Community pharmacy services such as the NHS New Medicine Service (NMS) have an important role in improving medicines adherence. Our evaluation identifies opportunities to strengthen delivery of the NMS and inform the development of a Personal Health Costs (PHC) intervention.

Commissioned by the Behavioural Science Unit at NHS England in partnership with the Department of Health and Social Care, this evaluation found that the NMS is highly valued by patients and community pharmacists. While pharmacists have the capability and motivation to deliver the service effectively, practical barriers can limit patient engagement and service delivery. These findings provide evidence to support future improvements to the service and inform the implementation of an updated PHC intervention.

The full report is available here.

Why this matters

Non-adherence to medication is a major problem for the NHS, contributing to poor health-related quality of life, increased hospitalisations and premature mortality¹

The NMS is an advanced community pharmacy service, available on the NHS since 2011. It gives structured support to people who start a new medicine for a long-term condition by recruiting them to the NMS; conducting an initial intervention consultation within 14 days of a new medicine being prescribed; and a follow-up consultation up to 21 days after the initial intervention.

A previous evaluation showed that the NMS increased medicines adherence by about 10% compared with normal practice. It also highlighted areas where the service could improve.

A pilot commissioned by the Department of Health and Social Care in 2014, tested a PHC behavioural intervention within the NMS. This involved patients signing a sticker placed on their medication to show their commitment to adherence. The pilot found that this PHC intervention helped people understand the personal consequences of not taking their medicines and improved adherence.

About the evaluation

The evaluation aimed to:

• Identify barriers and enablers to NMS delivery to support service improvement, with a specific focus on patients who receive cardiovascular disease (CVD) medications.
• Provide insights to inform the implementation of an updated PHC intervention to influence patient behaviours around new medicines adherence.

Using the Capability, Opportunity, Motivation and Behaviour (COM‑B) framework the evaluation explored how pharmacist and patient behaviours shape NMS delivery and engagement.

What did we find?

The evaluation found that pharmacists have the capability and motivation to deliver the NMS effectively and that the service is valued by both patients and community pharmacists for improving medicines adherence and patient understanding. 

The greatest barriers related to opportunity rather than capability. Patients were often unaware of the NMS, and the support community pharmacists could provide. Practical constraints including identifying eligible patients, arranging consultations and increasing use of home medicine delivery, limited when and how the service could be offered and received, at a time convenient to both patients and pharmacists.

Views on the PHC intervention were mixed, but both pharmacists and patients responded positively to approaches that support reassurance, ownership and simple reminders. A refined version could strengthen engagement if operational challenges are addressed; for example, adapting to the context of more patients having medicines delivered. 

Recommendations

The evaluation identified several opportunities to strengthen delivery of the NMS and support implementation of the PHC intervention. These included:

• introducing bookable NMS appointments to improve patient engagement
• exploring alternative methods of communication
• increasing patient awareness through wider promotion of the NMS
• developing NMS referral pathways from general practice into community pharmacy
• undertaking further research to understand which patients are most likely to benefit from the service and behavioural interventions.

The evaluation also identifies practical considerations for implementing the revised PHC intervention, including: integrating the intervention into existing pharmacy workflows; accommodating medicines delivered to patients' homes; and ensuring any future implementation is accompanied by robust evaluation.

Read the full New Medicine Service and Personal Health Costs evaluation report.

¹ Elliott, R. A. et al. (2016). ‘Supporting adherence for people starting a new medication for a long-term condition through community pharmacies: a pragmatic randomised controlled trial of the New Medicine Service’ in BMJ Qual Saf (25:747-758)