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Could MUR allegations undermine sector's funding cut fight?

Rob Darracott: Pharmacists must prove MURs' worth for future services to be commissioned

Pharmacy Voice chief Rob Darracott says claims that Boots staff are pressured to carry out unnecessary MURs have caused "significant harm" to public perception

The sector “does not have time to turn inwardly” in the wake of allegations that Boots pressured staff to abuse medicines use reviews (MURs), Pharmacy Voice has said.

The Guardian published an article last week (April 13) accusing the chain’s managers of treating the government’s 400-MUR cap as a “target”. The newspaper also claimed that one Boots pharmacist from the Midlands had been instructed to carry out an MUR on a patient with dementia.

Read Boots' denial of the allegations here.

"Significant harm"

Pharmacy Voice chief executive Rob Darracott said the story has already caused “significant harm” to the sector’s reputation, at a time when the “window of opportunity” to persuade the government against imposing a 6% cut on pharmacy funding in England is “narrowing by the day”.

“We should be under no illusions. Stories like this undermine the case for the sector and, in the eyes of the public, damage the reputation of our profession,” he said.

Mr Darracott reiterated the importance of MURs, after defending their proper use last week. Pharmacists must demonstrate the success of MURs to make the “strongest possible case” for being commissioned to deliver more advanced services in the future, he said.

“Whether our best is providing a first rate service to our patients or fighting off ill thought-out government proposals, right now we can ill afford to do anything less,” he said.

Pharmacists' Defence Association chairman Mark Koziol told C+D last Friday (April 15) that the MUR system should be "comprehensively re-engineered" to focus more on clinical care.

C+D will be hosting a debate on Twitter, to discuss MURs, patient safety and targets - on Friday April 22 at 2pm. Join in and share your views; follow @ChemistDruggist and use the hashtag #MURabuse.

Result

How often do you feel pressured to provide an MUR, regardless of whether it will benefit the patient?
More than once a day
32%
Every day
34%
Two or three times a week
7%
Once a week
4%
Once a month
2%
Never
21%
Total votes: 1110

 

Do you feel under pressure to meet targets?

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50 Comments

A Hussain, Senior Management

I wonder if the Lloyds MUR/NMS 'encouragement' conference calls went ahead this week?

Pill Counter, Pharmacy

How can such a thing even be taken seriously.

 

Shaun Steren, Pharmaceutical Adviser

The corporate owners are managing a media storm which they know will blow over within a few weeks. The area managers are probably being trained with new cue cards written by the legal department that tell them what to say word for word. These carefully written statements will allow them to still imply a threat of performance management whilst still protecting themselves from accusations of bullying and fraud.

Angela Channing, Community pharmacist

Has anyone actually had a patient raise this issue with them, having seen the articles in the Guardian or the Mail ? And if they do, what on earth does one say? ! 

Shaun Steren, Pharmaceutical Adviser

Tell them whatever you need to tell them. You are working to a tight schedule, so just meet the Drug Tariff specifications, a few empty words and a signature, performance management avoided. Completely legal, all above board, money taken from the old contract restored. After listening to some of the shysters who post on here I'm getting the hang of this money obsession thing. 

 

DM X, Locum pharmacist

Am largely in agreement with the folks denigrating Mr Darracott I am afraid. He has not said anything about poor working conditions and who actually does "Pharmacy Voice" represent?

Let us also not pretend that Boots is the ONLY culprit in this. Other multiples and small chains and even independent pharmacies have gone down the corporate route of Stefano Pessina- who I describe as an asinine oligarch who seems to know the price of everything and the value of nothing.

Sonal Mehta, Primary care pharmacist

If pharmacies were regulated by CQC rather than GPhC this issue may not have been ignored for so long.  By no means is CQC perfect but the current set up for pharmacy regulation is too conflicted.  I would urge you all to respond to the GPhC consultation on standards for pharmacy professionals.  The standards mean nothing without appropriate regualtion of pharmacy owners.

Paul Dishman, Pharmaceutical Adviser

The only "sigificant harm to the sector's reputation" has been to the reputation of Boots with the evidence of the Guardian's article branding it as a dreadful employer. No surprise there. Pharmacy Voice Of The Multiples

Meera Sharma, Community pharmacist

Its a shame that the plight of Boots pharmacists that has been ongoing for a few years has been brought to light and this is the response from Pharmacy Voice. While I appreciate that this does not reflect well on the profession, it should also be seen as an opportunity to negotiate a different contract, as opposed to re-hashing the same one and shouting about 6% funding cuts. It should make the professional bodies go back to the drawing board and work out a contract that has the backing of their pharmacy colleagues, not one which benefits some at the expense of others. I know there has been talk in previous years to get a new contract, how about Phramacy Voice actually see this as the opportunity? It's a shame that professional erosion is not seen more sympathetically by some organisations. I suppose you'd be happier with no 6% funding cut but a greatly eroded profession and alot less pharmacists???

Chris Pharmacist, Community pharmacist

The question is do MURs and also NMS provide value for money in an NHS increasingly looking to cut costs and make savings. The answer most certainly is no. There is no need for the media to investigate, just ask pharmacists providing the service...How on earth has it come to this? The PSNC that negotiated these inadequate services and the large multiples for enforcing strict targets pressuring and threatening pharmacists further devaluing the services. Both need to wake up, look at themselves and start being honest about them...it won't happen though, they will just blame ordinary pharmacists for their failure.

