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61% of pharmacists want MURs scrapped, rather than cap of 400 amended

Exclusive
Readers were asked whether the cap on the number of paid MURs should be amended
Readers were asked whether the cap on the number of paid MURs should be amended

Three fifths of pharmacists and pharmacy staff are in favour of scrapping the medicines use review (MUR) service completely, a C+D poll has suggested.

When asked whether the cap on the number of paid MURs should be amended, 61% – 68 of the 112 respondents to a poll, which ran on the C+D website from May 1-10 – said the service “should be stopped entirely”.

A further 19% said the MUR cap should be removed, while 9% of respondents said the current cap of 400 a year should be raised.

Just 6% of pharmacists and staff responding to C+D’s snapshot poll were in favour of keeping the current cap, while 5% voted to lower it.

The Pharmaceutical Services Negotiating Committee has said discussions around the future of the MUR service will form part of negotiations for the 2019-20 pharmacy contract, which officially began last month.

Result

Should the cap of the number of paid medicines use reviews be amended?
Yes, it should be removed
19%
Yes, it should be raised
9%
Yes, it should be lowered
5%
No, it should remain at 400 a year
6%
The service should be stopped entirely
61%
Total votes: 112

What’s next for MURs? Read C+D’s analysis on the future of the pharmacy service and pharmacists' thoughts on whether it should be redesigned, refined or scrapped.

47 Comments
Question: 
Does your pharmacy deliver 400 MURs a year?

Alastair Carmichael, Pharmaceutical Adviser

What a pointless article! Lose the MUR funding and it will be lost forever. Pharmacy needs to prove this is a vital service in the healthcare industry, not just be lazy and kick it into touch!

And message to PSNC - stop giving Pharmacist advice away for free!! No other professional body would allow this to continue.

The NPA campaign of "Ask Your Pharmacist" was the most naive and damaging promotion in the history of modern Pharmacy - discuss!  

R A, Community pharmacist

Does anyone else feel like Community Pharmacists are like the "Dodo" waiting for the coup de gras?

Community Pharmacist, Community pharmacist

Only those who behave like Dodo's.....

Peter Smith, Student

After years of abuse, bullying, and inappropriate pressure at the hands of not very bright area managers, I started suffering from mental health issues and had no choice but to quit pharmacy and have my name removed from the register. MURs were a big factor, I was harrassed even on my days off about my branch's MUR performance. I remember one occasion when I managed to perform 35 one week to get ahead before I went on holiday (the locums never did them), and guess what the area manager said? Not "well done", but "well, if you can do that many last week, surely you can do that many every week!".

It beggars belief, this is no longer a profession that I want anything to do with. GPhC and RPS do nothing, pharmacy minister does nothing, chief pharmaceutical officer does nothing, PSNC do nothing, it's a complete joke. The government clearly wants to get rid of bricks and mortar pharmacies and move to an Amazon-style delivery model, circumventing the need for an expensive pharmacist entirely. Bad luck if you're studying for a pharmacy degree, I mean you can't blame the government for wanting to cut costs - just a shame that pharmacists don't do anything, they get walked all over like a doormat, which encourages the government to make further cuts because pharmacists are a soft target and don't stick up for themselves like doctors do.

I wouldn't wish my experience on anybody, I felt like I really hit rock bottom and ended up losing all my savings and even going into debt because I couldn't work for so long. However, if there is a silver lining to all this, it is that I got away from pharmacy and found alternative work, nothing at all to do with pharmacy in the slightest. It's such a massive relief for me when I wake up every morning and realise that no, I don't have to go and work in an understaffed pharmacy with a huge queue of customers, 50+ EPS scripts still on the screen from the previous day, and a rude area manager who sets totally unrealistic targets for my team and only employs staff with zero pharmacy experience.

