Transcript NMS presentation (September 2011)

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for contractors/LPC members
Last updated: 3rd October 2012
NHS Community Pharmacy
Contractual Framework
The New Medicine
Service (NMS)
Background – 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.
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 nonadherent)
– 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. Qual Saf Health
Care 2004;13:172-175
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
New Medicine Service
• It’s all about helping patients 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
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
improve the evidence base on the effectiveness of the service
support the development of outcome and/or quality measures for
community pharmacy
Funding
• Up to £55m in both 2011/12 and 2012/13
• 2011/12 – implementation payment (£750)
and target payments
• 2012/13 – target payments
• Target payments depend on the achievement
of activity thresholds which are related to
prescription volume
Funding
Under the new payment structure contractors will be paid for full service
interventions as outlined below:
• All full service interventions provided by a contractor that fall below the
20% target will paid at £20 each
• Once a contractor reaches the 20% target all full service interventions
(including those which fall below the 20% target) will be paid at £25 each
• Once a contractor reaches the 40% target all full service interventions
(including those which fall below the 40% target) will be paid at £26 each
• Once a contractor reaches the 60% target all full service interventions
(including those which fall below the 60% target) will be paid at £27 each
• Once a contractor reaches the 80% target all full service interventions
(including those which fall below the 80% target) will be paid at £28 each
Funding – target payments
Volume of prescription
items per month
Number of NMS
completions per month
necessary to achieve 20%
target payment
Number of NMS
completions per month
necessary to achieve 40%
target payment
Number of NMS
completions per month
necessary to achieve 60%
target payment
Number of NMS
completions per month
necessary to achieve 80%
target payment
0-1500
1
2
3
4
1501-2500
2
4
6
8
2501-3500
3
6
9
12
3501-4500
4
8
12
16
4501-5500
5
10
15
20
5501-6500
6
12
18
24
6501-7500
7
14
21
28
7501-8500
8
16
24
32
8501-9500
9
18
27
36
9501-10500
10
20
30
40
+1000
(+1)
(+2)
(+3)
(+4)
NMS – outline service spec
• Three stage process
1. Patient engagement (day 0)
2. Intervention (approx. day 14)
3. Follow up (approx. day 28)
• Opportunity to provide
healthy living advice at
each stage
Make sure you
read the service
spec before
providing NMS!
NMS – Patient engagement
• Follows the prescribing of a new medicine for:
₋
₋
₋
₋
Asthma or COPD
Diabetes (Type 2)
Antiplatelet / Anticoagulant therapy
Hypertension
List of
medicines at
www.psnc.org.uk/nms
• Apply professional discretion where a formulation
change occurs
• Recruitment by pharmacy or via referral
• Dispense script and provide advice (as part of
Dispensing service)
NMS – Patient engagement
– Provide patient with
information on the service
– Patient leaflet text – use of
this text is not mandatory
– Collect written patient
consent
– Agree a method and time
for the intervention (in 7-14
days)
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
Make sure you
are aware of the
limitations of
telephone
consultations
NMS – Intervention
– Pharmacist provides advice and
support
• agrees follow up
• agrees solution(s)
• refers to GP (only where absolutely
necessary)
• Make a record of the discussion
using the standard dataset
• An NMS worksheet has been published to
help you make notes during the discussion
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
The Interview
Schedule has been
developed to prompt
a thorough
conversation with the
patient
NMS – Follow up
– Pharmacist provides advice and support
• Patient adherent
• Patient non-adherent
• refer to GP (using nationally agreed
NMS Feedback form)
• provide more advice and support
• Make a record of the discussion
using the standard dataset
• An NMS worksheet has been
published to help you make notes
during the discussion
Only refer to the
GP where
absolutely
necessary
Premises requirements
• Pharmacies must have a
consultation area that
meets the requirements
for the MUR service in
order to provide the
NMS
MURs and NMS
• Patients are not usually eligible for an MUR within 6
months of receiving the NMS, unless in the
pharmacist’s professional opinion the patient will
benefit from an MUR
• A note of the reason for carrying out an MUR within
6 months should be made on the patient’s record
• There is no limit on the number of NMS a patient can
receive in a year
DNAs and completed NMS
• If a patient
– does not attend the intervention or follow up
– cannot be contacted on the phone at the agreed
time
The pharmacy must attempt to contact them to
rearrange the appointment
• The NMS is only ‘completed’ in certain circumstances
• Only competed NMS can be claimed for
DNAs and completed NMS
NMS stage
Patient action
Pharmacy action
NMS complete?
