Transcript NMS presentation (September 2011)

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Questions or comments on this presentation can be
addressed to [email protected]
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
www.psnc.org.uk/pages/nms.html#referral
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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_profession
al_guides
Last updated: 26th November 2011
NHS Community Pharmacy
Contractual Framework
The NHS New Medicine
Service and targeted
MURs
Changes to the pharmacy contract
• The introduction of a New Medicine Service
(NMS)
• The introduction of nationally targeted
Medicines Use Reviews (MURs)
• Service changes were introduced on 1st Oct
2011
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.
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
• 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
Potential benefits
• PSNC and NHS Employers envisage that the
successful implementation of NMS will:
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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
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
NMS – Patient engagement
• Follows the prescribing of a new medicine for:
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Asthma or COPD
Diabetes (Type 2)
Antiplatelet / Anticoagulant therapy
Hypertension
• Recruitment by pharmacy or via referral
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)
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)
Premises requirements
• Pharmacies must have a
consultation area that
meets the requirements
for the MUR service in
order to provide the
NMS
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
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
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/GPswont-inundated-new-pharmacy-report-forms/
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.”
The RCGP viewpoint
Dr Clare Gerada, Chair of the Royal College
of General Practitioners
“Patients do sometimes experience
problems with their medicines and,
through the New Medicine Service, GPs
and pharmacists will work in partnership to
ensure those that need support receive it.
This will result in improving the care we
provide to our patients, and in turn our
patients’ health.”
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
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
Briefing documents
Briefing documents for GP Practice teams written by GPC /
PSNC / NHS Employers are available from the PSNC website
Working together…
Questions,
comments and
next steps