Community Pharmacist, Community pharmacist

Sorry to hear of your pain brother.I strongly advise using the PDA and GPHC to expose the bullies and have them criminalised for their abhorent behaviour chasing profit before service ....It's never too late if you are with the PDA for a retrospective claim for damages...You are not at fault  but their inappropraite actions have destroyed your professional career and that's simply unacceptable...Bullying a professional should carry a hefty criminal charge and a lawyer could advise on this.There would be a long queue of  MISmanagers for the dock...Bullying is actually illegal...The day the balance tipped from Independent Profession to corporate wage slavery was the start of the end...Cheers Lloyds,Boots,Well etc etc  NOT ....In addition, the 'management' in these faceless shareholder mouth feeding machines (not hubs...quite yet)is replaced /relocated/made redundant every 2 yrs... so all experience (very little) in Pharmacy is lost...Hence todays shambolic scenario in multiple pharmacies ...However, independents who benefit from multiple gross management incompetency continue to thrive as they satisfy real customer needs.Unfortunately some would  rather chase the latest trendy, poorly funded,'Blue sky services' dreamt up by desk jockeys climbing up the NHS/Corporate greasy pole of 'success'.....

Interleukin -2, Community pharmacist

PDA and ...... 

Lucky Ex-Boots Slave, Primary care pharmacist

If we were to report all the bullies then we are talking about reporting thousands of branch managers and area managers. And what makes you think GPhC will care? They never did and never will. PDA could be of help but there is so much they can do about these.

Anyway I'm outta community sector now and it's the best decision I've ever made. 

Peter Smith, Student

Unfortunately, I am now off the register, have no PDA cover, and obviously wasn't thinking straight at the time so didn't go to the length of using an app on my phone to record some of the conversations (I wish I had). I always found the rudeness and pressuring tactics very distressing, I'm not someone who deals wth confrontation well at all. So it would be one person's word against another, and after what I've been through taking any kind of legal action is the last thing that I want to do. Happy to have put it behind me, instead of blindly trying to grin and bear it, life's too short to risk your health for the monetary gain of an immoral conglomerate who would do anything to get an extra pound on the balance sheet, just look at the way some of these companies deal with their tax affairs.

Had I been smart enough to record everything in a diary and forward the emails to a private email account, there would have easily been enough to prove their wrongdoing, although going up against such nasty people is something I will have to leave to someone else, I know that others have had similar experiences with some of the people involved in my story. I don't know why you suggested contacting the GPhC - they certainly would have not been any help at all. They have made it clear that they do not exist to help pharmacists, in fact the opposite is true.

My employer knew exactly what was going on in my pharmacy, they knew very well that there were patient safety issues and a severe skill shortage, because they insisted on employing students and delaying their training, and only using the cheapest possible locums. They knew about the gross level of understaffing and how this was endangering both patients and the well-being of staff, because I raised it on more than one occasion, but as money would need to be spent to correct the issues, nothing was ever done. I was not allowed to offer overtime to the staff, and had no say in the hiring of new staff. Every possible corner was cut to save pennies wherever possible, and the exodus of competent staff to competitors begun, resulting in even more pressure on the poor remaining staff. It was a complete and utter disaster. They even prevented me from taking holiday at any time in the year where they couldn't find a locum for a rock-bottom rate, it was horrendous, and even forced me to cancel my holiday plans on more than one occasion, which caused me to lose quite a lot of money on various things I had booked.

I can't have been alone in having to deal with these kinds of conditions. When I spoke to my area manager about the staffing levels, I was told "if you can't manage, we will find someone who can".

Ronald Trump, Pharmaceutical Adviser

The way you were treated Peter really sucks and many pharmacists, including myself, can relate to much of what you said in your posts. Good on you for speaking up and I hope you have found a job in which you are treated fairly and with respect. But most of all I wish you happiness and good health in life. Another piece of anecdotal evidence of the situation! Do the GPhC, RPS and PDA read these threads...who's gonna stand up for the pharmacists on the ground?! Good news is that it seems the tide is changing with MURs and a power shift towards individual autonomy. Multiples ruined the game.

 

Ronald Trump, Pharmaceutical Adviser

So from reading this thread we've learned nothing new. Contractors/Pharmacy Owners/ Multiples want MURs to stay because theyre afraid they'd lose the money. Employee/ Locum Pharmacists want them scrapped because they believe they are a waste of NHS money and being abused by pharmacy owners for profit and to put pressure on pharmacists to deliver the services they dont believe in.