Recruitment
Patient refuses offer of service
-
No
Intervention
Patient does not attend appointment
Pharmacy tries to contact patient at least
once, but fails
No
Intervention
Patient cannot be reached on the
telephone at the agreed time
Pharmacy tries to contact patient at least
one further time, but fails
No
Intervention
Patient attends appointment and is
taking multiple new medicines
Patient has a problem with one medicine
which requires referral to the GP practice,
but other medicines do not necessitate a
referral. Patient continues to follow up
stage
No
Intervention
Patient attends appointment and is
taking multiple new medicines
Patient has a problem with all medicines
which requires referral to the GP practice
Yes
DNAs and completed NMS
NMS stage
Patient action
Pharmacy action
NMS complete?
Follow up
Patient does not attend appointment
Pharmacy tries to contact patient at
least once, but fails
Yes
Follow up
Patient cannot be reached on the
telephone at the agreed time
Pharmacy tries to contact patient at
least one further time, but fails
Yes
Follow up
Patient attends appointment /
telephone consultation
Patient has no problems with their
medicines or is provided with further
advice by the pharmacist
Yes
Follow up
Patient attends appointment /
telephone consultation
Patient has a problem with one or
more new medicines which requires
referral to the GP practice
Yes
Knowledge & skills for NMS
• Pharmacists must complete and
sign the NMS – self-assessment of
readiness for community
pharmacists
• There is no absolute requirement
for training before providing NMS…
• …but pharmacists must ensure they
have the requisite knowledge
Make sure you
record your NMS
related learning in
your GPhC CPD
record
CPPE learning materials
Comprehensive review
of the service
See what the service
looks like
Practise the skills for
the service
www.cppe.ac.uk/nms
Other training resources are listed on the PSNC website
Communicating with GP practices
• Pharmacy contractors or their
representative must
communicate with local GP
Practices before providing NMS
• LPCs may support contractors
with this task and may work
with the Local Medical
Committee
• A briefing document for GP
Practice teams is available from
the PSNC website
Don’t forget to
talk to Practice
Nurses as well
as GPs!
Communicating with GP practices
Available at
www.cppe.ac.uk
Data capture and reporting to the
PCT
• A standard dataset has been
developed for NMS
• This supports data capture in a
standardised manner, to support
evaluation of the service
• A standard report can be
requested by the PCT on a
quarterly basis
PharmaBase will
collate your NMS
data and produce
the quarterly PCT
report
Claiming NMS payments
• You must notify your PCT prior to providing
the NMS
• The £750 implementation payment could be
claimed once you had completed 6 NMS
• The target payments will be made by NHS
Prescription Services. The number of
completed NMS will be recorded on
the FP34(C) at the end of each month
PCT notification form
and Implementation
Payment claim form links on the PSNC
website
PharmOutcomes support
•
The NMS module in PharmOutcomes
supports contractors to provide the NMS
service, including the following functionality:
– patient registration
– printing consent forms
– scheduling interventions and follow ups using a
pharmacy calendar (which can also be used to
manage appointments for other pharmacy
services)
– printing a patient information leaflet and
appointment reminder
– creating a task list of patient reminders to be
provided prior to appointments
– recording the mandatory dataset for the
intervention and follow up
– creating NMS Feedback forms to refer patients
back to their GP practice
– an ‘NMS dashboard’ to allow the pharmacy team
to keep track of their NMS activity during the
month
– creating the quarterly reports for PCTs
Evaluation of NMS
• NMS will only be re-commissioned after
March 2013 if the benefits of the service can
be demonstrated
• The data collected via the NMS module in
PharmOutcomes will support the evaluation
of the service
• The Department of Health have selected
Nottingham and UCL SoPs to evaluate NMS
What do you need to do now?
• Read the service specification and the
Directions
• Read the PSNC/NHS Employers guidance
• Read the CPPE open learning programme
• Use the other CPPE and alternative learning
resources as needed
• Attend a local workshop on NMS (where
available)
What do you need to do now?
• Complete the pharmacist self-assessment form
and a CPD record or two…
• Develop an SOP (templates are available)
• Train your pharmacy team on the service
• With your support team, plan how the service
will operate in your pharmacy
• Familiarise yourself with the data recording
requirements and paperwork
What do you need to do now?
• Discuss the service with your local GP practice
teams (working with your LPC where
appropriate)
• Familiarise yourself with the PharmOutcomes
module
• Notify your PCT when you are ready to start
providing the NMS
PCT notification
form can be
downloaded from
www.psnc.org.uk/
nms
Questions & comments
www.psnc.org.uk/nms