Four or More Medicines (FOMM)
Community Pharmacy Future: Achievements and Results

The full results of this service evaluation have been published in the International Journal of Pharmacy Practice.

FOMM Support Service

  • Aimed at patients aged over 65 years taking four or more medicines.

    • High users of NHS resources who may not be getting optimal benefits from medicines.

    • Poor adherence can lead to worsening of the condition.

    • Adherence is more problematical with multiple medicines.

    • Older people are more susceptible to adverse drug reactions.

  • 620 patients recruited by 25 pharmacies across Wigan in four months across all socio-demographic areas.



Potential annual saving from reduced prescribing costs and hospital admissions as a result of ADRs.

Potential annual saving in hospital costs by reducing falls associated with fractures.

Our support for patients

Aims and objectives:

  • Review medication using STOPP / START criteria^ and make appropriate recommendations to prescribers.

  • Reduce falls risk and fear of falls through multifactoral risk assessment and interventions or referral to another health care professional.

  • Identify and provide additional support for those with long-term pain.

  • Identify and provide additional support for those with medicines adherence issues.

  • The long-term nature of the service aims to reinforce messages, detect problems as they start to develop, review changes proposed and improve medicines optimisation.

  • Promote multidisciplinary working to improve patient outcomes including increased adherence, reduced medicines-related hospital admissions and improved quality of life.

^. Screening Tool of Older People’s potentially inappropriate Prescriptions Screening Tool to Alert doctor to Right (appropriate, indicated) Treatments.

FOMM - Support Service
“Always thought just take it and don’t bother them, [but] since they’ve explained them I feel a lot better… they’ve explained it all [in the pharmacy]

FOMM patient
“It’s beneficial to me. They are taking an interest in how I am and how my medications working… and if I have any problems she’ll give me advice on what to do.

FOMM patient
Population demographics for FOMM service
Population demographics for FOMM Service

The Carstairs index is used to calculate deprivation quintiles for least and most deprived.

It is based on four census indicators:

  • low social class

  • lack of car ownership

  • overcrowding

  • male unemployment

FOMM Support Service: key results

  • 25 pharmacies in Wigan recruited 620 FOMM patients (51% male, average age 73.9 years)

Patients saw benefits from pharmacist interventions which improved their understanding of their medicines and addressed specific issues they were having.

After six months, our patients had:

  • Significant increase in medicines adherence

  • Significant reduction in medical and self-treated falls

  • Significant increase in patient quality of life

Patients reported a general improvement in health. Pharmacy teams picked up on a range of issues, not all medicines related. Patients were more satisfied with the management of their condition, a key NHS objective. Quality of life was improved in small but significant ways, such as advising on the correct length of walking sticks and how medicines could fit in with home and social life.

Based on the findings from the FOMM Service, we estimate that if the service was delivered from 11,100 pharmacies in England to 954,600 patients then the NHS would see annual benefits of:

  • £35.57m in reduced medicines costs and hospital admissions as a result of STOPP / START recommendations.

  • £33.87m in reduced hospital costs due to reduction in falls that result in fractures.

  • 17,200 QALYs.

  • Benefits as a result of improved medicines adherence, pain, and falls that do not require secondary care treatment have not been quantified.

help & advice
What patients are saying...
“ Nice to be able to speak to somebody really, feel like you have some support from someone, they understand where you are coming from ”

FOMM patient
“ It’s a marvellous thing to share your problem and experiences, because if you know you are not on your own it gives you confidence ”

FOMM patient
“ I come away happier and more content that what I’ve got is working and eventually I’ll get better "

FOMM patient
What professionals are saying...
“ Didn’t think it would be as successful as it was, I was pleasantly surprised ” 

FOMM pharmacist
“ [There is] an awareness of what we can do. People pop in now. It’s built relationships – they say ‘Can I just have a quick chat with you' ” 

FOMM pharmacist
“ When we sat down with the doctor to talk about her medication, the doctor said ‘we think it is the sleeping tablets’ and we said that we had identified this as part of [our review], so we’ve managed to get [the patient] from 10mg down to 2.5mg now ” 

FOMM pharmacist
The Community Pharmacy Future project is a collaboration between
Well Pharmacies
Lloyds Pharmacy
Rowlands Pharmacy a company of the PHOENIX group