Pharmacist struck off for carrying out MURs unaccredited

Reginald Brian Ranson claimed he was under “extreme pressure” to conduct MURs
A pharmacist has been struck off the register after carrying out medicines use reviews (MURs) for more than two years when he knew he did not have accreditation.

Reginald Brian Ranson, registration number 2016749, carried out MURs for two-and-half- years in a Hornchurch pharmacy and in local nursing homes despite not being formally accredited to undertake the service, a General Pharmaceutical Council (GPhC) fitness-to-practise committee concluded at a hearing on November 16.

The GPhC noted that Mr Ranson – who was not present at the hearing – had been a registered pharmacist for “over 45 years without any blemish on his character”, and had described being “under extreme pressure” to meet MUR quotas.

But it pointed out that during his time at the pharmacy, Mr Ranson “dishonestly misled his employer” by undertaking MURs, despite knowing he was not accredited to do so.

Providing MURs at Boots

Mr Ranson previously worked as a pharmacist at a Boots branch in Romford, Essex, where he undertook MURs from 2006 until 2012, the GPhC heard.

In order for pharmacists to carry out the MUR service, they must first receive accreditation, by either completing a distance-learning or university course, the GPhC representative said during the hearing.

In 2011, the Boots branch’s manager asked Mr Ranson to obtain his MUR accreditation certificate. Mr Ranson said he could not find this, but would request a replacement certificate from De Monfort University, the GPhC heard.

The GPhC noted that Mr Ranson had written to the regulator in 2013, claiming he had only provided MURs at the Boots branch when he “held a genuine belief that [he] was accredited to provide this service”.

However, the certificate did not materialise by the time Mr Ranson left Boots to join a Newlands Pharmacy branch in Hornchurch in Essex in 2012. The regulator concluded that by this point Mr Ranson was aware that he was not MUR accredited, but he omitted to inform his new employer.

"Pressure" to meet MUR quota

While working at the pharmacy, Mr Ranson conducted MURs on patients, the GPhC heard. The pharmacy also secured NHS authorisation to conduct MURs off-site in nearby nursing homes, and Mr Ranson was responsible for carrying out these reviews, the regulator heard.

In a letter to the GPhC in 2016, Mr Ranson claimed he was put “under extreme pressure to do MURs” by his line manager at the Newlands branch and “regrets the outcome”.

The line manager told the hearing that he had chased Mr Ranson and another employee about the number of MURs conducted at the branch. “They were below… ‘the quota’ and that meant the branch was not maximising potential revenue,” the fitness-to-practise committee's chairman summarised.

The manager also told the GPhC that when he challenged Mr Ranson about his MUR accreditation in a meeting in March 2015, he resigned on the spot.

The committee noted that his line manager described Mr Ranson as “a genuinely decent person”. It also highlighted that the MURs he conducted were “unlikely to have resulted in any patients receiving inappropriate treatment”.

But it added: “Nevertheless, we find the profession would indeed find the registrant's actions deplorable. It is unacceptable for a professional to deliberately mislead his employer and the NHS over a period of years.”

The regulator pointed out that Mr Ranson had “not offered any evidence of insight, remorse or remediation”. His “only excuse” was that he had been under pressure to do MURs, said the committee, which ruled to strike him off the register.

Read the full determination here.

78 Comments
Question: 
Have you ever felt pressured to perform MURs?

Daniel McNulty, Superintendent Pharmacist

The MUR accreditation did not improve my ability to conduct an MUR any more than any CPD I ever do.
The acreditation need demonstrotes that we are not viewed, by way of our qualification, creditable.
That and having the guts ripped out of our funding.

Quin Ooi, Community pharmacist

Unfortunately, the profession and regulations will never change after reading about news of MURS all these years.

Kishore Patel, Community pharmacist

I assume that , Boots, being a stalwart pharmacy organisation will pay back all the revenues received from all the MURs carried out? Had this been an independent, I have no doubt the NHS would not only expect the repayment but would also charge interest!! 

 

 

Amal England, Public Relations

I have always held the belief that MURs should be done in the GP practice, by a pharmacist who works in that practice, it should be an essential part of the GP contract, the funding coming from within.

As for the GPhC, it seems to be the political wing of the retail conglomerates. This perception will change when they start fining the abuse of pharmacy by the conglomerates. I understand the profession Should be clean and practice to high standards, but the best deterrent is not at the tentacles, rather at the root.

DAVID MACRAE, Pharmacy owner/ Proprietor

 

THE PHARMACIST should only talk to a patient when THE PHARMACIST feels it is CLINICALLY APPROPIATE for the patient, not when some CORPORATE  LACKEY says so!, surely the pharmaceutical society code of ethics should prevent this happening ! if not, it needs to be changed to benefit patients and pharmacists, and the profession. GPhC would be better served investigating the taxpayer MUR fees un-ethically claimed by certain large mulinational companies, and how this taxpayer money then ends up outside the UK as untaxed turnover, not re-invested in UK infastructure. Un-ethical and theft from the UK taxpayer on a grand scale !

It is time for practicing Pharmacists to take back ownership of our profession.

