills requirements

Pharmacists must check they have the necessary knowledge and skills before they are able to provide the New Medicine Service (NMS).

To assess whether they have the necessary knowledge and skills, they are required to complete and sign the NMS self-assessment form.

NMS self-assessment form (June 2020) (Microsoft Word)

NMS self-assessment form (June 2020) (PDF)

The completed form should be retained by the pharmacy contractor.


Learning Materials

The Centre for Pharmacy Postgraduate Education (CPPE) has a range of NMS learning materials which are available to pharmacists to develop their knowledge and skills which can be accessed via the CPPE NMS gateway page.

Patients eligible for the service and the NMS medicines list

From 1st September 2021, the following conditions are covered by the service:

  1. Asthma and COPD: 
  2. Diabetes (Type 2); 
  3. Hypertension; 
  4. Hypercholesterolaemia; 
  5. Osteoporosis; 
  6. Gout; 
  7. Glaucoma; 
  8. Epilepsy; 
  9. Parkinson’s disease; 
  10. Urinary incontinence/retention; 
  11. Heart failure; 
  12. Acute coronary syndromes; 
  13. Atrial fibrillation;  
  14. Long term risks of venous thromboembolism/embolism;  
  15. Stroke / transient ischemic attack; and 
  16. Coronary heart disease 

The antiplatelet/anticoagulant therapy eligibility continues, but it is now included in the above list by reference to the underlying condition/reason for prescribing.

Download a list of the NMS conditions

The NHS Business Services Authority (NHSBSA) has published a list of medicines that are suitable for NMS.

If a patient has been newly prescribed one of these medicines, 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. 

It is not generally appropriate for the service to be provided where there has been a formulation change. The rationale for this is that a change from one solid dosage form to another is unlikely to present major clinical issues for a patient and hence provision of the NMS in such circumstances would not provide value to the NHS. 

However, there may be circumstances, where in the professional opinion of the pharmacist, they believe the patient would benefit from the provision of the NMS where they are moving from one formulation of a medicine to another (for example the prescribing of the same inhaled medicine, but in a different inhaler device from that previously used by the patient). 

Providing the service

Patient consent

Prior to provision of the service, verbal consent must be sought from the patient. In seeking consent, contractors need to ensure that the patient is made aware that the consent enables:

  • the provision of the service;
  • the sharing of information between the pharmacy and the patient’s general practice if needed, to enable the provision of appropriate care;
  • the sharing of information about the service with NHSE&I as part of service monitoring; and
  • the sharing of information about the service with NHSE&I and the NHS Business Services Authority (NHSBSA) as part of post-payment verification (PPV).

The General Pharmaceutical Council’s Guidance on Consent provides information on consent for pharmacists and their teams.


Information for patients on the service

The service specification requires information on the NMS to be given to the patient; this requirement may be fulfilled by providing a leaflet to the patient.

NMS patient leaflet (Microsoft Word)

NMS patient leaflet (PDF)

If an NMS item is dispensed for a patient, but the medicine is being delivered to the patient, or a representative is collecting the prescription, the following template leaflet may be used to offer the NMS to the patient:

Template NMS patient leaflet for use when the patient is not present in the pharmacy (Microsoft Word)

Template NMS patient leaflet for use when the patient is not present in the pharmacy (PDF)

Further guidance on creating your own patient communication materials can be found on the Communicating with patients page.


The consultations with the patient – using the NMS interview schedule

The NMS interview schedule should 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 helped to design it.

Interview schedule with notes

Interview schedule without notes


Referring patients to their general practice

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 GP Feedback form to communicate with the GP practice.

NMS GP Feedback Form (Microsoft Word)

NMS GP Feedback Form (PDF)

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 GP 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.

PSNC is sometimes contacted by contractors or LPCs because local GPs have queried the wording in the NMS Feedback form which puts the responsibility to follow up with the patient on the GP practice, rather than the patient being asked to make an appointment with their GP. The NMS Feedback Form was designed by PSNC, the GP Committee (GPC) of the British Medical Association and NHS Employers and the wording regarding referral back to the GP practice was proposed by the practising GPs representing the GPC.

