Posted by: Ranveer Bassey15 AUG 2011
Complicated will probably be theword of choice used by pharmacists to describe the New Medicine Service (NMS),especially when compared beside the MUR service. NMS is something I have blogged aboutpreviously here in March when it was first announced. Since then further information has beenreleased.
The complexity of NMSstarts with the delivery of the service itself. It is not a one-shot affair, but instead involves three processes: initial recruitment, a consulation seven to 14 days after recruitment, then a follow-up consultation 14 to 21 days after this. Thankfully the PSNC will be developing amodule for their PharamaBase system to make this process easier and uniformacross pharmacies.
Payment for the service is also complex. Gone is the MUR approachwhere one MUR completed is one MUR paid for, with a universal annual maximum ofMURs that can be completed. Instead therewill be a new monthly maximum tailored to the number of items a pharmacydispenses in a given month. This is basedon the belief that the number of people that will be eligible for NMS will berelative to the number of items dispensed. It's predicted that approximately one person will likely be eligible forNMS per 200 items dispensed.
Payment will be received forpassing thresholds based on this maximum number. For example, the maximum number for apharmacy dispensing 5,000 items a month is 25. Pharmacies will receive payment when reaching 20% (5), 40% (10), 60%(15) or 80% (20) of this figure at a rate of £25 each. Should a pharmacy deliver the service 14times, they will only receive payment for 10 of these unless they deliver 15 therebyreaching the 60% threshold. The 20%threshold will no longer exist after the first year. There will be a £750 conditional implementationpayment.
You can see the logic behind thepayment structure. Tailoring the maximumto the number of items dispensed will help ensure that the right patientsare selected for the service. It's alsopotentially more equitable in that busier pharmacies are not constrained by acap which does not consider the number of patients that could potentiallybenefit from the service. The payment structurealso effectively lengthens the stick the carrot dangles from, and shouldencourage more NMSs to be completed.
One issue I can potentially seeis that whilst a pharmacy can forecast the monthly items they are likely to dispense,it will never be exact. Should aforecast straddle one of the thresholds, too many or too few NMSs may becompleted. It's better to err on theside of caution and do too many but the pharmacy may then not be compensated forthe resource implications associated with this.
Many will be glad to know thatthere is no accreditation process required, other than a form filling exercise. Pharmacists do have to be MUR accredited toprovide the NMS service though. Importantly, the outcomes of the service will be measured, as will theoutcomes of MURs. This is the first steptowards developing an evidence base that can act to support further commissioningof pharmacy services.
My thoughts are that the added bureaucracy associatedwith the service is not the maddening type which results from lack of forethought. Every part of this service hasbeen designed with intent. That is toensure that the skills of pharmacists, and the impact they can have on patients,are best represented. The service feelslike the next species in the evolution towards fulfilling the service-basedagenda for pharmacy. Maybe thought ofin this light, delivering the service will feel less grating than perhaps manypharmacists expect.