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Revealed: MUR levels fall in wake of newspaper allegations

NHS data shows the number of reviews delivered across England fell 15% in the three months after the Guardian article was published

The number of medicines use reviews (MURs) carried out across England dropped in the wake of newspaper allegations that some of these reviews were being conducted solely for profit, a C+D investigation has revealed.

The Guardian published an article in April claiming that managers in Boots branches were instructing staff to carry out unnecessary MURs to maximise income from the service. Boots said at the time that it did “not recognise” these claims.

An exclusive C+D data investigation has since revealed that the number of MURs delivered by both independents and multiples declined by 15% in the three months after the Guardian’s article was published, from around 302,500 in April to around 258,300 in July (see graph, below).

MURs delivered by all pharmacies in England

The number of MURs delivered by Boots’ branches in England fell by a steeper rate of 18% – from 57,000 to less than 47,000 – between April and June 2016. In March, the month before the article, the number of MURs it delivered stood at 55,275 (see graph, below).

MURs delivered by Boots branches in England

However, Boots’ MUR performance bucked national trends by bouncing back to more than 52,000 in July, the data, obtained by C+D from the NHS Business Services Authority (BSA), revealed. According to the BSA, this coincided with “approximately 70” Alliance pharmacies being recategorised as Boots branches. The data also showed the average number of MURs delivered per Boots branch went up from 25 to 27 over the course of June.

'No assessment framework' for Boots MURs

Boots declined to comment specifically on the figures.

In response to a freedom of information request, Boots general counsel Andy Thompson told C+D: “There is no framework to assess the performance of pharmacy managers that specifically relates to the delivery of MURs.”

Boots also said it reminds “both pharmacists and managers that professional judgment – and not commercial pressures – should be used to determine whether a patient receives a MUR”.

The number of MURs conducted at Boots stores has increased slightly – by 2.3% – in recent years, from 762,000 in 2013-14 to 780,000 in 2015-16, C+D’s investigation revealed.

Overall MUR trends

Lloydspharmacy, the UK’s second-largest multiple, saw its total number of MURs fall slightly from 46,297 in April to 45,160 in July, despite taking on almost 270 of Sainsbury’s pharmacies during this period, C+D’s investigation revealed.

Lloydspharmacy told C+D it encourages each of its branches to reach the target of 400 MURs a year “where eligible”. While the multiple insisted all of its MURs are “clinically appropriate”, it added: “When we are made aware of any inappropriate delivery of MURs, this is addressed.

“Our performance review framework includes progress against values, behaviours and business objectives. In addition, discussions are held regularly between each pharmacist and his or her line manager.”

How are allegations of service pressures being addressed?

The Guardian’s allegations of unnecessary MURs being conducted at Boots were based on findings from the Pharmacists’ Defence Association’s (PDA) survey into workplace pressures at the multiples.

In response to the findings, the General Pharmaceutical Council (GPhC) pledged in June to conduct a “programme of work” to “build a greater understanding of workplace pressures within [community] pharmacy and to discuss how these issues could be addressed”.

However, at its meeting on October 18, GPhC chief executive Duncan Rudkin stopped short of urging individual companies to resolve the issue, instead saying it is up to everyone in the sector to create a “corporate culture” to tackle workplace pressures. 

What do you think: should MURs be scrapped or altered? Or do you see the value in them? Join in the debate with C+D’s LinkedIn group here.

Listen to C+D’s exclusive interview with PDA chair Mark Koziol about the MUR investigation here.

What’s next for MURs?

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