Counterculture 46: How would you explain the new medicine service and MURs?
"What's going on in that little room over there?" William asks Amanda. "All morning I've been seeing people going in there with Dee. I thought that the pharmacist's job was to do the prescriptions."
Amanda replies: "It's the pharmacist's job to check that patients' prescriptions are correct, and safe and suitable for them, but we've got dispensary staff who actually get the medicines ready."
"So what's Dee doing in there with those people?"
"It could be anything from a whole range of services we offer. There's the pharmacist's traditional role of giving advice to people about treating minor illnesses or symptoms they've got. But on top of that the pharmacist provides several services paid for by the NHS, plus some that people pay for themselves."
"I've heard you ask patients if they want a chat about their medicines. Is that an NHS service?" William asks. "And is it available across the UK?"
Questions
1 What is an MUR and what is the new medicine service?
2 Do all pharmacies in the UK provide these services?
Answers
1 MUR stands for medicines use review, and its purpose is to ensure patients get the maximum benefit with the minimum of problems from their prescribed medication. The pharmacist goes through a patient's medicines with them, checking they are taking them correctly and there are no problems. At least half of a pharmacy's MURs must be for patients in three target groups: those recently discharged from hospital (or on blood pressure medicines in Wales), those on certain ‘high risk' medicines, and those with respiratory diseases. The NMS, or new medicine service, is designed to help patients recently prescribed a medicine for a long-term condition (either high blood pressure, type 2 diabetes, respiratory problems or to prevent blood clots). The pharmacist goes through the medicines to make sure the patient understands why they are taking them, how to take them, and answers any questions. The pharmacist then checks how the patient is getting on at a follow-up two to three weeks later.
2 No. Only pharmacies in England and Wales are paid to provide an MUR, and not all pharmacies offer the service. Currently only pharmacies in England offer the NMS. In Scotland, patients are able to register with their pharmacy for services. These include a minor ailments service and a chronic medication service, which sees the pharmacy share the care of a patient with the GP. Pharmacies in Northern Ireland do not offer services similar to MURs or the NMS, but there is a programme called Building the Community-Pharmacy Partnership (BCPP), which aims to improve health promotion in communities. In Wales, pharmacies now offer a discharge medicines review service (DMR). This service is designed to support patients being discharged from care; pharmacists receive a copy of a patient's discharge letter, check the correct prescription is issued, and advise patients how to get the most out of their medicines. MUR target groups will be introduced on December 1.
Where the pharmacist comes in
As a result of carrying out MURs, pharmacist Dee has identified and resolved several problems connected with patients' medication. Here is an example.
During an MUR an obese woman, who had been taking medicines for high blood pressure for some time and was recently diagnosed with diabetes, admitted that she was not taking her diabetes medication because it was upsetting her stomach.
Dee found that the woman had been started on a very high dose of the diabetes medicine, which could cause this side effect. She recommended to the patient's GP that she should be started on a much lower dose and the dose gradually increased and adjusted so it brought down her blood sugar level without causing this problem. Dee also thought that the patient's blood pressure medicines were not suitable for someone with diabetes and could cause problems, and recommended an alternative.
Dee also suggested that because she was very overweight the patient's cholesterol level should be checked, which it hadn't been, and a medicine prescribed to lower it if necessary.
At a later visit to the pharmacy, the woman said that her GP had followed Dee's advice and altered her medications accordingly, and she was now feeling better than she had for years.
