Is there a minimum age for which an NMS can be carried out?
Strictly speaking there is no minimum age BUT, the patient must be capable of giving written consent themselves, i.e the parent or guardian cannot give consent on the child's behalf. The child must understand the purpose of the service and have the capacity to consent to the sharing of information.
Can we carry out NMS on someone taking isosorbide mononitrate?
Isosorbide mononitrate is indicated for angina which is not an eligible long-term condition under the NMS terms of service.
Pharmacists must ensure that the patient is suffering from the specified condition and that the medicine they have been prescribed is on the list of eligible medicines. These are:
- Asthma and COPD
- Type 2 diabetes
- Antiplatelet/anticoagulation therapy
Where can we get a referral form for sending patients back to the GP?
An official NHS referral form is available to download to refer patients to their GP if an adherence issue is identified which cannot be resolved in the pharmacy.
If the strength of the new medication has been increased by the GP during the initial 28 day period, can the NMS continue?
There is nothing which prohibits continuing with the service. Several medicines, for example the ACE inhibitor ramipril, are initiated at a low dose and titrated upwards so this will be a common occurrence.
A change in strength does not affect how the service operates except that adherence may be affected by the return of side effects after a dose increase. This should be appropriately managed within the NMS consultation.
Is it possible to delay the NMS completion and submission in order to be carried over to the next months target?
The PSNC states that completed NMS episodes cannot be held back to the next month in order to improve performance for that month.
However, it should be noted that an NMS episode started in one month is unlikely to be completed until the next month as it takes 28 days to complete the service.
This is important when trying to achieve target numbers each month - any NMS started this month will count towards next months target.
If two new eligible medicines are prescribed together can two NMS episodes be claimed for?
No, if two new medicines are initiated at the same time they must be treated as one single NMS episode with the full service provided for each medicine.
If the medicines are initiated at different times then they are counted as two separate episodes.
Can an eligible medicine be considered new if the patient has been initiated on it previously and there has been a break in treatment?
No, it must be the very first time of dispensing, no matter how long the gap since the previous time of dispensing. This is also true if the medicine has been previously dispensed in hospital, even if it's just a few days worth of medication.
Can salbutamol be included in NMS if the patient hasn't had a confirmed diagnosis of asthma as yet - the GP is 'just trying it out'?
This is a grey area but our best advice is that no, an NMS consultaion should not be carried out in this case. NMS can only be carried out on patients with the specified long-term condition and taking an eligible medicine.
In this case the patient must have been diagnosed with asthma in order to justify an NMS intervention. Some concerns have been raised as to the appropriateness of including salbutamol on the list of eligible medicines.
Can an NMS consultation be carried out on a patient started on aspirin 75mg?
Aspirin 75mg is on the list of eligible medicines due to it being in BNF section 2.9 Antiplatelet drugs.
There is no associated long term condition with this subsection of NMS so there is nothing to prohibit NMS being carried out on someone taking aspirin for secondary prevention of stroke. There is scope for healthy living advice to be provided and there are conceivable adherence issues with aspirin.
However, concerns have been raised over whether it is appropriate to include aspirin in NMS. You should use your professional judgement as to whether you feel the patient would actually benefit from being provided the service.
Can a claim for NMS be made if the patient requires referral back to the GP?
Yes, referral to the GP occurs if adherence issues are identified which cannot be resolved in the pharmacy. This can occur either during the initial intervention or in the follow-up discussion and referral marks an end to that service. A claim should be made in the normal way.
Is enoxaparin eligible for NMS under the anticoagulant section?
No, eligible medicines are those listed in BNF reference 2.8.2 Oral anticoagulants. Enoxaparin is a a parenteral product so is not eligible.
Can NMS be performed where there has been a change in formulation?
Yes, the service specification has recently been amended to allow pharmacists to use their professional judgment when a change in formulation occurs.
It must be clear that the patient will benefit from the intervention, so a change from tablets to capsules would not be appropriate whereas changing to a new inhaler device might be.