 

 

 

 

Amal England, Public Relations

The abuse of the MURs by the big brands is staggering, yet the GPhC share lavish offices in Canary Wharf, alongside global giant, Citigroup.... Citigroup, which has revenue in excess of £50 billion and assets I cannot apprehend. Sitting in these offices, sipping barista coffees, thinking of new ways to make life harder for us.... For which we are paying. No sooner can pharmacists wake up from this nightmare and take action.

*This comment has been edited to comply with C+D's community principles*

Brian Smith, Pharmacy technician

An MUR is basically a nice chat about a patients meds.  Pharmacists used to do this for many years without all the need for accreditation etc.  This was absolutely fine.  Speak to the patient in a quiet corner, sort any problems, patient sorted....job done. Now it's all box ticking, hassle, formal accreditation, time wasting, form filling, constantly harrassing busy patients, phone call after phone call from head office chasing targets, area managers getting on their high horses about every little thing, stickers, wasting paper, support staff time, being in and out of the consultation room when scripts need checking, keeping patients waiting.  MUR's are an absolute menace.  They cause so much trouble. All this for what was once a chat.

David Moore, Locum pharmacist

And to be struck off after a long, blemish free career is appalling

Benjamin Leon D'Montigny, Non Pharmacist Branch Manager

I feel after 45 years, particularly when he "Resigned on the spot" he was finished with his career in pharmacy and what we read was just the GPhC flexing muscle inefficaciously just to prevent a Sisyphean outcome?

Flagin Obi, Allocation & Distribution

The punishment does not fit the crime. I have always said that this  model that is practised in UK is s abhorent  to the core . How can educated pharmacist pay exorbitant fees to GPHC and GPHC does not even protect us ? If the GPHC regulatory function is to the Public which is noble ( I concur) then the Public , ie the Government should fund the GPHC. We the pharmacists  should channel our registration fees to a professional body designed to fight our cause.  I have never seen a profession so despised and downtrodden like the pharmacist. I repeat the GPHC has no business collecting dues from us as they dont represent us.Taxation with  No Representation.  I wonder how this anomaly became normal.......Too much use of Hammer for a fly

Jupo Patel, Production & Technical

It's very simple. GPhC is essentially run by Boots and the multiples for their own benefits. Individual pharmacists are harmless irritants to be swatted if they step out of line or dare to cross Boots/multiples.

D F, Primary care pharmacist

Being struck off for this does not seem fitting. I agree with T.Pharm and Shaun to name a few. My accreditation years ago was very simple and didn't really help - you find your own way to help and benefit pt's through mur  - accreditation now is more thorough. 

David Holdsworth, Community pharmacist

 

Just to confuse matters this is taken from PSNC site ;

. The community pharmacy contractor has the responsibility to provide the local NHS England team with a copy of the MUR certificate of all pharmacists providing the MUR service in the pharmacy before each pharmacist can undertake MUR consultations. However a local NHS England team may accept a copy of the MUR certificate from locum pharmacists, who may work in several different pharmacies, but there is no obligation on the local NHS England team to do so.  Because the contractor has the obligation to notify NHS England and produce a copy of the MUR certificate, many contractors may prefer to submit the copy certificate themselves, to avoid NHS England later finding the  contractor in breach.

What a bizarre carry on ! Is there no simpler way of running this?

I am also disgusted by this striking off.

T. Pharm., Community pharmacist

So, in a nutshell.... BEFORE any pharmacist(s) can carry out even a single MUR the contractor (i.e. employer) must first check to see even if the pharmacist(s) are accredited to do so?

Wouldn't that make superindendants at Boots/Honchurch Pharmacy just as accountable as Mr Ranson for this offence?

Will they be struck off? I think not.

 

 

Simon Clark, Community pharmacist

Why didn't he just do the course? I know it is harder if you're 40 odd years into the profession than fresh out of uni but surely there are people would have helped him. The real problem here is knowing he was wrong but doing it anyway, for a long time and repeatedly. Imagine forgetting to pay your fees, then realising but not doing something about it straight away....

Why didn't the employers who knew raise the alarm the first time? They missed an opportunity to help.

anonymous Pharmacist, Primary care pharmacist

I was wondering the same. Perhaps not used to online / computer training.

Raluca Chisu, Community pharmacist

"A pharmacist has been struck off the register after carrying out medicines use reviews (MURs) for more than two years when he knew he did not have accreditation.

Reginald Brian Ranson, registration number 2016749, carried out MURs for two-and-half- years in a Hornchurch pharmacy and in local nursing homes despite not being formally accredited to undertake the service, a General Pharmaceutical Council (GPhC) fitness-to-practise committee concluded at a hearing on November 16.

The GPhC noted that Mr Ranson – who was not present at the hearing – had been a registered pharmacist for “over 45 years without any blemish on his character”, and had described being “under extreme pressure” to meet MUR quotas.

But it pointed out that during his time at the pharmacy, Mr Ranson “dishonestly misled his employer” by undertaking MURs, despite knowing he was not accredited to do so.

...

