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Day Lewis: Positive MUR findings show cap should be lifted

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Jay Patel: Patients express their satisfaction with MURs on a daily basis.

Research showing high levels of patient satisfaction with medicines use reviews (MURs) supports an argument for lifting the cap of 400 consultations a year, Day Lewis has said.

The multiple partnered with the East of England Respiratory Clinical Network and the University of Reading for research which found that 97% of surveyed patients “agreed or strongly agreed they were satisfied” with their MUR.

Of the 490 MURs conducted across 105 Day Lewis branches between June and August, patients were satisfied with “the time spent by the pharmacist listening” 98% of the time, and with the “pharmacist's personal approach” 99% of the time, the university said when it published its fundings on September 22.

Pharmacies are currently only paid to carry out a maximum of 400 MURs per year, and Day Lewis chief innovation officer Jay Patel told C+D last Friday (September 30) that the research raised the question of “why could there not be funding for more high quality patient-centred consultations – beyond 400”.

Mr Patel said he was unsurprised by the results of the research, because patients express their satisfaction with MURs “on a daily basis”.

The findings should be shared with pharmacy minister David Mowat, who should view them “as an opportunity for more nationally funded medicines optimisation services”.

“We are now focussing more on outcome-based MURs and new medicines service [interactions] – for example patients on four or more medicines,” Mr Patel added.

Only two thirds wanted an MUR at outset

The research also showed that while only two thirds of patients wanted to have an MUR at the outset of their pharmacy visit, nine in 10 said they would use the service again.

There is an “urgent need” to carry out MURs on a larger group of patients to confirm the research’s findings, the University of Reading added.

Last week, NHS England’s Jill Loader told pharmacists that the Guardian’s accusations in April of MUR abuses at Boots means the sector needs to offer “assurances" that the services it provides are "effective".

How many MUR patients were satisfied with the…

…explanation of the aims of the service – 96% 

…comfort and privacy of the consultation room – 96%

…opportunity to raise questions and concerns – 97%

…have their questions answered – 94%

…the pharmacist’s advice and recommendations – 96%

Source: The medicines use review: Patient satisfaction survey, September 22, 2016

42 Comments
Question: 
Do you think the 400 MUR cap should be lifted?

Pharmacy Career, Design

Certain that you get a daily phone call from Day Lewis managers for not doing one Mur a day and 300 by Christmas...

DM X, Locum pharmacist

..

Brian Austen, Senior Management

Surely the measure of whether the MUR service is an effective service is:

The patient is educated about their medication;

There is an improvement in compliance;

There is less waste.

The current feedback used by 'Day Lewis' is more customer service orientated than a measure of patient outcomes.

Soon-To-Be Ex-Pharmacist, Superintendent Pharmacist

Hmmmm.....and this fellow has just been voted onto the PSNC? THAT bodes well for the future......(shame irony doesn't come across too well in the written word)

Valentine Trodd, Community pharmacist

One thing I find it very difficult to understand is the almost religous belief by all that the current MUR system is set in stone - like the commandments given to Moses by God - a set of principles set in stone that man nor beast can alter. So, this leads to entrenchment on both sides - and I too am guilty of this. Why can't we just fix what's broken - all concerned parties sit down and thrash out a revised specification? Get rid of the target aspect and a lot of pharmacists will embrace the service. Hindsight is a wonderful thing - lets use it.

John Urwin, Community pharmacist

Don't recall ever advocating the MUR should be set in stone. I do argue that a system enabling a pharmacist to spend time with a patient in order to ensure they maximise the benefit achievable from their medication is necessary. To be practical that has to be funded.

Get rid of the target aspect... Not sure that is possible. The NHS does not enforce a target, but rather specifies an annual maximum number per pharmacy. Any target setting is by the pharmacy's management. Removing the 400 ceiling would not relieve pressure on pharmacists.

Personally, I encourage pharmacists to aim for the 400 but there are no sanctions. I am more concerned that any MURs conducted are of a high quality that, if examined, would reflect well on my business.

Clive Hodgson, Community pharmacist

Failing to meet the 400 maximum can, in many Multiples and others, result in the loss of ones job through performance management. The pressures and bullying in some Corporates to “max out” is considerable as the many letters sent to the Guardian in response to the Boots expose will testify. The mental health and wellbeing of those Pharmacists who are on the receiving end of these constant pressures is no doubt being adversely affected. The matter of NHS fraud rears its head in these circumstances.

If MURs are to continue a total redesign is needed to prevent them being used as a Corporate cash cow for which compulsory targets are enforced. I did make a post to an earlier article suggesting that Pharmacists are employed directly to perform MURs with the contractor paid to host the sessions. 

Valentine Trodd, Community pharmacist

John, what I meant was the steadfast refusal by the powers that be to change any aspect of the current system. If half of pharmacists are calling the service unfit for purpose and asking for it to be scrapped, then there MUST be significant problems. I'm just amazed that someone with some clout can't get people around a table and revise the existing specification into something a majority can agree has a chance to work effectively.

John Urwin, Community pharmacist

So are we moving to a consensus that there is not an MUR problem as such but rather that lack of time and excessive management pressure makes it difficult for many pharmacists to deliver quality MURs?

