Development of the New Medicines Service increases patient adherence to medicines and improves patient safety
Submitting InstitutionUniversity College London
Unit of AssessmentAllied Health Professions, Dentistry, Nursing and Pharmacy
Summary Impact TypeHealth
Research Subject Area(s)
Medical and Health Sciences: Nursing, Public Health and Health Services
Summary of the impact
Work led by Professor Nick Barber at the UCL School of Pharmacy showed
that a majority of patients have problems soon after starting a new
medicine for a chronic condition, and this led to the development of a
post-consultation intervention by pharmacists that was shown to be more
effective and cheaper than normal care. This entered Department of Health
policy for pharmacy in 2008 and Barber helped design the New Medicines
Service that was launched in October 2011. This service is offered by
community pharmacists in England and by the end of May 2013 over a million
patients had received the service. The intervention increases patient
adherence to medication, thus improving quality of care, and reducing cost
to the NHS from wastage. It also improves patient safety through better
identification and resolution of adverse effects.
Professor Nick Barber at the UCL School of Pharmacy, along with
colleagues at Kings College London and Birmingham Universities, received a
Department of Health (DH) policy research grant on prescribing in 1995. A
study on doctor-patient communication interviewed a series of patients
after consultation with their GP. This revealed that many patients felt
that they had not been able to raise the issues that they had in fact
wished to raise before the consultation took place, resulting in
misunderstandings on both sides. One significant consequence of this was
that many patients did not take prescribed medicines as advised [1, 2].
Analysis of the consultations showed that `biomedical' consultations had
worse consequences in terms of adherence than `lifeworld' ones (i.e. those
that engaged with the patient's life and preferences) . As a
pharmacist, it seemed to Barber that patients' lives could be made better
via professional intervention after the consultation and after they had
experienced the medicine, and helping them solve their medicine-related
problems in a patient-centred way via consideration of their individual
needs and concerns.
On the basis of these findings, Barber (as PI) was funded in 2001, along
with Rob Horne as co- investigator (then University of Brighton, now UCL
School of Pharmacy) and Sarah Clifford (then UCL School of Pharmacy), by
NW Thames Regional Health Authority to conduct a larger, quantitative
study involving 258 patients recruited from 23 community pharmacies in
south east England. It showed that 10 days after starting a new medicine,
around one third of patients were non-adherent and two thirds stated that
they had problems or concerns regarding their medicines .
In 2003, NW Thames then funded Barber (with Horne, Clifford and Rachel
Elliott, University of Manchester) to develop and evaluate a service to
improve adherence. The team designed a telephone-based pharmacy advice
service, guided by the self-regulatory model, which recognises that
adherence to medication is frequently influenced by symptoms or beliefs
about the illness that are unique to each patient. The theory was used in
training the pharmacists to adopt a patient- centred approach. The
intervention was designed to elicit patients' experiences with, and
concerns about, their new medicine; this was then used as a starting point
for the pharmacists to meet each individual's specific needs with
information and advice. As non-adherence to new medicines for chronic
conditions develops rapidly, the team developed a service in which a
pharmacist telephoned patients two weeks after they had started a new
medicine for a chronic condition. The pharmacist listened to the patient's
problems and gave advice or information if needed. In this study the
effectiveness, safety, utility and the patient acceptability of the
service were assessed. The service was then tested in a proof-of-concept
randomised controlled trial involving forty pharmacies across England. It
was found that the proportion of non-adherent patients was significantly
reduced in the intervention group . What is more, the patients'
beliefs regarding their medicines became on balance more positive .
The study included a health economic evaluation (led by Elliott) that
followed up patients' utilisation of health resources, modelled them and
calculated incremental cost effectiveness ratios. The intervention was 90%
likely to be both cheaper and more effective than normal care due to more
efficient medicines usage .
References to the research
 Britten N, Stevenson FA, Barry CA, Barber N, Bradley CP.
Misunderstandings in prescribing decisions in general practice:
qualitative study. BMJ. 2000 Feb 19;320(7233):484-8.
 Barry CA, Stevenson FA, Britten N, Barber N, Bradley CP. Giving voice
to the lifeworld. More humane, more effective medical care? A qualitative
study of doctor-patient communication in general practice. Soc Sci Med.
2001 Aug;53(4):487-505. http://dx.doi.org/10.1016/S0277-9536(00)00351-8
 Clifford S, Barber N, Horne R. Understanding different beliefs held
by adherers, unintentional nonadherers, and intentional nonadherers:
application of the Necessity-Concerns Framework. J Psychosom Res. 2008
 Elliott RA, Barber N, Clifford S, Horne R, Hartley E. The cost
effectiveness of a telephone- based pharmacy advisory service to improve
adherence to newly prescribed medicines. Pharm World Sci. 2008
Details of the impact
In 2008, the Department of Health published a white paper entitled Pharmacy
in England: building on strengths, delivering the future in which it
outlined the new service which was being developed, referencing the work
of Barber, Horne and Clifford [a]. This idea was taken forward by
the Labour government, but then frozen when the election was called. The
coalition government, however, took up the policy again, naming it the New
Medicines Service (NMS), and continuing its development through to
implementation in October 2011 [b]. The Chief Pharmaceutical
Officer for England has confirmed that "it is the research in question
that forms the fundamental building block to this important development
in health policy" [c].