In 2011, the Boots branch’s manager asked Mr Ranson to obtain his MUR accreditation certificate. Mr Ranson said he could not find this, but would request a replacement certificate from De Monfort University, the GPhC heard.

The GPhC noted that Mr Ranson had written to the regulator in 2013, claiming he had only provided MURs at the Boots branch when he “held a genuine belief that [he] was accredited to provide this service”.

However, the certificate did not materialise by the time Mr Ranson left Boots to join a Newlands Pharmacy branch in Hornchurch in Essex in 2012. The regulator concluded that by this point Mr Ranson was aware that he was not MUR accredited, but he omitted to inform his new employer." (C&D)

 

The quintessence of our profession is to be passionate and accountable for our work. 

"Humanum fuit errare, diabolicum est per animositatem in errore manere"(Sain Augustin,Sermons (164, 14))

Mr Ranson persisted in his error and breached the 7th principle from ethical code:"TAKE RESPONSIBILITY FOR YOUR WORKING PRACTICES."

Being with good intention, being good pharmacist, implies also to admit the limitation in order to avoid to put your employer in jeopardy.

After all you enter into a contract with clear terms...and the remuneration is provided by employer based on trust that your work is honest and professional.

What if any of us would have been the owner of the business where Mr Ranson provided these services?

Before we display a superficial judgement, let's start by being accountable for our work and then we will be able to be respected and considered equal partner with other healthcare professionals.

Hope to live that day!

 

sanjai sankar, Locum pharmacist

You should stick to writing in Latin...Its better than your English....

Paul Garcia, Student

this is very rude comment Sanjai

Rampant Locum, Community pharmacist

no its not ...he commended his latin....

Akbar Aslam, Superintendent Pharmacist

...

Meera Sharma, Community pharmacist

Raluca, you are confusing the legal issues with the competence issues. By virtue of his experience, this particular pharmacist is more than competent to carry out an MUR - he does not need a certificate to prove his competence. He is legally required to have a certificate for contractual purposes. Breaking this rule does not make him irresponsible or incompetent, just a pharmacist who made a mistake. The punishment doesn't fit the crime, it is much harsher for reasons best known to the GPhC!

Sau Sheung Yuen, Pharmacy Area manager/ Operations Manager

My question is had he not been subjected to undue pressures to perform MURs would he still have done the same? Be real, my guess is there are more than one culprit here! If his branch manager did not asked for his accreditation certificate for 2 years, we have a case of negligence and management failure here right away - the GPhC would have, of course, denied responsibilities here if he/she is a non-pharmacist. Do I think the GPhC is doing the job they are supposed to do? No. In addition, I wonder how this came to light ... stinks.

Shaun Steren, Pharmaceutical Adviser

Is there anybody saying he is not accountable for his actions? Is there anybody saying what he has done is not wrong? No, there isn't. Pharmacists are merely showing some empathy for a fellow pharmacist who has made an error in judgement. Applying context to his situation and considering relative justice is a perfectly reasonable thing to do. Do you see everything is such a black and white manner or are you being purposely obtuse? 

 

Lucky Ex-Locum, Superintendent Pharmacist

Are you personally utterly perfect? Never made a dispensing error? Thought so....

Allan Postgate, Non Pharmacist Branch Manager

I'm in the possibly unique situation of being MUR Accredited but have never done an MUR.  (For anyone who is interested, I did the course just before I retired, and only to work through it with my wife who is still practicing).  I thought the course and the exam were of very poor quality and, had I wanted to do MURs, I don't think I felt any better qualified to do them after becoming accredited.  So I feel this poor pharmacist should have got his certificate, but it wouldn't have made any difference to the quality of his MURs.

Chemical Mistry, Editorial

A once proud profession and now it comes to the stage where a pharmacist who looks at indecent pictures of children on his computer and convicted paedophile is suspended for 12 months and this pharmacist is struck off in my book it should be the other way around.

Glad I left and never looked back, best wishes to the pharmacist hope pharmacist support will be there for him if needed.

 

Pharmacy Helps People , Make Some Noise, Manager

Shame he couldn't talk to his bosses and get support to become accredited. Shows you how lonely it is working in the frontline of pharmacy care.

MURs are recycled money removed from the old drug budget, if you do it properly you enhance understanding of medicines and purpose of prescribing and also  improve compliance and get buy in from patients to discuss medicines and side effects with you .

 

 

John Randell, Non Pharmacist Branch Manager

Why aren't chemist and druggist covering the land mark case of the Belfast pharmacist who made a dispensing error that lead to a death but was not charged with manslaughter.... Please please please get the lawyer guy from your website..Charles I think to go through this.....this is breaking news...we should have to go to the BBC for news like this.....

Robin Conibere, Primary care pharmacist

Very sad that it came to this, what about the responsibility of the employer/Superintendent to ensure the pharmacists employ are accredited to provide services (in 2006?) did they not ask for a certificate then?

A long and distinguished career ended when he realised in december 2010 that he was not accredited to provide MURs he continued to provide them and gave the impression that he was accredited, all could have been stopped by saying "I thought I had, but I haven't so until I have completed the accreditation I can no longer do them"

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