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Lloydspharmacy investigating locum MUR pressures

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Lloyds will remind its teams to ensure all services are appropriate for the patient
Lloyds will remind its teams to ensure all services are appropriate for the patient

Lloydspharmacy is investigating pressures on locums to hit medicines use review (MUR) targets in one of its branches, the multiple has told C+D.

A locum – who wishes to remain anonymous – photographed the notice below in a Lloydspharmacy branch in south-east England last month.

Lloydspharmacy superintendent pharmacist Steve Howard told C+D the company is “investigating the matter internally”.

Mr Howard stressed that Lloydspharmacy does not set targets for locums and said the company has “addressed” instances where MURs were “delivered inappropriately”.

“While we encourage each of our stores to reach 400 MURs a year, we only do so when patients are eligible and when it’s deemed clinically appropriate by the pharmacist,” said Mr Howard.

“We will remind our teams of their responsibility to ensure that all services we provide are appropriate for the patient,” he added.

Mr Howard did not comment on the notice’s claim that each locum's MURs are “monitored”.

His statement comes a week after Rowlands confirmed that MUR targets are “not optional extras for locums.

77 Comments
Question: 
Are you under pressure to hit MUR targets?

Marcus Jones, Student

You don’t get the point, Pharmacists have raised real concerns in this thread, they are being asked to do more and more to the point where it is unsafe to the public.

You appear to want to dismiss these real concerns

What you appear to be saying (correct me if i am wrong) is that you think is it professionally acceptable to put the public at risk to generate you or the company more profit, and breach professional standards. 

Where the locum or pharmacist who is responsibly in charge is told that they can not apply their professional judgement, and therefore have it taken away from them by the pharmacy / company but must still take responsibility for their actions. 

This really goes against all professional standards, and make mockery out the profession. 

Considering you are a member of the Medicines Ethics and practices Advisory group, i find your comments, to be very misjudged, rude and certainly not what i would expect from such group.  I hope not representative of the entire group, please read all the comments and fully understand the situation.

I shall forward comments to the chairperson of the group tomorrow, personally I think you are very out of touch with pharmacists in general, I certainly would not want you advising or representing the profession.

I think this is the problem with Pharmacy in general having people like you on advisory boards.

Maybe people should think twice about working with or for you, is this what you apply in Dudley Taylor Pharmacies? Do you force locums to overwork themselves and do more MUR than the full-time pharmacist? 

Does Dudley Taylor Pharmacies follow Lloyds Pharmacy's example and have signs up for locums prescribing the number of MURs they must do? 

 

Jonny Johal, Pharmacy Area manager/ Operations Manager

May I ask if you have contact details for the MEP advisory group please? I can't find them on Google, and I want to write to them about Stephen Eggleston too. 

Jonny Johal, Pharmacy Area manager/ Operations Manager

I worked with Steve Howard in the late 80's and 90's, I think I know where his 'internal investigation' will lead to ... he is a company man (Teflon coated?). I sort of question the tone of this article, is there any implied suggestion here that these notices are appearing in Lloydspharmacy's dispensaries the content of which is unknown to their superintendent?

Fuzzy Wuzzy, Dispenser Manager/ Dispensing Assistant

What does amaze me is that as fellow of the RPS and I assume an intelligent man He seems deaf, blind and dumb to everything that goes on in his pharmacies...time for explanations and actions not draining of the NHS!  Should also serve as a warning of how remote supervision can't really work 

Valentine Trodd, Community pharmacist

The GPhC have become a laughing stock - how many of us take them seriously anymore? Whatever happened to the online consultation on workplace pressures they carried out a while back? I contributed to this and my piece on MUR pressures was in the top 3 voted contributions - but nothing has been done?! The disturbing thing is that they don't appear to care... Personally speaking, I've left the register and am chuffed I don't have to but up with this BS anymore.

sanjai sankar, Locum pharmacist

Unfortunately those still working have to take them seriously as they are our regulator. I went to the workplace pressures forum that they held in central London. Apart from one excellent presentation by Professor West, the other talks were just waffle in my opinion...I was also alarmed that amongst the key note speakers, not one was a front line dispensary based pharmacist with first hand experience of these pressures....and you are right, Everything has gone quiet on that front it seems....Can we as registrants not vote for change if we feel our regulator is not acting in our best interests...? Clearly the overwhelming opinion on this site is that they are not....