The rationale for this approach is that it allows the GP practice to deal with the issue as they see fit, which may require an appointment with the patient’s usual GP, or it may involve another practice team member, such as a practice nurse, dealing with the query. It also provides flexibility for the GP practice to manage the issue by telephoning the patient if that is deemed an appropriate alternative to an appointment in the practice. The GPC view was that this approach provided more flexibility for practices to manage queries in the best way for their patients and using the full range of skills within their team, rather than requiring all queries to be dealt with via a face to face appointment with a GP.


Record keeping requirements

Pharmacists providing the service must make records to support ongoing provision of the service to patients, their future care and audit of the service. The records must be kept for at least two years from the date on which the service is completed or discontinued.

Contractors must also provide to the NHSBSA a summary of the NMS conducted on a quarterly basis; further information on this is provided in the section below.

The minimum requirements for record keeping are detailed in the service specification. If you do not have access to a computer in the consultation room, 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 then summarise your discussion with the patient (to support the creation of summary data for submission to the NHSBSA).

NMS Worksheet

Coding to be used to record the ethnic group of people


Working with PCN clinical pharmacists

The development of Primary Care Networks (PCNs) has resulted in the employment of clinical pharmacists within PCNs, based at general practices; in many cases the clinical pharmacist may be able to assist the community pharmacist and patient with the matter identified during the NMS.

NHS guidance for PCNs on the provision of Structured Medication Reviews includes referrals being made to the patient’s community pharmacy  for provision of the NMS.

The guidance outlines how PCNs should work with community pharmacies to connect patients appropriately to the NMS.

Catch-up NMS

The temporary introduction of catch-up NMS allows contractors to offer patients who were prescribed a new, eligible medicine (including from the expanded conditions) during the COVID-19 pandemic, but who did not receive the NMS at that time, additional support.

The catch-up service may be offered to eligible patients between 1st September 2021 and 31st March 2022.

Eligible patients must have:

  • Had a medication which falls into the eligible therapeutic categories newly prescribed between 1st April 2020 and 31st August 2021; and
  • Not previously received an NMS in respect of that prescribed medicine when it was originally prescribed.

Providing a catch-up service

Provision of a catch-up NMS will ordinarily follow the standard NMS path as described above, however, it is recognised that patients are likely to have started using the new medicine(s) and may have been established on the regimen for several months, so the timings of the different stages may be varied from the standard approach.

It is expected that in most cases the contactor will have dispensed the first prescription for the eligible medicine(s) at the point it was initially prescribed. However, it is recognised that the patient may have changed their community pharmacy since the medication was initially dispensed. Therefore, to provide a catch-up NMS the contractor does not have to have dispensed the first prescription, but the contractor should confirm with the patient that they have not previously received an NMS in respect of that medication.

The patient engagement and intervention stages of the NMS may occur simultaneously at the point the patient is identified or contacted by the pharmacy (for example, the pharmacy could identify suitable patients by a proactive review of their dispensing records or by making a check of the individual patient record when the medication is next dispensed by the pharmacy).

Additionally, if during the intervention stage it is identified that the patient has no issues with the prescribed medication requiring further follow-up, the pharmacist can document this in the clinical record and determine the NMS to be completed (and claimed for as such), without undertaking the follow up stage.

Submitting NMS summary data to the NHSBSA

Contractors must provide a summary of the NMS conducted on a quarterly basis to NHSE&I; this data is collected by the NHSBSA on behalf of NHSE&I.

The summary data, which is detailed in the service specification, is an extract of information from the clinical records of each NMS provided.

If a contractor normally provides NMS, but does not do so in a specific quarter, there is no requirement for the contractor to submit a ‘nil-return’ submission of data to the NHSBSA.

Contractors must submit the data to the NHSBSA within 10 working days from the last day of the quarter the data refers to (last day of June, September, December and March).

There are two ways to submit your data to the NHSBSA and contractors can choose which method to use (but most contractors find submitting data via the online form is the easiest approach):

  1. Online form
  2. Electronic Reporting Template

Further information and links to the online form and electronic reporting template can be found on the NHSBSA website.

Funding for the service and claiming payment

Contractors claim payments by stating on their monthly FP34C the number of completed NMS they have undertaken in a given month.

When is an NMS provision complete?

Read about the funding paid for provision of the service

Frequently Asked Questions

NMS statistics and evaluation

 



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