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'No evidence MURs are clinical or cost effective'

An evidence review commissioned to inform the Murray report into pharmacy services has suggested commissioners learn from the failings of medicines use reviews (MURs).

While the service was introduced in 2005 to improve medicines adherence, and revised in 2015 to ensure a greater proportion of reviews are delivered to target groups, “there is currently no evidence for the clinical or cost-effectiveness of MURs”, the review’s author suggested last month (December 14).

The review – which was completed before the funding cuts were implemented on December 1, 2016 – states that the implementation of MURs was “unstandardised from the outset, resulting in significant variability in delivery”, and has led to inequity in access to MUR provision across England.

The review's author David Wright, professor of pharmacy practice at the University of East Anglia, pointed to the fact that independents are less likely to offer MURs.

MURs are expected to be delivered “in addition to” the essential services pharmacies already provide, which has resulted in increased workload and pressure on pharmacy staff, he said.

With a lack of evidence of the cost and patient benefits, “national funding of the MUR service requires review”, Professor Wright concluded.

Influence on future service provision

The Murray report, which Professor Wright’s review helped to inform, stopped short of calling for MURs to be scrapped altogether. Instead, it recommended to NHS England last month that the service be "redesigned" to include "ongoing monitoring and regular follow-up with patients".

Professor Wright said: “The problems found with MURs largely derived from training, service introduction and service targeting.”

These problems would have been identified if the service had been “appropriately feasibility-tested with a view to service refinement”, he added. 

"[The issues with MURs] need to be carefully considered and addressed within any newly commissioned community pharmacy services," he concluded in the report.

GPs don't see value in MURs

The potential benefits of MURs are also not being maximised because of a lack of support from GPs, Professor Wright said.

While patients have been broadly positive regarding MUR provision, GPs have been “less so”, with many reporting an “unnecessary duplication” of workload and pharmacists making clinical recommendations beyond the original remit of an MUR.

“Negative perceptions regarding the value of MURs by GPs may result in non-implementation of recommendations, which further reduces their cost-effectiveness," Professor Wright said.

While giving pharmacists access to the summary care record might help reduce some of the duplicated work, “it will not remedy the lack of collaboration between the two professions”, he warned.

This is the second of C+D’s three-part analysis of Mr Wright’s evidence review. You can read the first article here and look out for the third article later this week.

Readers have been discussing the future of MURs on C+D's LinkedIn group. Share your views by joining the discussion here 

What would improve current MUR provision?

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