Marcus Jones, Student

How do we vote for change? or do we have to start online petition to get the following message through to them:

 - A vote of no confidence the current GPHC leadership team

 - A vote for immediate review of service contacts and contracts of services relating to:

 a) Enforced targets

 b) Amount of work per day, number of hours, items, scripts additional services etc to ensure safe levels are maintained,

 c) Minimum rates

 d) The ability to have a proper break 

 - A Vote for Pharmacy management to be included in investigations where it is believed Pharmacy practices / pressures are contributory to mistakes. (with unlimited fines and possible cancellation of licence is the pharmacy is found in breach)

 - A change to the law, so that Pharmacists are not held criminally liable for mistakes unless there is criminal intention, so that it is inline with others in the medical profession

- A Vote for a Pharmacy code of conduct to be in place regarding the treat of staff and contractors in the profession

We need to be extremely clear here the risk and reward of being a pharmacist is not balanced.

Risk - Total risk is on the pharmacist for nearly everything, the Pharmacy / Company shares none or very little of this risk but most of the reward. (most employed people in other industries do not have this amount of risk / potential liability)

Reward - Both salaries and locum rates have dropped they are not compensated for any additional risks taken ensuring the Pharmacy’s targets are met (most of the time), and undertaking more work. The Pharmacists lower rates do not fairly represent the risk they undertake.

The Pharmacies make additional profits from the increased risk yet share none of the burden of the increased risk, which unfortunately encourages them to continue with this practice.

They make very good profits without the associated risk.

Change is needed, and the current people in the GPHC appear to be incompetent, do not to have the skills, knowledge nor experience to move this forward.

If the GPHC are reading this prove you look after you profession and start taking action!

Valentine Trodd, Community pharmacist

I'm not a legal eagle, but is there some mechanism that registrants can call the leadership of the GPhC to account? The following makes interesting reading...

http://www.pharmaceutical-journal.com/news-and-analysis/features/special-general-meetings-of-the-royal-pharmaceutical-society/20004325.article

This refers to a special general meeting of the RPS (the pre-2010 regulator) being called. According to the byelaws of the Royal Pharmaceutical Society, "upon the requisition in writing of not less than 30 members requiring the Council to convene a special general meeting for the purpose specified in the requisition". Surely there are similar allowances under the byelaws of the GPhC? It's time the voice of the silent majority suffering at the coalface was heard.

Marcus Jones, Student

Thank you, i think i will follow through with this, but start with a petition on change.org. its about time the GPHC, enforce the standards that are set, and protect their members,

sanjai sankar, Locum pharmacist

The employers know that Locums in particular can be replaced very quickly and due to the oversupply, there is no problems with finding another locum....The fear induced by veiled threats such as this notice has the knock on effect of some locums  cutting corners to hit targets.This  appeases companies, and the locums may  keep their positions...However, this corner cutting  inevitably leads to dispensng errors and poor quality MURS....A "dispensing" incident can then lead to an "inspector" from the GPHC investigating  and telling the Locum that there is no excuse for errors regardless of how busy you are....They (the GPHC) then notify the superintendent of the company who then terminate the locums bookings anyway as the superintendent  doesnt  need the hassle of dispensing incidences being reported to the GPHC....Everyone keeps their jobs apart from the locum or employee pharmacists....

Something similar to the above happened to me recently with another company....I was livid at the time  but accepting of the fact that nothing will change unless there is some major reform at the GPHC....Only they can do something about this....

 

Marcus Jones, Student

Completely agree, about time the Pharmacies Management take some responsibility, i would like to think the professions would protect the general public and pharmacists from being put under duress. 