Ask yourself this guys...who is the paymaster of the NHS contract? THE NHS! It's taken years but finally the NHS has woken up and smelt the coffee. The current MUR model is not fit for purpose and doesnt allign with NHS future strategy. I'm so glad MURs are going to change and pharmacists may be relieved of the relentless pressure and passive aggressive emails from management to perform this unwanted service. They may also feel now that they can gain some professional autonomy back and have more time to choose the patients that would gain the most benefit from their help. RIP MURs. Lets get the money reinvested into treating minor illness and ...what people actually want as they cant get a GP appointment for love nor money!

 

 

 

 

Ronald Trump, Pharmaceutical Adviser

Pharmacy is changing. Contractors, if you're nearing the end of you're career/ close to retirement and you dont want to change, evolve and develop your ways of working then please sell and enjoy your retiremnt, or find another job. Sell to a pharmacist who is going to embrace change and move community pharmacy forward into the modern world. Sell to someone who is going to embrace digital change and automated technology. Someone who is going to develop themselves professionally and learn, so they can offer really useful services to the public that meet the demands of a changing healthcare landscape. Please do not moan that you are losing 12k a year on a poor service that is ripping off taxpayers money. Its very greedy!

SP Ph, Community pharmacist

"Lets get the money reinvested into treating minor illness"

Are you not aware of pressures on Pharmacists/ Managers to increase the number of interventions in the areas where this service is locally commissioned???

Any new service which draws a FEE from NHS will have targets, don't you think? 

Just because some don't want to interact with people and discuss their medicines and instead stay in the dispensary, don't blame the service to be ineffective.

As a BUSINESS, every contractor is entitled to make money for providing a service to the community. That's how they pay the staff (whatever they pay) and any drop in their income will have a direct impact on their pay and jobs.

Why no one complains about the NHS/ Gov spending millions/ billions on un-necessary consultations, consultants and so called experts, when the problem can be solved with using commonsense???

Ronald Trump, Pharmaceutical Adviser

If targets are set by management for treating minor/acute illnesses then I would argue this is unethical and unprofessional. Certainly, regionally where I work it is written specifically in the PGD/service spec that that there should be no targets set for such a service where the onus is mainly on the patient to access the service.

I'm not saying the service is ineffective because some pharmacists 'don't want to interact with people and discuss their medicines and instead stay in the dispensary'. I'm saying the current community MUR model is not fit for purpose, does not allign with future NHS strategy, and is being used by multiples to rinse the NHS of money that could be better spent elsewhere in community pharmacy.

Your last poiint on consultants being un-necessary and that we can solve most consultant referrals with commonsense has cracked me up lmao

SP Ph, Community pharmacist

"Your last poiint on consultants being un-necessary and that we can solve most consultant referrals with commonsense has cracked me up lmao"

You seem to assume lot of things and don't read properly. The consultation/ consultants and experts in my sentence are not medical professionals but those sitting in the ivory towers and suggesting what the NHS or Gov has to implement to save money!! Its more like spending £1 for saving 50p and leading to reduced services and chaos. Got it??

Interleukin -2, Community pharmacist

And why do you have that view if I may ask ?

Ronald Trump, Pharmaceutical Adviser

My bad SP Ph! That type of consultant...Got it! Don't be mean!

Chris Pharmacist, Community pharmacist

''so they can offer really useful services to the public that meet the demands of a changing healthcare landscape.''

What services? There is no remuneration for them and no evidence that this is going to change in the future. Pie in the sky thinking that 15 years after the 'New Pharmay Contract' with minimal roll-out of services that this is going to dramatically change in the near future.

Your post is just a series of bs phrases and David Brent style management speak.

Ronald Trump, Pharmaceutical Adviser

You have to think outside the box, design new services and fight for remuneration for them Chris, thats the point. Replace the MUR money with money for a service that you patients wan.

SP Ph, Community pharmacist

Your comments really make me LOL. You are suggesting to dismantle an existing system and then spend time and money creating a new system with no hope of getting a funding. And when it gets funding, get booed by these same people about how pressurising the service is. Unless the contractors get paid well, no matter what services patients want they won't be implemented/ successful. Unless, all those dis-satisfied Locums form an association and approach the NHS/ Gov to provide these services from a location other than the Pharmacy. Is this possible??

Ronald Trump, Pharmaceutical Adviser

Please read Peter Smith's comment below- if you dont think thats a problem then you're blinded by contractor greed.