Shaun Steren, Pharmaceutical Adviser

Exactly. Listen to the contractor response on here, it is either 'this is money taken from the contract' or 'remember MURs pay your wages'. Nothing about professional independence, ethics, evidence for cost-effectiveness or public demand. Always about damn money. Money, money, money is all you ever hear from them. Everything can be excused by a potential negative effect on the bottom line. 

Paul Samuels, Community pharmacist

Unfortunately---"money makes the world go round"

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Shaun Steren, Pharmaceutical Adviser

Social value does not have to be mutually exclusive to profit, it is the order in which you put them. In community pharmacy the first order is to guarantee a monopoly profit and then follows some thought about how the sector can create the illusion of social value in order to superficially justify the profit. The first order should be whether community pharmacy can add social value and if so can it be done cost effectively (empirically proven) when taking into account the profit taken. It is this order of priority that explains the difference in opinion between many employees and contractors (the contractors posting on here often being the worst of their type).

Shaun Steren, Pharmaceutical Adviser

One can only hope the public will use this information and begin to question how they currently subsidise (through tax) the very profitable monopoly that is community pharmacy. 

Pill Counter, Pharmacy

Can't be far off a tabloid putting a hidden camera on a pharmacist to record the goings on during some MURs. Would certainly be interesting methinks......

sanjai sankar, Locum pharmacist

Austerity, corporatisation of pharmacy, poor wages and a difficult job market is creating fear amongst some pharmacists and a reluctant resignation to the fact that we must remain in work at all costs....even if that means putting up with some unethical practices like the MUR fiasco....Some of the situations I have personally ben in  regarding MUR pressure have been unbelievable...Whistleblowing is often not an option for many of us....Its a real shame whats happening in community pharmacy, after qualifying in '95.... 

DM X, Locum pharmacist

Well put Sanj, and lets be honest about independents who are "aping" the slave drivers at Boots!

M Yang, Community pharmacist

I don't think the independent sector has anything to worry about. The Guardian (as well as Daily Mail and the Sun) are overwhelmingly targeted against Boots, there's almost no mention of independent pharmacies or other multiples. In my time working for Boots, I had people come in and shout accusations. We were seen as minions/lackeys who they vented their anger on. I've had a group of guys come to loudly and openly slag Boots in front of everyone in the pharmacy, saying they would never work in such a s***ty place. As a locum who works mostly for independents, I've yet to encounter anything similar.

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           I think it's the combination of tax evasion and misuse of public funds that's really pushing public and media perception toward the level of resentment we're now seeing. Everyone knew about the tax evasion, but the Panama scandal has brought it back to the fore, plus misusing NHS money. The GPhC were unwilling to do anything previously, often citing workplace issues as being outside their jursidiction. Now, it looks like someone has been doing their homework and gathering evidence all along. The regulator's hand has now been forced.

Angela Channing, Community pharmacist

 

Good. The Guardian has really opened up community pharmacy's grubby little secret. About time too. There is another  Guardian article today, the letter's editor says the original 'longread' generated the most letters they can ever recall from a single article! Mostly from burnt out pharmacists I would imagine! I hope the RPS and GPhC do something about this. I'm fed up of being hounded every day about these damn MURs. If we weren't paid £28 for each one no one would care. And yes, I know it wasn't new money and yes, I know some of them may occasionally be useful, but that doesn't excuse what non-pharmacist managers have pressurised a group of healthcare professionals to do. And then the GPhC, when involved, totally ignores the bullying and goes after the poor individual pharmacist. I remember the poor guy at BTC who made up hundreds of them for no financial gain! Why on earth would you do that if it wasn't that, or be forced out of a job. And shame on all the 'great and the good' trying to excuse it or brush it under the carpet. Well, the cat is out of the bag, and I'm sure nearly all patient-facing community pharmacists think GOOD!  Personally I think MURs should be reduced to 150 a year, that's 3 a week, rather than 3 a day, and the rest of the monies should be used for the cuts or put into the global sum to fund a safe dispensing service. To be perfectly honest, I'm amazed this abuse of a supposedly clinical service has taken this long to become public knowledge. 

 

Pill Counter, Pharmacy

If you'd posted that 2 weeks ago you'd have been deluged with abuse on here. 

Shaun Steren, Pharmaceutical Adviser

Deluged with abuse by those who personally benefit from each £28

N O, Pharmaceutical Adviser

Let's rather close C$D

N O, Pharmaceutical Adviser

Let's just hear to those who actually do MURs than, just commenting, while supposed to be working.

Simon MEDLEY, Community pharmacist

being a single independent shop, I have never felt pressured to do MUR's until now, with impending cuts it could be the only way of balancing the books

Pill Counter, Pharmacy

So you'll have mitigating circumstances for committing fraud ?  Let us know how that works out for you.

Stephen Walsh, Community pharmacist

Out of order pal. 

Pill Counter, Pharmacy

Mr Waldron are you not able to get hold of someone at Boots. Interesting that the cat is out the bag now?  How does everyone feel about those labelled trolls for pointing all this out ages ago?

James Waldron, Editorial

We have invited Boots to provide a more detailed response to the Guardian's MUR allegations, but their current position remains the one outlined to C+D here: tinyurl.com/zu4eauj. We will update readers as soon as we have further information on this issue.

Regards,

James Waldron, C+D editor

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