They should look to fine or remove a pharmacy’s licence if they force pharmacists or put undue pressure on them to meet unsafe targets.

At the moment the Pharmacist is expected to be professional and say no to pressure and work at a safe pace, however there is no regulatory protection. 

It about time things change the GPHC deal with this!

Ilove Pharmacy, Non Pharmacist Branch Manager

The only thing deemed worthy of protection is PROFIT.

CAPT FX, Locum pharmacist

Steve Howard made an ominous statement , "investigating matters internally" and this is how they do absolutely nothing in the face of serious violations at all levels.* They never investigate, they apportion blame and most of this blame is laid squarely on the Locum Pharmacist. That Locum Pharmacists are forced to do MURS is a no brainer. *

The letter in this article is one variant of may documents you find stuck in their Pharmacies. In some instances the wording is spectacularly colourful. Lloydspharmacy sets targets in all their shops, including MURS and its dissapointing for a man who is the most senior Professionalin the company to pejure himself so openly on a public forum. The people tasked with administering issues like this branch level are managers who are not qualified to handle such issues. I worked with a 23 year old Manager in one of their branches who had just finished the dispensary assistant course. Suddenly she had the authority to interpret and determine patients where is was clinically appropriate to do MURS. This is an undisputed fact, Pharmacists in general and Locum Pharmacists in particular are overrulled by Managers, Team Leaders and Technicians who usurp the Pharmacist role. Do we expect the Superintendent Pharmacist to know?  Absolutely not and where he knows its dealt with internally. 

Lloydspharmacy is a behemoth that is seriously struggling to deal with Professional and administrative issues in Branches. It is like a runaway train. This area of MURS is one of many and like a runaway train I hope they dont wake up when it derails at a hospital. Denial like they do with everything helps no one because mistakes and errors never get to be rectified. Yes, Lloydspharmacy sets targets without doubt and yes, Lloydspharmacy blacklists locum Pharmacists who dont meet these targets. They say it overtly in the Branches and they say they are entitled to do this as a business. I am surprised Steve Howard is singing a different song here. SUGGESTION:  As a Pharmacist go undercover as a locum Pharmacist into yourBranches. It is too ghastly to contemplate what you will find there. 

*This comment has been edited to comply with C+D's community principles

Sue Per, Locum pharmacist

Captain Fx, has summed it up correctly, and the root cause of all this is a Useless Regulator, who is not prepared to deal with the undermining of the Professional independence  and authority of the R.P.

After the observer "Murgate" article, there was an opportunity to dealt with these type of  abuses, and the Regulator stated, "we will have discussions with the stakeholders"., A year later the situation has not changed, and the gangmasters continue as before safe in the knowledge that the GPHC is incapable of restraining them in any shape or form!! - Because it is USELESS - Not fit for purpose, for the majority of the members. 

 

Paul Dishman, Pharmaceutical Adviser

 

"I worked with a 23 year old Manager in one of their branches who had just finished the dispensary assistant course. Suddenly she had the authority to interpret and determine patients where is was clinically appropriate to do MURS. This is an undisputed fact, Pharmacists in general and Locum Pharmacists in particular are overrulled by Managers, Team Leaders and Technicians who usurp the Pharmacist role."

There's no way that any Pharmacist should accept this nonsense

 

Jonny Johal, Pharmacy Area manager/ Operations Manager

... this is not restricted to contractors, you only have to look at how the GPhC operates. I once had dealings with a "Case Worker (Investigations)" from the GPhC, she was investigating whether a complaint should be escalated. It was obvious to me that she didn't understand the professional issues involved, she told me she is not a pharmacist, but refused to tell me her qualifications, and when I complained to her superior, a "Senior Case Worker", who also refused to tell me her qualifications but assured me that they are 'supervised by a pharmacist'! One wonders why are the professional qualifications of the GPhC staff, who investigate pharmacists' professional conduct, are such secrets?

