Why do we have community pharmacists? Why doesn’t the government hand over the supply function of medicines to a large distributor like Amazon or use the spare capacity of hospital robots? Why doesn’t it allow all GPs to dispense medicines?

The answer is that community pharmacy adds additional value to the dispensing process. But only at two points. At the beginning of the process – when performing a clinical check – and at the end, when handing out medicines to the patients and interacting with them.

Everything else can be delegated to trained staff or even automated using a robot.

Medicines use reviews (MURs) were introduced by the government to formalise and record some of the interactions between patients and their pharmacists. They were the government’s first attempt to pay pharmacists for delivering more to patients than simply providing a supply function with checks and balances.

At least 55% of patients don't take their medicines correctly and are therefore being treated sub-optimally and not getting the most from their medicines. The MUR service was an attempt to improve concordance and therefore long term patient outcomes with the accompanying savings to the NHS.

Pharmacists were at last going to be recognised for doing something that good pharmacists had always done. We were encouraged to speak to our patients, to ask them if they knew how to take their medicines correctly, identify any side effects they were experiencing, and therefore maximise the cost effectiveness and benefits of their prescribed medicines.

There were some caveats. We are only paid for a maximum of 400 reviews per year, on patients taking multiple medicines and only if the conversation takes place in a consultation room.

Part of the solution

There are no criteria around who or what would be "appropriate". There is no need to find a serious medication issue or to make a clinical intervention. Indeed, isn’t that the role of the initial clinical check?  An MUR is simply a service provided by a pharmacist to check that a patient is using their medicines correctly, paid for from money that was taken from dispensing fees when the community pharmacy contract was changed in 2011.

The NHS is obviously under severe pressure, nowhere more so than at GP surgeries. Many areas are finding it impossible to recruit new GPs or even practice nurses.

 I believe community pharmacists can form a large part of the solution. We can help on many fronts, but a quick win is to use the most straightforward MURs, the ones that some C+D readers call “inappropriate”, to ease some of the burden on GPs.

Repeat dispensing

A pharmacist doesn’t know what the outcome of a MUR will be until they’ve done it. It’s impossible to predict if they will have to provide a significant clinical intervention or not. So let’s assume they don’t. Let’s assume the patients know how to take their medicines. Let’s assume they aren’t experiencing any side effects and that they are taking them regularly and appropriately as prescribed.

Wouldn’t this person be an ideal candidate for a repeat dispensing service? Let’s say the average GP practice has 2,000 of these stable patients on multiple medications. Most of them wouldn’t have all their medicines synchronised, so would probably be requesting repeat prescriptions from the surgery at least twice per month. That’s 4,000 interactions with the surgery each month, or 48,000 per year.

Signing these patients up to repeat dispensing for their regular medicines and synchronising their prescriptions would mean they would only interact with the surgery once a year – that's a total of just 2,000 annual interactions for the surgery. A massive reduction in the prescribing burden of that practice.

Not only that, the patient would still visit the pharmacy 12 times per year, within a timeframe that the pharmacy could predict. If the patient isn’t collecting their medicines at the correct time, then the pharmacist could identify non-compliance and make an intervention if needed, adding further value to the dispensing process.

Talking to patients about their medicines is always a good thing. If that conversation is formalised into an MUR, a benefit to the patient and the NHS overall can be realised, whether or not a new issue is discovered. No MUR on a consenting patient is ever “inappropriate”.

Paul Mayberry owns a chain of six pharmacies in south Wales
 

Do you agree with Mr Mayberry?

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