The new medicine service: evidence that community pharmacists are looking after patients while saving NHS resources

New research has provided evidence that the new medicine service (NMS) is both effective and cost-effective and should continue to be commissioned, with a view to extending the service to other therapeutic areas (The Pharmaceutical Journal,
doi: 10.1211/PJ.2017.20203374)^[1]
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Since its inception in 2011, the expectation has been that the NMS would improve adherence by ensuring pharmacists engaged with patients when they were first prescribed their medicines and explain what they were for and what they would do, when to take them and what side effects might be experienced. It was seen as a way of tackling the problem of unnecessary hospital admissions and keeping patients as well as can be expected for as long as possible.

Since then and up until the end of August 2016, some 3.59 million NMS consultations were conducted with patients in England by community pharmacists, according to the researchers at the University of Manchester and University of Nottingham.

The NMS journey begins with a patient presenting a prescription to a community pharmacy for a new medicine. If the medicine has been prescribed for hypertension, asthma or chronic obstructive pulmonary disease, or type 2 diabetes, or if antiplatelet or anticoagulant therapy is required, the patient can request the service or be referred by the prescriber. A pharmacist can also suggest the NMS. The service, which can last up to five weeks, involves a consultation 7–14 days after the patient has started using the medicine, with a follow-up 14–21 days later. Consultations can be done face-to-face or by telephone.

Research like this is just what community pharmacy needs, given the continued cuts in funding

According to the researchers, who conducted an economic evaluation of the NMS service from 2011–2016, £75.4m of short-term savings to the NHS have already been made. In the long-term, the authors of the research suggest that £517.6m cash savings to the NHS could be made, and 179,500 quality-adjusted life years will be gained from the NMS.

The researchers also conducted a randomised controlled trial which assessed the effectiveness of the NMS over 10 weeks (n=504, 251 patients had the NMS, 253 did not). It was found that the NMS significantly increased the proportion of patient-reported adherence by more than 10% (from 60.5% under standard practice to 70.7% when the NMS had been conducted).

A report published in 2010 on the scale, causes and costs of waste medicines estimated that health gain forgone through poor adherence to medication costs NHS England more than £500m per year in just five diseases (asthma, type 2 diabetes, high cholesterol/coronary heart disease, hypertension and schizophrenia)^[2]
. Additionally, the report stated that improving adherence from current levels to 80% across these five areas alone would save the NHS more than £500m per year.

There is also compelling evidence to suggest that NMS should be extended to other conditions, especially mental health. Adherence to medication in patients suffering from schizophrenia is of particular concern, at just 52%^[3]
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The researchers acknowledge that the effect of the NMS may not be long-lasting. They questioned whether the effects would disappear, be maintained, or initiate a change in the patient’s motivation or ability to adhere to medication that leads to sustained adherence over the long term. As such, the potential for integration of the NMS with other community pharmacy-led medication concordance services should be considered. The NMS could be integrated with the medicines use review (MUR) service, which involves pharmacists conducting a structured review with patients about their medicines use, in order to improve patients’ knowledge, adherence and everyday use of medicines, as well as providing an opportunity for lifestyle advice to be given.

Extending the new medicine service would benefit patients and improve medication outcomes

For example, the NMS could be followed up with repeated, medical condition-targeted MURs, conducted quarterly (or at other appropriate intervals) with the patient, to ensure medication adherence is sustained or enhanced further within an appropriate commissioning and clinical governance framework. This would benefit patients and improve medication outcomes, thereby providing long-term cost savings to the NHS. It would also allow patients to flag up any concerns or adverse effects experienced with the pharmacist, so that appropriate action could be taken, including referral to the prescriber. Long-term follow-ups would also allow pharmacists to have an opportunity to discuss dietary and lifestyle changes to help improve the patient’s health, such as smoking cessation or weight-loss programmes, which it may not have been appropriate to discuss with the patient during inital consultations about their new medicines.

Prescribers would need to be informed, so community pharmacists being granted write access to the patient summary care record, in line with the Royal Pharmaceutical Society’s policy, would be most welcome.

It might come across as preaching to the choir when pharmacists are told about the value of the NMS, since they have been conducting these consultations for more than six years and will have had plenty of positive feedback from their patients about the efficacy of the intervention. However, research like this is just what community pharmacy needs, given the continued cuts in funding to the sector and to the NHS, and the failure of NHS England and the Department of Health to recognise the clinical or social capital value of the community pharmacy network. Research which provides solid evidence of the value of clinical services offered in community pharmacy should help inform policy makers and commissioners that investment in the sector produces a healthy return in terms of health gain for patients, and cash for the NHS. Certainly, the government should take note of the long-term savings such pharmacist-led services could make, not to mention improving the health of the population.