Marcus Jones, Student

I think we need to publically share these notices where ever they appear, presure needs to be put on the pharmacies to change the way they look after thier staff and pantients saftey.

The GPHC needs to take action.

Ilove Pharmacy, Non Pharmacist Branch Manager

What sort of action do you envisage?

Valentine Trodd, Community pharmacist

I used to work for one particular chain in the south east and every year we get a Christmas card from the MD with the same old message to the effect - times are tough, we must do more MURs and NMS.

R Patel, Community pharmacist

Why don't you all complain about the way the number of MURs are directly related to the contractors income. Perhaps we should have had a say in the way it was negotiated. The employers loses a lot of money if the target is not achieved. Remove the target and we should be paid if you do them and lose out if you don't. There should be no minimum or maximum. All good pharmacists have been doing them informally but now they are having to do them for a part of the remuneration.

Pharmacist Pharmacist, Community pharmacist

As an ex employee of Lloyds I can tell you that not only locums are pressured but so are employee pharmacists. We are made to feel unworthy if target numbers of MURs are not performed.

And locums are monitored for their MURs. If they do not perform then the locum co ordinator is informed and the locum is blacklisted

BL E, Primary care pharmacist

I'd agree, employee and locum pharmacists alike. We used to receive two to three phone calls a day asking how many MURs we'd done in a 10,000 item branch next to a GP surgery, two nursing homes and 60 MDS patients. No ACT, no double cover so only the regular pharmacist or locum to check everything. And the patient's wanted everything ''right now'' - puts pharmacists in a very difficult position trying to keep everyone happy and maintain patient safety.

Sue Per, Locum pharmacist

I have been in those type of sweat shops., Quite frankly whoever signs up as the R.P, and handles that work load., is in my opinion a Robotic, Moronic Idiot., Never sign in, and simply walk out on grounds of inadequate staff and in-appropriate skill mix, to deliever a safe and ethical patient centered service. Almost imposssible. I have seen some of those in D&T and I am surprised, they havent been shut down!!!.... and we know why: Because the regulator is on the snooze, and will only wake up when the scandal breaks out in the papaers, or someone suffers irreversible damage.

Pharmacist Pharmacist, Community pharmacist

I totally agree about the phone calls. I used to dread it whenever the phone rang.

N O, Pharmaceutical Adviser

OFF THE TOPIC..... Dear Editor, The new outlook of the C&D website is bizarre and a bit confusing (at least to me) There used to be clear-cut sections for you to look out for what you want, like where Xrayzer et al used to have their blogs, the CPD section separate from the news etc. Just a feedback. 

James Waldron, Editorial

Thank you for the feedback.

All your favourite sections can still be found in the top bar, next to the C+D logo. For example, CPD is found under 'Learning', while blogs (such as Xrayser) are found by clicking 'In-Depth', and then selecting 'Views'. 

We'll continue to make changes to the site over the coming weeks, so please let us know if you're still finding it hard to navigate after a few days.

Regards,

James Waldron

C+D Editor

A Hussain, Senior Management

Is it any surprise that good pharmacists feel the pressure to complete fake MUR's to satisfy management? Then they are left to fall on their sword by the company and the GPC.

Fuzzy Wuzzy, Dispenser Manager/ Dispensing Assistant

Well well well....doesn't this surprise anybody? Big company's area and regional managers pressuring locus and employees into "performing" this service.  The lovely KPI's are based around "professional income' or in other words MURs and NMS as that value is what is budgeted for in each branch.  Superintendent denies all knowledge of it yet sits on the board of directors who discuss profits all the time....GPhC remain very quiet!  Mr Howard has indicated that there are "some" inappropriate MURs....let's have details and numbers eh!

Matt Omi, Pre-reg Pharmacist

Welcome in Sheffield 

Anonymous Anonymous, Information Technology

I locum for Lloyds and can show you a photograph of a similar sign in a different store! The problem is endemic and not specific to one scapegoat store!!!

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