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How effective are NMS hypertension reviews in pharmacies?

Just 4.5% of NMS patients were referred on within two weeks of starting a hypertensive
Just 4.5% of NMS patients were referred on within two weeks of starting a hypertensive

The results from a review of NMS hypertension appointments have led researchers to suggest “an extended prescribing role” for pharmacists to manage this condition.

The study – published last month in the British Journal of General practice – collected responses from 131,419 patients with hypertension who undertook a new medicine service (NMS) consultation in pharmacies across England between 2011 and 2012.

The study’s authors, from the Nuffield department of primary care health sciences at Oxford University, found that “overall referral rates were low” among these patients, with just 5,895 (4.5%) referred by their pharmacy to a GP within the first two weeks of starting a new hypertensive. The most common reason for referral was side effects, followed by “negative feelings towards the drug” and “uncertainty regarding the efficacy of the new medication”, the authors added.

“In contrast, patients who were provided with more information about their new medication from the pharmacist, and those using their medications as prescribed, were less likely to be referred to their GP.”

The authors, who pointed out that hypertension accounts for “almost one in 10” GP consultations, suggested that an “extended prescribing role for community pharmacists could reduce referral of routine cases to an already overstretched general practice”. However, they acknowledged this “would require many [pharmacists] to undertake further training”.

The authors concluded that “efficient communication systems between pharmacists and GPs” could also result in reduced patient referrals “by allowing pharmacists to implement changes to medications or doses in a more timely manner in pharmacies”.

They suggested further research to “analyse clinical notes made by pharmacists following consultations with patients with hypertension”, to assess the “specific advice or recommendations” being provided.

More about the study

The authors said that to their knowledge, this was the first study “exploring factors associated with pharmacy referrals to general practice due to newly prescribed antihypertensive medication”.

The data for the study was provided by the Pharmaceutical Services Negotiating Committee (PSNC) and related to patients starting a new medication for newly diagnosed or pre-existing hypertension. Excluded individuals included patients not engaged with the service and those receiving an antihypertensive for a condition other than hypertension.

The authors acknowledged some limitations to their study, notably that pharmacies may have selected patients who were “more engaged with their condition”. Having information about those who rejected the service would have strengthened their findings, the authors added.

The NMS was introduced in England in 2011 to provide support for patients within the first month of starting a new medicine. It was the fourth advanced service to be added to the country’s community pharmacy contractual framework (see more on the PSNC website here).


A. Albasri et al. Hypertension referrals from community pharmacy to general practice (last accessed 07/08/2018)

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Peter Sainsburys, Community pharmacist

The answer to the headline is "completly ineffective and a massive waste of money".

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