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'MUR plus' could have a future if funded properly

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David Wright: Reviewing community pharmacy's funding model was a "real eye opener"

Medicines use reviews (MUR) could benefit pharmacists and patients if they are funded beyond the initial consultation, a pharmacy professor has said.

While his review – which informed the Murray report into pharmacy services – concluded that there is “no evidence that MURs are clinicallly or cost effective”, David Wright, professor of pharmacy practice at the University of East Anglia said he is in favour of “changing MURs” rather than scrapping the service altogether.

“[MURs] would work much better if the funding model didn’t just cover the initial consultation, but the follow-ups with the patient”, he told C+D last Monday (February 13).

The former practicing pharmacist said he had “conducted MURs [him]self” but admitted there is no funding incentive to check again with the patient.

“The problem with current MURs is that they are generic, so you can’t get a clinical measure because it covers too many clinical areas,” Professor Wright said.

“The outcome in that case cannot be patient satisfaction because that’s not what the government pays for.”

Patient-focussed targets

MUR “targets” could still work if they are focused on patient care and measured by clinical outcomes, he added.

He said much of the clinical evidence is either already available or can easily be collected electronically. Examples include cholesterol, diabetes, asthma and blood pressure.

“I’m very much in favour of changing MURs so that they are a kind of chronic disease service to become an ‘MUR plus’ with a follow-up check,” he said.

“Perverse” funding incentives

Reviewing the evidence of the community pharmacy funding model was a “real eye opener” for Professor Wright, but he is “very hopeful” that the recommendations from the Murray report will be implemented.

“I would like to see us being paid for doing things well, rather than doing lots of things," he said.

While chief pharmaceutical officer for England Keith Ridge "had no real input" in the evidence review, Professor Wright is confident that NHS England's plans to better integrate pharmacy into the rest of the heath service, will be met.

“I think if the integration fund is used appropriately we can implement [Richard Murray’s recommendations]...and have a real clinical impact," he said.

"The one thing that needs to be sorted is the funding model as everything pivots around that."

14 Comments
Question: 
Are you in favour of developing more specific MURs?

Freelance Chemist, Pre-reg Pharmacist

I DO MURS AND ENJOY SITTING DOWN FOR 30 MINUTES (THATS RIGHT 30 MINUTES!).

I DO THEM IN THE CORRECT WAY, IF THEY WANT ME TO DO THEM I MAKE SURE I GIVE MY FEET A WELL DESERVED BREAK FROM STANDING THE DISPENSARY!

 

MY TYPE GUYS:

-DO THEM IF APPROPIATE

-ENJOY 30 MINUTES OF SITTING DOWN IN THE CONSULTATION ROOM

Benjamin Leon D'Montigny, Non Pharmacist Branch Manager

Turn it into more specific things with check ups. Like inhaler usage. I had attended a training evening where everyone was tested how to use an inhaler. Me, a Respitory Consultant and a Community Nurse were the only three out of 50 or so medical professionals that managed to do it correctly.

Lucky Ex-Locum, Superintendent Pharmacist

It's ok for you to make these recommendations Benjamin. You won't have to do them.

Shaun Steren, Pharmaceutical Adviser

Many (if not most) of the DPI and MDI devices have been around since the 90s, as have some of the best papers on performance characterisation. With newer products you follow the same principle of device specific counselling to ensure optimal aerosolisation performance, consistency in efficacy and strong patient adherence. 

None of this is new or innovative and certainly does not support the use of MURs. I was giving this advice decades ago, ironically in a more convenient, expeditious and human way. Giving an activity a name and making it more bureaucratic is not progress. 

Valentine Trodd, Community pharmacist

Considering the conclusion of the report is that there is “no evidence that MURs are clinically or cost effective” then I see no reason why they shouldn't be scrapped immediately. Any other course of action is a waste of pharmacist's time and taxpayers money.

Clive Hodgson, Community pharmacist

Consider the conclusion of the report mentioned that there is “no evidence that MURs are clinically or cost effective” and then combine that with the near certainty that there will be no extra funding.

Surely the only logical course of action should be to scrap MURs sooner rather than later and use the £100 million released on a service that could actually benefit patients?

………and this time make it a service that does not suffer from the serious flaws of the MUR type of “service” that we are all very familiar with.

Jonny Johal, Pharmacy Area manager/ Operations Manager

Is this what Professor Wright really thinks? I wonder when did he last practiced in a pharmacy.

Professor of Pharmacy Practice, University of East Anglia.

Tom Kennedy, Pharmacy Area manager/ Operations Manager

He's right.  I'd consider lowering the payments too, would make the service much more efficient.

Lucky Ex-Locum, Superintendent Pharmacist

Big thumbs up for the irony (I HOPE you were being ironic....)

Sarah Willis-owen, Community pharmacist

I think it could work.

Lucky Ex-Locum, Superintendent Pharmacist

And who is going to create the extra hours (presumably unpaid) in the day to enable us to expand on our MURs?

Arun Bains, Community pharmacist

No Professor. The MUR model would work if the multiples let the pharmacist decide when to do them rather then bashing out 400 ever year for the sake of defrauding the NHS.

Sue Per, Locum pharmacist

Murs, are still a target commodity, and need to be scrapped entirely. Majority have very little positive outcomes, and only serve as a cash cow for the contractors., mainly the Multiples!!! Scrap them along with the NMS

Lucky Ex-Locum, Superintendent Pharmacist

No.

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