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

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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?

will cockburn, Community pharmacist

The quality of an MUR is dependant on the pharmacist providing it. How does a multiple MAKE a pharmacist perform a poor MUR. It is tough being a professional. The way you work is ultimately your choice.. it might not be perfect but if you think you’re own work is rubbish then the problem is there for you to fix. ... as hard as that might be 

Peter Smith, Student

How does a multiple make a pharmacist perform a poor MUR?

Let me explain. Nowadays, pharmacists are usually pharmacy managers, which means they have dozens of jobs to complete during their shifts. With MURs attracting £28 for something which can be done in under 10 minutes, they are a cash cow for the big multiples. As an example, Lloyds earn around £17m if their pharmacies all hit 400. Pressure comes from the top, down to the area manager to get this money, however, there seems to be little understanding of what MURs are and why they exist, they only understand the money.

This is why you will always be asked "how many have you done?", and you will NEVER be asked what the outcomes were - the multiple doesn't care about the patient and what you discovered in the MUR, they just want the £28 and could not care less about how you get it.

Therefore, pharmacists are CONSTANTLY hassled and pressured about their MUR performance, and are not alloted any additional time to perform them. As fake MURs will have you off the register faster than you can say "pharmacy sucks", the only option when you have no time is to perform MURs on anyone who is technically eligible - pharmacists therefore will tend over time to rush them just to get the tally up and keep the rude area manager from constantly ringing or naming and shaming you on the group emails.

It is much easier to perform an MUR on someone taking paracetamol, cetirizine and levothyroxine, than on a patient on 12+ meds, which means pharmacists will be tempted to get the quick one rather than the one which could take 20-30 minutes, when it's the person on a dozen meds who would be more likely to benefit. This completely defeats the object of the service, but as the company just pressures you into performing "an MUR" without caring about the quality or allowing you any time during your shift for them, over time the quality of MURs will go down, with pharmacists doing the barest minimum to qualify for an MUR payment rather than spending a proper amount of time with the patient and providing a real service.

Interleukin -2, Community pharmacist

What you just described above is the reality on the ground and we are all collectively guilty of this.The MUR chapter in 50 years time will be taught to pharmacy students or whatever they'd be called long after we all gone as one of the biggest scandals in pharmacy history, in a text akin to Dale and Appleby...it will be in the chapter right after [email protected]

Peter Smith, Student

I wouldn't say that the pharmacists on the ground are guilty of anything, they are just trying to survive whilst being forced into carrying out useless tick box exercises, which help nobody, just enrich the employer.

C A, Community pharmacist

In these days of self care it would be quite easy to do a good MUR on someone on paracetamol, cetirizine and levothyroxine, and probably benefitial for the surgery as well so there is less push back when they deprescribe.

Also with the new targeted MUR categories, there are only so many MURs that you can do on patients on the like of paracetamol, cetirizine, and leveothyroxine (120 untargeted MURs per year).

How High?, Community pharmacist

I'm not against MURs per se.

Unfortunately as soon as a cap was introduced the multiples read that as "target". This led to pressure on pharmacy teams to deliver the magic 400.

This in turn led to low quality, rushed, botched and pointless MURs dressed up to hit the targetted percentage and that mythical 400.

However I wouldn't want to see us lose the money so my proposition would be make MUR delivery a core service with no additional funding and allow pharmacists the professional discretion as to when these (what can be) valuable interventions should be made. However zero delivery = zero practice payment.

I'd then like to see that money made available to fund a proper national common ailment service or other service desperately needed to take pressure off GP practices and other areas of the NHS.

Yes I'm a pharmacy manager and not an owner. Yes I've performed 400 MURs every year since they were introduced with no personal financial gain. Yes 98% have been an utter waste of time but around 2% have saved lives each year and I'd be sad to see the trust that patients now give us thrown away because a few folk can't handle a bit of pressure from their employers........

C A, Community pharmacist

There is a problem with your suggestion - there no longer is a practice payment, and the Government is against it, so it's not coming back, as they see it as subsidising Pharmacy.

Marc Krishek, Pharmaceutical Adviser

don't throw the baby out with the bathwater

Adam Hall, Community pharmacist

Two points:

First, 112 respondents out of a registration population of 55258 is 0.2%. Of that 112, those that want MURs scrapped is 68 - 61% of respondents but only 0.1% of registered Pharmacists. Now, it has been a long time since I did any statistics, but based purely on common sense, it is disingenuous on the basis of this ad hoc poll to say that 61% of Pharmacists want MURs scrapped

Second: Money for MURs was money taken away from contractors in the first place. All this was doing was giving us back our 'own' money for doing something (talking to patients about their medication) on a more formal basis. It's fine for people to complain about pressure to provide MURs but, as N.O. has said, be careful what you wish for - no money to contractors = no money to locums

 

 

C A, Community pharmacist

Have you learnt nothing from Brexit, numbers don't matter, statistics don't matter, it's a simple Majority Vote!

Benie I, Locum pharmacist

So keep them you suggest because it was money originally taken away. What about a new service where you have to tickle 400 patients every year too keep the money? Would that be okay Adam?

David Moore, Locum pharmacist

I'm not surprised there's a desire to scrap them. They have been much abused by the various head offices.

N O, Pharmaceutical Adviser

I would read it as 68 locum pharmacists (who are unable to get a long term booking due to not performing MURs) want MURs scrapped.

Next, these same people would say they want all the services to be scrapped, where the payment is rather made to the contractor and not to them directly.

If and when the NHSE and DoHS takes their side and scrapps all paid services, this will lead to only dispensing role for the Pharmacist. Hence, all the major chains and indi chains will full fledgedly support 1) Hub & Spoke 2) Remote Supervision 3) Pharm Techs can give out medicines. Which would then result in Pharmacists ending up either as Pharm Techs/ Dispensers or taking new career path and finally (may be) on Universal Credit.

So, ONLY IN MY OPINION, please choose carefully what you wish for. If your paymaster don't get paid = you don't get paid. Simples!!!!

Ronald Trump, Pharmaceutical Adviser

I smell a contractor.

N O, Pharmaceutical Adviser

No need to smell. Any sensible person would agree with what I have written. No secrets about it.

Interleukin -2, Community pharmacist

I think you've just been busted. The reek ifi dare say  is that of greed and profit...not ptaient health

Benie I, Locum pharmacist

Do you work for a multiple

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