The NHS has expanded its New Medicine Service (NMS) to include depression and more structured pharmacist-led interventions. The service, designed to help patients newly prescribed medicines for long-term conditions, went live on 29 October.
According to the NHS, “research has shown that pharmacists can successfully intervene when a medicine is newly prescribed, with repeated follow-up in the short term, to increase effective medicine taking for the treatment of a long-term condition.” It adds that “the New Medicine Service demonstrates increased patient medicine adherence compared with normal practice.”
Concerns over medication adherence
While the expansion has been welcomed, Norman Niven, CEO of The Medication Support Company, argues that it still does not address the core problem of medication non-adherence, which remains one of healthcare’s most persistent and costly challenges.
Niven, who was a pharmacist for more than 30 years, said: “Medication non-adherence leads to poorer population health, which creates a raft of downstream problems from hospital re-admissions to an increased burden on the social care sector.
“The enhanced NMS is to be welcomed for extending the range of conditions that qualify and for improving the intervention regime, but no amount of meetings with pharmacists can stop people at home from not taking the right meds on time, in the right dosage.
“The only guaranteed way to achieve this is to literally witness it happening, so some form of in-home monitoring system is absolutely essential. Most importantly, that system must be used every time meds are due.”
A widespread and costly challenge
According to Community Pharmacy England, around 15 million people in England live with a long-term condition, and “the optimal use of appropriately prescribed medicines is vital to the management of most LTCs”. But studies across different conditions and countries consistently estimate that about 50% of prescribed medicines are not taken as directed.
Niven said unintentional non-adherence is often due to forgetfulness, especially among older people, while intentional non-adherence is a far greater concern. “It is easy to understand unintentional non-adherence; sometimes people, especially older people, simply forget to take their meds. But intentional non-adherence represents a different class of problem; it is much more significant in terms of numbers, and it is a silent killer.
“Some people don’t finish the course they’ve been prescribed, whilst others will tell their doctor their meds aren’t working when in fact they haven’t been taking them. The associated costs, from unnecessary hospital admissions and re-admissions, and social care visits, mount up very quickly.”
How the service works
Patients are recruited to the NMS either by referral from their GP or directly through community pharmacy staff. When a new medicine is dispensed, patients are offered the opportunity to use the service, and follow-up consultations are arranged to monitor their progress and discuss any concerns.
The NMS aims to support patients in the early stages of a new treatment, ensuring they understand how and when to take their medicine. It is particularly beneficial for those managing complex or newly diagnosed conditions.
A call for stronger measures
According to NHS England, the health service spends more than £19 billion each year on medicines, while pharmacies dispense over one billion prescriptions annually, according to data from the NHS Business Services Authority. After staff costs, medication is the NHS’s largest expense.
Niven believes tackling non-adherence requires more than pharmacist intervention. “The NHS really needs to deal properly with non-adherence, not pass the buck to pharmacists. The enormous, extra costs generated are the direct result of people becoming less well, putting further pressure on the NHS.
“As well as failing to address the real problem, the expanded NMS throws up a range of other issues, including liability. For example, are pharmacists to be held accountable if a patient self-harms or worse after a consultation?”