Sanjay Mistry (Pharmacybox), Community pharmacist

Not a great poll and majority of repsondents must be working for the larger multiples. 
MURs go.. so does the livelihood of a pharmacy team member in my opinion. Yes we know all the cons of MURs but there are pros if you do them correctlyworking with the surgery. Medicine reviews are useful to patients but as pharmacist we think it is straight forward as we assume patients know all the basic things. 

I wont go on but if MURs are taken away then I fear that funding will not return to the community pharmacy sector again and as a whole we will all be worse off. 

Jovin Mulloor, Community pharmacist

I agree. This is just another way to take funding off pharmacy. MUR was part of the funding, irrespective of whether you do it or not, then it was capped to those who did up to a maximum of 400 and now it will be completely scrapped.  It's a way to make more cuts.  GPhc is worried about protecting the public and RPS (never understood what they actually do), this is our downfall, as we don't stand together and not represented like the Drs. 

 

C A, Community pharmacist

"I wont go on but if MURs are taken away then I fear that funding will not return to the community pharmacy sector again and as a whole we will all be worse off. "

Yes, in these challenging times I don't think it would be easy to hold onto the money, there is no chance it would go back into the global sum, so it's entirely possible Community Pharmacy would just say goodbye to another £100 million of funding, I'm sure the Government would be happy with another "4% efficicency".

Chris Pharmacist, Community pharmacist

MURs have little value. Randomly selecvting patients for a discussion regarding their medicines unsurprisingly discovers very few meaningful or significant interventions. Of course the multiples have just turned them into a weekly/annual target further rendering them useless.

Community pharmacy has a great deal to contribute in terms of reducing pressures on surgeries by resolving minor ailments and this should be expanded to prescribing rights in an initial small number of areas eg eye infections, UTIs, impetigo, eczema emollients, etc...monitor and expand our repetoir if successful.

 

Clive Hodgson, Community pharmacist

The MUR “clinical service” has caused much damage in CP because of its very poor design/financing and especially in that it can be set as a numerical target purely for the revenue it generates.

Is anyone aware of anything else that has proved so polarising and divisive in CP?

Paul Roberts, Accuracy checking technician

Mur has become nothing more than a stick to beat pharmacists with masquerading as patient care. Everyone knows pressure is put on pharmacists to achieve the magic 400. Why? Cash. It is a gross waste of NHS money and a pharmacists life would be much better off without it to stop bosses higher up making life intolerable in some cases. I am not a pharmacist nor would I want to be with the current state of affairs. If MUR goes then good riddance.

Kelvin Chang, Primary care pharmacist

The concept of MUR and NMS should really evolve, there is hardly any benefit from the patient’s perspective if it’s only driven as a target. Giving an example, patient on more than 4 medications (3 antihypertensive and 1 statin).

60% of Pharmacist would just check compliance and check if any side effects then get a signature. (Good effort)

30% of Pharmacist would ask more about QRisk related questions like smoking status, dietary control, any pre-diabetic status, risk for obesity. (Fantastic review)

10% of Pharmacist would just get a signature then say goodbye. (Worst Practice)

Likewise, same for Asthma/COPD reviews and Mental health reviews. Pharmacist should be more clinically driven, approaching patients in a more holistic point of view.

Therefore, I do think MUR/NMS is essential as part of advanced service ; in fact more fundings should be invested in it incorporating elements of QOF from primary care in given circumstances where patient is disengaged with their prescribers and only ordering repeats ; Not getting routine review ; Pharmacist can acts as a checkpoint for significant harm reduction.

V K P, Community pharmacist

the MUR is a medicines USE review and not a clinical review. the surgery would like the CP do all the work for them and meet all their QOFs so that they can cash in the money and the CP do it for free. enjoy moving to the other side. good riddance. thankfully a contractor is not loosing out employ someone like you.

Interleukin -2, Community pharmacist

Pls kindly and patiently explain to me the difference " practical terms pls" between a medicines review and a clinical review ? I need to get this crystal clear, pls bear with me as I know it  sounds like a dumb question.

will cockburn, Community pharmacist

Sound comments.. aiming to develop care and the role. Make this approach  your editorial stance C&D. But community is not the surgery .. and I don’t think patients want it to be.

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