Barber, Horne and Clifford were involved in the development of the
service during this period. They participated in stakeholder meetings in
which the nature of the new service was agreed and the intervention and
subsequent training designed [c]. Barber and Clifford co-authored
the questions the pharmacist should ask and also some of the CPPE training
manual and some of their teaching was put on YouTube to be widely
available [d]. Barber participated in a series of national day
long `road show' which visited all Strategic Health Authorities to
publicise the launch of the service.
The service is targeted at NHS priority groups and at medicines
associated with avoidable hospital admissions (typically due to poor
adherence). Any patient starting a chronic medication who is prescribed a
diuretic, anticoagulant, or has asthma, chronic obstructive pulmonary
disease (COPD) or type 2 diabetes is eligible, and should be offered the
service [e]. The pharmacist sets up a meeting with the patient a
couple of weeks after the patient presented the prescription and asks a
series of open questions to elicit the patient's experiences with the
medicine, their adherence and any problems or questions. The pharmacist
should explore possible ways to deal with any issues raised. Two weeks
later the pharmacist contacts the patient again to see if the issues have
been resolved, to check adherence and to find out whether any further
advice is needed. The pharmacists are paid for this if patient completes
the whole process.
Impacts on patients
By the end of May 2013, 1,023,697 patients had received the service [f].
In December 2012, Gary Warner, Chairman of the Pharmaceutical Services
Negotiating Committee's service development subcommittee (which had
undertaken an interim evaluation of the NMS based on 224,554 patients)
commented: "NMS interventions are making a real difference to so many
patients". The report showed that 32% of formerly non-adherent
patients became adherent to their medication after the NMS intervention.
In addition, pharmacists gave 366,702 pieces of healthy living advice to
patients while they provided the service [g].
Improved patient safety
One of the innovations of the service was to encourage pharmacists to
fill in `yellow cards' reporting adverse drug events. In August 2012 the
Medicines and Healthcare products Regulatory Agency (MHRA) announced that
there was a 120% increase in Yellow Card reports received from community
pharmacists since the launch of the NMS, compared to the same time period
a year ago, indicating that the service leads to rapid identification of
side effects of medicines, strengthening the national regulatory process [h].
Impacts on professional training
Barber and Clifford were heavily involved in preparing the professional
training for the NMS prepared by the DH-funded national Centre for
Pharmacy Postgraduate Education (CPPE) and wrote some of their training
material. They also made a series of videos for CPPE and ensured that
these materials were open-access. The reference to this work can be found
in YouTube videos (see above) and the CPPE open learning programme that
can be accessed by GPhC members only [i].
Economic benefits to the NHS
Elliot's health economic study showed a saving to the NHS of £95.40 per
patient. The impact assessment prepared for the Government estimated the
likely costs and benefits of the scheme under various scenarios. Using the
middle of three scenarios they estimated the net benefits of adopting the
service to be £1.5bn (discounted) over a 10 year period [j].
Other national & international schemes
The research presented above has led to a similar service becoming policy
in Scotland, where it has been integrated with their chronic medication
There has been interest from other countries in introducing a similar
scheme. For example, pharmacists from the Norwegian pharmacy organisation
Apokus visited the UK in December 2012 to learn about the service. The
visit followed interest from Norwegian community pharmacies in undertaking
a pilot NMS for new anticoagulant medicines. The team learnt about the NMS
and met with individuals involved, including a member of the UCL team
(James Davies) involved in evaluating the service [l].
Sources to corroborate the impact
[a] Pharmacy in England: building on strengths, delivering the
future. Cm 7341. Department of Health, 2008. White paper on the
future of pharmacy in England, April 2008. Page 65 makes reference to
Barber's underpinning research, and describes the new service that was
[c] Letter of testimony to corroborate this impact provided by the Chief
Pharmaceutical Officer for England. Copy available on request.
[d] The videos for the NMS involving Barber and Clifford, can be found
[e] Details of the New Medicines Service from the Royal Pharmaceutical
[f] Data aggregated from http://www.nhsbsa.nhs.uk/PrescriptionServices/3545.aspx
[g] Evaluation carried out by the Pharmaceutical Services Negotiating
[h] Press release about increase in yellow card reporting:
[i] New Medicine Service. Delivering quality and making a difference.
Available to GPhC members on http://www.cppe.ac.uk/learning/Details.asp?TemplateID=NMS-D-02&Format=D&ID=18&EventID=42101
[j] See summary on p22 of
[k] Scottish policy www.sehd.scot.nhs.uk/pca/PCA2012(P)19.pdf
— see reference to research on p.3
Description of NMIST service in Scotland:
[l] Press release about interest from Norwegian pharmacies: