Kristoffer Stewart on MURs: Dishonest practice surrounds us
The issue of unnecessary MURs is found across pharmacy, says C+D's clinical editor
The allegations that Boots is encouraging pharmacists to carry out unnecessary medicines use reviews (MURs) is as much of a revelation as millionaires dodging tax. This behaviour is most definitely not confined to Boots. It just happened to be the biggest – and arguably one of the easiest – targets.
I can’t speak for all my peers, but I feel confident most pharmacists have felt under pressure to carry out additional services at some point – a view reflected in C+D’s 2015 Salary Survey. This pressure can have a number of causes. Some pharmacists may want to prove their worth, show that the sector can make a difference, and that they should be considered on an equal footing to doctors and nurses.
However, there are also less noble pressures – usually financial. I’m not arguing against reimbursement for providing services, but in some pharmacies, the management see service funding as their right, rather than a privilege.
As a locum, it’s not uncommon to be told that you need to carry out MURs to ‘help’ the store reach their targets. This is something I have come to consider the norm.
I have been part of “Friday morning reviews” to discuss how “we” haven’t reached service targets for the week. In one independent pharmacy, I received a talking-to because I gave advice on inhaler use to an elderly patient, but didn’t get an MUR consent form signed. I have also worked in a pharmacy that was run as if it were a coffee shop. MURs were treated like latte sales – just another target.
The pressures I feel personally as a locum are twofold. Firstly, this is my livelihood. If I don’t perform as expected I may not be invited back to work. Secondly, I am often offered a higher locum rate depending on the number of MURs carried out. Although I have scruples, how am I to resist the temptation to earn more money just by saying a few words and getting a signature on a page, regardless of whether the patient benefits?
Actually I do care, just like the majority of pharmacists I have worked alongside. They work tirelessly day in and day out to ensure their patients have the best possible care. They certainly do not do it for praise; they do it because they feel both morally obliged and because they get a sense of satisfaction from helping people.
I think the allegations brought against Boots – regardless of their accuracy – are a stark reminder that dishonest pharmacy practice surrounds us. It lingers in corners and the ‘bad apples’ in the profession gives all of us a bad name. It is no wonder that when new services – such as the national pharmacy flu service – are introduced, we find GPs opposing us. Many still see us as health professionals hoping to turn a profit, at a cost to both the NHS and the quality of patient care.
To reassert our moral authority, we each have a responsibility to ensure patients come before profit.
Kristoffer Stewart is CPD and clinical editor of C+D, as well as a locum community pharmacist. Email him at [email protected] or contact him on Twitter at @CandDKristoffer
Read readers' reactions to the MUR abuse allegations here.