Valentine Trodd, Community pharmacist

John, the MUR system IS the problem! I have no problem in sitting down with patients and discussing their medicines all day long. But the way in which the service is implemented encourages a target of 400 being set, repercussions for not meeting said target, complete lack of quality control (for example, my area manager is just interested in the number at the end of the month - she's never once asked to see an MUR) and even outright fraud. I wouldn't be in this job unless I wanted to help patients - I want to make this work, but the current sytem is SO broken. The NHS, RPS and GPhC is full of reasonably intelligent people (some even have PhDs...) - why can't everyone sit around a table for a day and come up with a new specification that works for patients, pharmacists and contractrors? We've just successfully crashed a satellite into an asteroid - surely we can manage a redesign of MURs?!

John Urwin, Community pharmacist

Surely any system where payment is related to quantity of work done (whatever the quality control) could result in pressure on employees. Equally any system that resulted in flat rate payments regardless of actual service provided is subject to abuse.

Matthew Edwards, Community pharmacist

At the end of the day there are no targets for MUR unless imposed by an employer. As most of the pharmacists in the country work for multiples, and these are the pharmacists who want MUR scrapped, surely that says something about the employer not the system.  There are too many people complaining about a service that has lots of potential and can provide benefits to patients if done properly.  If locums and employee pharmacists actually had the intelligence and balls to ignore the target demands and only put their name to worthwhile MURs this conversation would never be. Its actually getting boring now.  Employers are at fault for enforcing targets but every pharmacist who does an MUR on the basis of meeting targets is enabling the employer to carry that culture on.  What are they going to do? Sack everyone?

Soon-To-Be Ex-Pharmacist, Superintendent Pharmacist

Pretty much!

 

Clapton Chemist, Other healthcare profession

FRAUD will be plentiful.

Soon-To-Be Ex-Pharmacist, Superintendent Pharmacist

I've just had a rather bizarre thought and it pains me to admit it but this may actually be a good thing...which contradicts everything I've previously posted. I'm expecting the trolly backlash but imagine - unlimited MUR with the £28 price tag attached. Employ a second pharmacist, book in 20 a day and Bob's your uncle - everyone wins. Manager or branch pharmacist has more time and less hassle, MUR pharmacist has a nice couple of hundred quid, thankyou very much, and employer pockets the rest. Patient gets a decent service from both pharmacists and goes away happy. It just might work.....

Paul Miyagi, Information Technology

Lifting the cap for additional payments would obviously favour Day Lewis, Boots Lloyds and the rest of the multiple conglomerates . Would they be in favour of anything over 400 being unpaid -- think not. Also do a survey of "everyday pharmacists" and most would say they do not have time and puts the rest of their time for "general safe dispensing" at risk. No, scrap them as many community pharmacists suggest because it does not endear to a safe working enviroment as it is.

If Day Lewis are so keen on the clinical benefits of MUR 's let them do anything over the 400 for free - nope, oh well then maybe there's an alternative motivation!

John Urwin, Community pharmacist

If they did presumably their staff would volunteer not to be paid for their  efforts in performingthe additional unpaid work.

Sad to have to repeat to a (presumed) healthcare professional but (Gross) Profit is what is used by business owners (including Partners in GP Practices) to pay wages and other bills. (Net) Profit is what feeds and clothes the owner's children.

DM X, Locum pharmacist

Nail on the head! Mr Patel is not interested in MURs helping patients, he's only interested in the bottom line. 

John Urwin, Community pharmacist

Does it have to be one or the other? Might it not be both?

DM X, Locum pharmacist

you actually think Mr Patel is not interested in $$$ ?

John Urwin, Community pharmacist

Err... No. Hence my comment. Are you familiar with the concept of "an honest day's pay for an honest day's work"?

Frustrated Pharmacist, Community pharmacist

Well done Jay!  What's your next "innovative" idea - 12 hr days and 7 day weeks? 

Frustrated Pharmacist, Community pharmacist

God help us if "more MURs" is what passes as "innovation" these days. We're in more trouble than I thought!

Marc Krishek, Pharmaceutical Adviser

Are we being complacent about a satisfactory service?

Valentine Trodd, Community pharmacist

No, we're questioning the validity of an unproven service.

Clive Hodgson, Community pharmacist

Lift the MUR cap? A mad idea.

More funding for more MURs can only mean less money for things many times more important....such as the essential medicine supply role. That is the basis behind the Global Sum.

As we are to have cuts to funding isn't a dubious "service" such as MURs the obvious place for them to fall?

Kevin Western, Community pharmacist

I'm not sure wether you have noticed, but less money for what we are doing now is already happening. Anyone who thinks the DoH isnt going to continue to cut the cost of the supply function has a wonderful set of blinkers on.

Unpopular though it may be with Pharmacists firmly welded to their checking bench, services and the related income will be what keeps them in jobs going forwards - MURs arent popular partially because of the way they have been handled by Large multiples and at least partially because as a Profession we are afraid to come out of the dispensary and demonstrate our knowledge to our patients in a way that generates revenue 

Soon-To-Be Ex-Pharmacist, Superintendent Pharmacist

The problem isn't particularly that we don't WANT to do MURs. It's that generally we don't have time to do them properly because we are, as you put it, welded to the checking bench. I would love to spend half an hour with a patient sorting their medications out but if I did that I'd have thirty odd cheesed off waiters ready to give me the benefit of their opinion when I came out. Yes, maybe dispensing will die but it's very much alive and kicking, with the emphasis on kicking, right now.

John Urwin, Community pharmacist

You appear to be saying, in essence, that your problems are wholly with the staffing and management policies of pharmacy multiples rather than with the principle of the MUR. I can understand your concerns but regret the denigration of MURs that this has lead to.

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