Can the NMS be provided in the patient's home?
No, the Pharmaceutical Services (Advanced and Enhanced Services) (England) Directions 2013 (hereafter known as the 2013 directions) only permit the NMS to be provided in a consultation area in the pharmacy or over the phone.
Can the NMS be provided to a carer, rather than the patient?
No. One of the key aims of the NMS is to encourage appropriate adherence to the new medication. Some patients who receive the service may be intentionally non-adherent. Therefore, the conversation should be between the pharmacist and the patient to encourage a change in medicines taking behaviour.
Can the NMS be provided to a patient in a care home?
Yes. Patients in care homes have the same entitlement to take responsibility for their own treatment as they would in their own home, unless they are incapable of doing so. If a patient in a care home is prescribed an NMS medicine for the first time, then they are just as likely to face the issues with their medicines as patients in their own homes, and so should be able to benefit from the NMS. If the patient is not able to access the pharmacy arrangements would need to be made for the consent form to be signed by the patient and returned to the pharmacy, and the intervention and follow-up stages would need to be undertaken by phone.
Can a ‘Special’ medicine that contains one of the active ingredients listed in the NMS medicines list trigger the provision of the NMS?
Yes, if the active ingredient is in a British National Formulary (BNF) category listed in the NMS medicines list and a special is prescribed containing that active ingredient, it can trigger provision of the NMS, as long as the pharmacist can ascertain that the special is being prescribed for one of the NMS target conditions.
How long should the NMS records be retained by the pharmacy?
The 2013 Directions require that NMS records are retained for two years following the conclusion of the individual instance of the service.
How long should patient consent forms for the NMS and MUR be retained by the pharmacy?
The 2013 Directions do not state how long they should be retained. It is recommended that the consent forms should be retained for two years from the time of provision of the service, in line with the requirement for retention of NMS records. Pharmacies can retain electronic copies of the consent forms if they wish, i.e. scanning and storing images of the completed forms. However they are stored, community pharmacies must ensure they meet the requirements of the information governance programme in Schedule 4, part 4, paragraph 28 (2) (f) of the National Health Service (Pharmaceutical and Local Pharmaceutical Services) Regulations 2013 (hereafter known as the 2013 Regulations). It is recommended that any hard copies of forms are stored at the community pharmacy where the patient receives the service.
What should I do if a carer or relative picks up a new medicine for a patient who is eligible for the NMS?
Explain about the service to the representative so they can pass on information to the patient. You may want to give the representative a leaflet on the service and a consent form to take to the patient. It may be necessary to speak to the patient on the phone to provide essential information on their new medicine. You may then be able to explain about the NMS and get the patient’s verbal consent to use the service. Confirmatory written consent should then be obtained prior to provision of the intervention.
What should I do if we deliver prescriptions to a patient’s home and the patient may be eligible for the NMS?
It may be necessary to speak to the patient on the phone to provide essential information on their new medicine. You may then be able to explain about the NMS and get the patient’s verbal consent to use the service. Confirmatory written consent (using the agreed wording) should then be obtained prior to provision of the intervention.
Can I provide the NMS to a child? (Is there a minimum age for provision of the NMS?)
You can provide the service to a child, provided that they are competent to give consent a) to receive the service and b) for information to be shared as required by the consent arrangements. There is no minimum age, but pharmacists will know that the younger the child, the greater the likelihood is that they would not be competent.
Can I provide the NMS to a non-competent child or adult?
No. The patient (of any age) must be competent to give consent to receive the service and for information to be shared, as required by the consent arrangements in order to be eligible to receive the service.
Can I develop my own patient leaflet for the NMS?
Yes, but any leaflet should ideally cover the consent arrangements for the service. NHS Employers and PSNC have published suggested text which can be used in patient leaflets, but its use is not mandatory.
Can pharmacy logos, or other additions or alterations be made to the NMS Feedback Form?
No. The NMS feedback to GP form is approved by the Secretary of State and must be used, where necessary, to communicate with GPs.
Can we use the NHS logo on our patient leaflet for NMS?
No. The NHS logo is a trademark and must only be used in line with the guidelines on its use by community pharmacies. These guidelines (available at www.nhsidentity.nhs.uk) do not permit the use of the NHS logo on pharmacy advertising, including leaflets (special rules apply to the pharmacy practice leaflet).
The service specification says that the intervention should take place ‘typically 7 to 14 days after patient recruitment’ and the follow up ‘typically between 14 and 21 days after the intervention’. How rigidly should these timings be applied?
Pharmacists should exercise professional judgment in order to determine whether it is appropriate for a patient to have the intervention or follow up outside the timings indicated above. The Directions allow for flexibility in the timing, but pharmacists should be cognisant of the underlying aim of the service which is to provide support to patients in the first few weeks after the prescribing of a new medicine.
A patient has their new medicine dispensed in hospital but is not referred to the NMS. They have subsequently been given another prescription for the same new medicine by their GP; do they still qualify for NMS if it is the first time they present the prescription in a community pharmacy?
No. The patient would be ineligible to receive the NMS as their new medicine has already been dispensed for the first time in hospital and they were not referred to the community pharmacy at this time.
If a patient gets a new medicine dispensed at a pharmacy that does not offer the NMS, but then requests the service from another pharmacy, can the second pharmacy provide the service?
Can NMS only be offered on NHS prescriptions issued by GPs in England?
No. The NMS can be offered to any patient presenting a valid NHS prescription for a medicine on the approved list of medicines.
Could GPs use a stamp or sticker on a prescription to indicate that the medicine was new to the patient?
