NHS Community Pharmacy Contractual Framework

1. NHS Community Pharmacy Contractual Framework The New Medicine Service (NMS)

2. NHS Community Pharmacy Contractual Framework Why NMS and why engage?

3. Background – the problem • £100 billion plus spent on NHS England in 2009/10 • About 10% on medicines • QIPP challenge to improve quality whilst making £20 billion efficiency savings by 2014-15

4. Background – the problem • 15 million people have LTC – cannot be cured at present only managed by medication • Will increase over next 10 years • People with LTC use disproportionately more primary and secondary care

5. Background – the problem • Preventable medicines related hospital admissions represent 4-5% of all hospital admissions • Optimal use of medicines vital to self management of LTCs but 50% of medicines prescribed not used properly

6. Background – non-adherence • Sub optimal medicine use can lead to inadequate management of LTC and a cost to patient and the NHS • Adherence interventions may have a far greater impact on the health of the population than any improvement in specific medical treatments

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 • 30% of patients still taking the medicine were non-adherent • 45% of non-adherence was intentional

8. Non-adherence to newly prescribed medicines • Research published in 2004 showed that 10 days after starting a new medicine: • 61% of patients needed for substantially more 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%)

9. Policy options A) Do nothing B) Introduce an intervention • NMS for new medicines prescribed for a restricted number of LTCs, over an initial period of October 2011 to March 2013, as an Advanced Service in the Community Pharmacy Contractual Framework with a full evaluation

10. Policy options • Consistent with existing policy to increase patient access and value for money • Consistent with White Paper to expand role of pharmacist and optimise medicine use

11. Policy should • Help patients manage new medicines • Recognise importance and expanding role of pharmacist in medicine optimisation • Increase adherence and consequently reduce wastage • Promote multidisciplinary working • Opportunity for other advice to promote well being • Reduce hospital admissions and quality of life by increased adherence

12. 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 • The number of patients reporting medicine-related problems was significantly lower in the intervention group compared to the control

13. New Medicine Service • It’s all about helpingpatients to get the most from their newly prescribed medicine • Based on proof of concept research • Advanced service (time limited to March 2013) • Service will continue if it has demonstrated value to the NHS • Provision commenced 1st October 2011

14. New Medicine Service • Limited to asthma/CPPD, diabetes, Anticoag and hypertension as large demands on NHS and potentially significant improvements • Advanced so pharmacy has a choice and uncertainty about long term benefits • Evaluation

15. New Medicine Service success criteria Success if • Positive impact on adherence, understanding and outcomes • Positive impact on cost effectiveness • Positive feedback from patients and professionals • Development of interprofessional relationships

16. Funding • Up to £55m in both 2011/12 and 2012/13 • New funding • Not carried forward

17. Why it is important to provide NMS • Patient benefit at critical time • Longer term strategic benefit for pharmacy • Limited time to show value so important to get started in October • Significant income stream • Extension of what pharmacists do already

18. Support • Resources • Pharmacy organisations • CPPE • LPC- events, material, LMCs, local lobbying, local press

19. Other issues Potentially a stable environment to develop services such as NMS if proposals to change control of entry regulations come into force next year

20. Other issues New regulations: • Consultation until January with regs laid February • Existing test goes • If need based on PNA -must grant, or • Better access , choice, improvement to services, unforeseen benefit may grant

21. Other issues New regulations: • Exemptions all go including 100hr except one • Now Exceptions- distance selling but tighter controls • No right for 100hr to convert • Restore confidence

22. Other issues New regulations: • No longer neighbourhoods as will be based on PNAs • Relocations test : reloc ok if does not result in significant change in pharm services

23. Other issues New regulations: • New power to remove form list where quality criteria not met • Link to proposals on PSNC website

24. Latest information …. www.psnc.org.uk/nms