Read and delete this slide…

1. Read and delete this slide… Questions or comments on this presentation can be addressed to alastair.buxton@psnc.org.uk You can pick and choose the elements of the presentation that suit the needs of your event / discussion with GP practice colleagues A document summarising the contract changes for GP practice teams can be downloaded from the PSNC website http://www.psnc.org.uk/data/files/PharmacyContract/Contract_changes_2011/GP_guide_to_contract_changes_Aug_2011.pdf

2. Read and delete this slide… A guide to MURs for GPs can be downloaded from http://www.psnc.org.uk/publications_detail.php/267/gp_guidance_on_murs Documents summarising the work of community pharmacy for GP practice teams (and a document describing GP practices for pharmacy teams) can be downloaded from the PSNC website http://www.psnc.org.uk/publications_detail.php/266/inter_professional_guides Last updated: 3rd September 2011

3. NHS Community Pharmacy Contractual Framework The NHS New Medicine Service and targeted MURs

4. Changes to the pharmacy contract • The introduction of a New Medicine Service (NMS) • The introduction of nationally targeted Medicines Use Reviews (MURs) • Service changes introduced from 1st Oct 2011

5. New Medicine Service • Provides early support to patients to maximise the benefits of prescribed medication • Proof of concept research shows that an intervention by a pharmacist can help to improve patients’ adherence • In the research patients who used the service experienced fewer medicines problems and made less use of other NHS services, saving money and GP time • The cost of the service is offset by savings created by community pharmacy medicines procurement

6. The challenge of non-adherence • Estimates vary on the frequency of non-adherence: • Between 33% and 50% of medicines for LTCs are not used as recommended • 20-30% don’t adhere to regimens that are curative or relieve symptoms • 30-40% fail to follow regimens designed to prevent health problems • 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 Haynes R, McDonald H, Garg A, Montague P. (2002). Interventions for helping patients to follow prescriptions for medications. The Cochrane Database of Systematic Reviews, 2, CD000011.

7. Non-adherence to newly prescribed medicines • Research published in 2004 showed that 10 days after starting a new medicine: • 7% of patients had completely stopped taking the medicine (completely non-adherent) • 30% of patients still taking the medicine were non-adherent • 45% of non-adherence was intentional (the remainder was unintentional) • 61% of patients expressed a substantial and sustained need for further information • 66% of patients still taking their medicine reported at least one problem with it: • Side effects (50%) • Concerns about the medication (43%) • Difficulties with the practical aspects of taking the medication (7%) Patients’ problems with new medication for chronic conditions. Barber N et al. QualSaf Health Care 2004;13:172-175

8. The ‘NMS’ research • Research was published in 2006 reporting on a randomised controlled trial (n=500) on which the NMS is based • At 4-week follow-up, non-adherence was significantly lower in the intervention group compared to control (9% versus 16%, P = 0.032) • The number of patients reporting medicine-related problems was significantly lower in the intervention group compared to the control (23% vs. 34%, P = 0.021) • Intervention group patients also had more positive beliefs about their new medicine, as shown by their higher score on the ‘‘necessity-concerns differential’’ (5.0 vs. 3.5, P = 0.007) Patient-centred advice is effective in improving adherence to medicines.  Clifford S et al. Pharm World Sci 2006;28:165-170 The cost effectiveness of a telephone-based pharmacy advisory service to improve adherence to newly prescribed medicines. Elliott R A et al. Pharm World Sci 2008;30:17-23

9. Potential benefits • PSNC and NHS Employers envisage that the successful implementation of NMS will: • improve patient adherence • increase patient engagement with their condition and medicines • reduce medicines wastage • reduce hospital admissions due to adverse events from medicines • lead to increased Yellow Card reporting • receive positive assessment from patients • support the development of outcome and/or quality measures for community pharmacy

10. The BMA viewpoint Laurence Buckman, Chairman of the GPC “If both professions can form stronger links it will benefit both them and their patients. LMCs and LPCs are ideally placed to make this happen.”

11. NMS – outline service spec • Three stage process • Patient engagement (day 0) • Intervention (approx. day 14) • Follow up (approx. day 28) • Opportunity to provide healthy living advice at each stage

12. NMS – Patient engagement • Follows the prescribing of a new medicine for: • Asthma or COPD • Diabetes (Type 2) • Antiplatelet / Anticoagulant therapy • Hypertension (but not where it is only a dosage or formulation change) • Recruitment by pharmacy or via referral

13. NMS – Intervention • Intervention typically day 7 – 14 • Face to face in a consultation area or over the phone • Semi-structured interview technique to: • assess adherence • identify problems • identify the patient’s need for further information and support • Pharmacist provides advice and support • agrees follow up • agrees solution(s) • refers to GP (only where absolutely necessary)

14. NMS – Follow up • Follow up typically between 14 and 21 days after the Intervention • Face to face in a consultation area or over the phone • Semi-structured interview technique to: • assess adherence • identify problems • identify the patient’s need for further information and support • Pharmacist provides advice and support • Patient adherent • Patient non-adherent • provide more advice and support or • refer to GP (using nationally agreed NMS Feedback form)

15. Referring to the GP practice • National NMS Feedback Form designed by GPC/PSNC/NHS Employers • Referrals will only be made when absolutely necessary • GPC advised that pharmacists should refer to the practice, rather than suggesting patients make an appointment with their GP • This approach allows the practice to determine how they want to deal with the issue raised in the Feedback Form

16. Referring to the GP practice GPs will also only be sent forms if an issue is identified that the GP needs to address, Dr Bill Beeby, chairman of the GPC clinical and prescribing committee, told GPonline.com. He said the final version of the form would be easy for GPs to gain information from and would improve patient safety. ‘The form will be on one side of paper,’ he said. ‘GPs won’t be inundated with non-reports.’ Reports would only be sent when the pharmacist identified an issue with a patient initiated on a medicine that the GP needed to deal with, he said. ‘For the vast majority you won’t get a piece of paper.’ http://www.gponline.com/News/article/1083644/GPs-wont-inundated-new-pharmacy-report-forms/

17. Targeted MURs • MURs aim to improve a patient’s knowledge, understanding and use of their medicines • From 1 October 2011 pharmacies must ensure that at least 50% of the MURs they provide are targeted on patients who: • are taking “high risk medicines” (diuretics, NSAIDs, antiplatelets and anticoagulants) • have been recently discharged from hospital with an amended medicines regimen. Ideally patients who are discharged from hospital will receive an MUR within four weeks of discharge but in certain circumstances the MUR can take place within eight weeks of discharge • have respiratory disease

18. Targeted MURs • As now, MURs will cover all the patient’s medicines not just those that fall within a target group • Pharmacists will still be able to provide MURs to patients who fall outside of the target groups who they think would benefit from the intervention

19. Briefing documents Briefing documents for GP Practice teams written by GPC / PSNC / NHS Employers are available from the PSNC website

20. Working together… Questions, comments and next steps