Anything stamped on a prescription has a risk of adversely impacting on the accuracy of the optical character recognition (OCR) prescription pricing system used by the NHS Business Services Authority (BSA). As a consequence of this risk, it is recommended that such an approach should not be used to highlight patients who may benefit from the NMS. GPs could instead give the patient a leaflet about the service.
Can a different pharmacy complete the intervention and / or follow up from the one which undertook the patient engagement?
Does a pharmacy contractor have to send NHS England a copy of the completed pharmacist self-assessment form for all the pharmacists that will provide the NMS at the pharmacy?
No. The pharmacy contractor just needs to keep a copy of the completed forms on file.
The pharmacist has to have an MUR certificate in order to be able to provide the NMS; does a pharmacy contractor have to send NHS England a copy of the pharmacist’s MUR certificate?
No. The pharmacy contractor just needs to keep a copy of the certificate on file. If, however, the pharmacist might undertake MUR consultations for the pharmacy, then the pharmacy contractor should send a copy of the MUR certificate to NHS England as required in the MUR service specification.
Does a new patient consent form need to be completed every time a patient receives the NMS?
Does the patient have to have been using the pharmacy for a certain period of time in order for them to be eligible to receive the service?
Can dispensing doctors refer their patients to a pharmacy to receive the NMS?
Such a referral would only be valid if the new medicine was prescribed on an FP10 which was dispensed by the pharmacy.
If a patient hands in a prescription for a new medicine and then doesn’t collect the dispensed script for a few days, when should the intervention take place?
The timing of the intervention should be assessed based on the point at which the patient receives their dispensed medicine.
If a patient is recruited in one month, but the intervention and / or follow up are provided in the second month, when should the payment claim be made?
An NMS episode can straddle two months, or in some exceptional cases, three months. The claim should be made in the month that the episode is completed.
Can I claim an NMS completion if the patient was recruited to the service but could not be contacted for provision of the intervention?
Does the pharmacy that provides the NMS have to dispense the medicine?
Yes. The only exception to this rule is where the new medicine has been dispensed by a hospital and a healthcare professional at the hospital has referred the patient to a community pharmacy for provision of the NMS.
Can a pharmacist provide NMS on any new medicine prescribed from the list regardless of who prescribes it?
Yes, the NMS applies to all NHS prescriptions for items that are on the NMS medicines list.
What is to stop patients who use a range of different pharmacies from receiving the service at a different pharmacy each time they get a prescription for a medicine on the NMS medicines list?
Patients presenting a prescription for a medicine on the NMS medicines list at the pharmacy will be asked whether this is the first time they have been prescribed the medicine. Those patients who respond “yes” can be offered the service. While some patients may not answer the question accurately we expect that the offer to participate in the NMS may remind them that they have taken the medicine in the past.
Can pharmacy technicians provide the NMS intervention and follow up?
No. The NMS intervention and follow up must be delivered by a pharmacist who has self-declared that they have the skills and knowledge to do so. However, the pharmacy can make good use of skill mix by allowing support staff to book appointments, prepare copies of forms, and transcribing details of the consultations where these are later entered into electronic records.
Is it true that pharmacists must be MUR accredited to provide the NMS?
If different pharmacists undertake the intervention and follow up stages of the service for the same patient, how will the pharmacist undertaking the follow up know what has happened at the intervention stage?
Pharmacies are required to keep records about the service each patient has received. These include details of the discussion at the intervention phase as well as the outcome of the follow-up.
How do patients get referred to the NMS?
Pharmacies should be able to identify patients eligible for the NMS who present a prescription. However it is recognised that it could be helpful for pharmacies if patients were also referred into the service. It is hoped that local discussions between pharmacists and GPs will encourage GPs to refer their patients to the service. In addition patients can be referred into the service by a secondary care provider that has already dispensed the new medicine as part of the discharge process.
Are patients who are prescribed more than one new medicine at the same time eligible for more than one NMS?
No. The NMS should cover all new medicines prescribed at the same time.
My patient started two new medicines at the same time. While I am able to continue the NMS for one medicine until the follow-up stage, I need to refer the patient back to the GP for the other medicine. How does this work?
There may be occasions in which a patient who has been prescribed two new medicines has trouble with one medicine and requires early referral back to their GP while they are able to continue to the follow-up for the other new medicine. In this case the pharmacy will be able to claim for one completed NMS once the patient has completed the follow up appointment.
How much will a pharmacy get paid if it completes a greater number of NMS interventions than the 80% target figure for its prescription volume band?
There are four target payments for the NMS. The level of payment the pharmacy receives for each NMS full service intervention depends in which target band (if any) the pharmacy meets in that month. If the pharmacy exceeds the 80% target it will get paid £28 for each full service intervention (including those which fell below the 80% target). The target (number of full service interventions the pharmacy can claim for) is limited to 0.5% of the pharmacy's volume banding (for more information on this please see pages 29-30 of the NMS guidance)
One of the pharmacy records for the NMS is the ‘patient reports negative feeling about the medicine’. What does this cover?
This pharmacy record covers patients who report feeling different since they started taking the new medicine but do not report it as a side effect. This could cover a range of occurrences that the pharmacist may recognise as potential side effects or may consider as not related to the new medicine.
Why have you chosen the current four long term conditions for the NMS?
We believe that the initial conditions (asthma and COPD, type 2 diabetes, antiplatelet/anticoagulant therapy, hypertension) will help pharmacies to best demonstrate the value of the service. In selecting these conditions we also considered the original proof of concept research.
Are contractors required to submit their quarterly reports (if requested by their area team) electronically and using the agreed form?
Yes, contractors must use the agreed form and submit their reports electronically. Please note that this also applies for the Medicines Use Review (MUR) service.