Title: Understanding and Appraising the New Medicines Service in the NHS in England
Funder: Department of Health (England)

Abstract: Background About 25% medicines prescribed for long-term conditions are not taken as directed, and approximately 15% people receiving a new medicine take few, if any, doses. Intervening soon after initial prescribing can resolve medicines-related problems and improve adherence. The New Medicines Service (NMS) is to be offered by community pharmacists in England to people starting a new medicine for asthma/COPD, hypertension, Type 2 diabetes or anticoagulation/antiplatelet therapy. It aims to improve adherence and patient outcomes and reduce non-adherence-related costs to the NHS. To realise these benefits, NMS needs to be implemented in an optimal way and requires engagement with patients, pharmacists and general practitioners (GPs). Aims in relation to the issue to be addressed: To evaluate the NMS to inform decisions about continuation of the service by assessing impact on medicines-taking behaviour, patient outcome, and cost-effectiveness from an NHS perspective. To explore operation of the NMS, to determine acceptability to patients, pharmacists and GPs, indicators of successful implementation, generalisability and replicability across the four disease indications in multiple pharmacy settings. Research plan and methods of investigation We will assess effectiveness and cost effectiveness using a robust, pragmatic randomised controlled trial in community pharmacies in the East Midlands, South Yorkshire and London. We will recruit 500 patients from 6 to 8 pharmacies, from a range of pharmacy settings and follow them up for two months after the intervention to assess effects on adherence, patients’ reported problems with medicines, referrals to their GP and use of NHS resources. We will use modelling techniques to estimate the clinical and economic impact of changes in adherence caused by Nms We will compare and combine the evidence generated with data being collected as part of NMS service delivery to provide wider estimates of effectiveness and cost-effectiveness. A qualitative workstream will explore NMS to deepen and explain the technology appraisal, and to identify how to improve implementation and future development, using profiling of each participant pharmacy; patient & intervention tracking; exploration of pharmacy and GP experience and attitudes to NMS and how this links to wider contextual factors. We will carry out interviews and focus groups with patients, pharmacists and GPs to characterise facilitators and barriers to service uptake, informed by individual and organisational perspectives. We will synthesise these sources of evidence to optimise the use of wisdom gained, to inform future effective stakeholder engagement and successful implementation and continuation. Research team The team consists of academic and practising pharmacists, an academic and practising GP, health economist, sociologist, patient expert and statistician, a team of experienced researchers, supported by an expert advisory panel representing all key stakeholder groups, and local and national collaborators enthusiastic to contribute to successful execution of the project. The team has extensive combined expertise and track records in the area and methods, collaborating on many complex, robust studies with timely policy-relevant outputs including the original intervention on which NMS is based, other community pharmacy based interventions and a wide portfolio of adherence research. Potential impact/influence on the relevant policy field, users and wider stakeholders The NMS aligns with health policy objectives, and has potential to increase patients’ involvement in their care. This study we provide evidence to be able to advise health care commissioners on the potential benefits and costs of using the NMS, as well as patient and professional experience. Importantly, we will be able to provide learning on how the service can be successful, or not, in the four LTCs under consideration, across a wide range of community pharmacy settings. We will be able to present facilitators and barriers to successful implementation, from the perspective of GPs, pharmacists and patients.


Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: STROKE;CANCER AND NEOPLASMS;METABOLIC AND ENDOCRINE;CARDIOVASCULAR;ORAL AND GASTROINTESTINAL