Pharmacy could struggle to improve the care of patients on multiple medicines because GPs are reluctant to refer them for MURs, pharmacists have argued.

The King's Fund has called for pharmacists to work "coherently" with GPs and nurses to perform regular medication reviews for elderly patients taking multiple drugs, in a report published last week (November 29). Patients on multiple medication were more likely to suffer side effects and pharmacists were "suited to focused medication reviews", it said.

Pharmacists agreed that polypharmacy was "problematic", but argued that GPs' reluctance to refer patients for MURs made it more difficult for them to monitor those on multiple drugs.

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	"There's still a certain amount of reluctance to see MURs as a useful tool. I think that many [GPs] see it as a box-ticking exercise in order for us to get money, and maybe of limited use," James Bryce, contractor at Silversands Pharmacy, Orpington, Kent, told C+D.

GPs could be more interested in MURs once they started to see that they could improve adherence and identify clinical issues, he added.

Al Patel, contractor at Lee Pharmacy, Lambeth, said pharmacists and GPs should work more closely together to tackle the problems associated with polypharmacy, but he had never known a GP to refer a patient for an MUR. "When MURs first came out, I was sending referral letters to GPs and in the majority of instances the GP would say, ‘you've sent me this, what do you want me to do with it?'" he recalled. "Their feeling is that their reviews are more important than the ones we're performing," he said.

However Dr Richard West, chairman of the Dispensing Doctors' Association, argued that the MUR service had not been designed to enable GPs to issue referrals and they could only suggest that a patient speaks to a pharmacist. Pharmacists needed access to a patient's medical record before they did more regular reviews, he said.

"I think you can do MURs in pharmacies, but it is very important they have the access to the reasons why [the drug] was prescribed. You need to know why it was prescribed to help the patient the most," he added.

The Royal Pharmaceutical Society (RPS) agreed doctors and pharmacists needed to work more closely together. "Now is the time to ensure that older people, as well as others taking many medicines, are given access to regular patient-centred medication reviews by pharmacists to improve their health and prevent adverse reactions," said RPS spokesperson Neal Patel.

The King's Fund report also suggested that prescribers should be more willing to consider stopping medication, particularly in cases of limited life expectancy, and that doctors should receive better training in managing patients with various complex conditions. 

NHS England urged GPs to turn to community pharmacists for help in providing medicines reviews, in a report published last week (November 28).

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