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UPDATED: Pharmacy services review recommends MUR 'redesign'

Keith Ridge: Review points the way to a more clinical future for community pharmacists

NHS England has today (December 14) published the long-awaited independent review into pharmacy clinical services.

The review, commissioned by England’s chief pharmaceutical officer Keith Ridge and led by the King’s Fund director of policy Richard Murray, is designed to “make the most of the existing clinical services that community pharmacy can provide”.

It sets out a number of recommendations to better integrate community pharmacy into the health service.

Redesign of MURs

The review recommends that existing medicines use reviews (MURs) should be "redesigned" to include "on-going monitoring and regular follow-up with patients".

“Ultimately MURs should evolve into full clinical medication reviews, utilising independent prescribing as part of the care pathway,” Mr Murray said in the review.

For MURs to be “safe and effective”, Mr Murray recommended pharmacists are given access to a patient’s full medical record.

NHS England must decide on minor ailments

“NHS England should set out how it intends to deliver” its commitment to have locally commissioned minor ailments schemes across England by April 2018, Mr Murray said. "Progress towards [the commitment] clearly needs to happen sooner."

He also recommended “building on the experience in Scotland”, where a national minor ailments scheme has been available for “nearly a decade”.

National smoking cessation services

“Consideration should be given to smoking cessation services becoming an element of a national contract,” said Mr Murray.

However, he said the King's Fund recognises the current “complex payment and governance” systems, and “budget constraints”, which could be barriers to implementing pharmacy services on a national scale.

Electronic repeat dispensing

Mr Murray recommended “full use” of the electronic repeat dispensing service, and for it to become the “default” option for repeat prescribing – except for patients who are not yet stabilised on their medication.

Integrating services

Community pharmacists should be more involved in NHS England's Vanguard sites to better integrate them into "long-term condition management pathways", Mr Murray said. He also recommended greater support from NHS England and national partners to help integrate community pharmacy into the 44 sustainability and transformation plans (STPs) across England.

“Specifically this should look at the changes necessary to make local pharmaceutical services contracts easier to use,” he stated.

Breaking down professional boundaries

The King's Fund urged the Royal Pharmaceutical Society (RPS), Royal College of General Practitioners, the British Medical Association and the Pharmaceutical Services Negotiating Committee (PSNC) to "come together and unravel professional boundary issues", to promote closer working relationships.

Independent prescribing

Mr Murray recommended "incentives for more rapid uptake of independent prescribing", to overcome the "relative low take-up" across community pharmacy.

Independent prescribing "makes full use of the clinical skills and expertise of the pharmacist", especially when it comes to medicines optimisation, he stressed. 

An "apparent tension between the current volume-driven community pharmacy contract and enhanced prescribing roles" could explain the low uptake of independent prescribing in the sector, he added.

Reaction to the review

Dr Ridge said Mr Murray's “useful report points the way to a more clinical future for community pharmacists and pharmacy technicians”.

“The NHS locally and nationally will want to consider many of the ideas the report lays out,” he added.

PSNC chief executive Sue Sharpe said the negotiator is “ready and keen... to implement [the recommendations] as soon as possible”.

“The events of the last year have badly dented the confidence of pharmacy contractors, but energy in moving forwards will do a lot to restore it,” she added.

Pharmacy Voice chief executive Rob Darracott welcomed the review, but said “some of the recommendations will need further reflection to understand how NHS England would look to implement them on a practical basis, and how potential unintended consequences would be avoided".

Sandra Gidley, chair of the RPS's English pharmacy board, said the review is "completely in line with [the RPS's] own vision for the profession".

However, “it is not credible for anyone who works on the front view this report without reference to the reduction in funding for community pharmacy", she said. 

"The profession needs to hear how and when [the £300 million integration fund] will be deployed to ensure clinical medication reviews and independent prescribing move from being aspirations to reality."

Nitin Sodha, chair of the National Pharmacy Association's policy and practice committee, said NHS England needs to "act with pace" to implement the recommendations from the review." The Department of Health "must be prepared to talk about a sensible level of funding that can sustain this kind of positive development over time", he added.

Read the full report here.

What do you make of the recommendations?

Valentine Trodd, Community pharmacist

I've read the 'full' report - typical luke-warm response and notable for both it's complete lack of any specific recommendations or reference to target pressures. I fear that the 'redesign' will miss the point entirely and actually make the situation even worse for employee pharmacists by requiring more time, more effort and more paperwork per MUR. The service needs complete restructuring - the relentless chasing of numbers and the 'quantity not quality' aspect needs to be designed out once and for all.

Jupo Patel, Production & Technical

Bets on whether Boots will be the ones redesigning?

Kevin Western, Community pharmacist

An "apparent tension between the current volume-driven community pharmacy contract and enhanced prescribing roles" could explain the low uptake of independent prescribing in the sector, he added.

His ignorance is showing.. the real barrier apart from cost is the lack of willingness by GPs to help (unless you are going to work for them) and of CCGs to commission services so we can use the skill - no common factor there is there...

Soon-To-Be Ex-Pharmacist, Superintendent Pharmacist

Reading between the lines this seems to imply that the existing MUR is pointless. Why did they bother doing a review to work that out? They could have just asked us...

Shaun Steren, Pharmaceutical Adviser

They have invented 'clinical' services to create the illusion of taxpayer value. Tinkering every few years creates the further illusion of continual improvement. This is how people who have no experience or expertise in what they control survive. By not asking employee/locums for their views, they avoid the very people who have the experience and expertise to expose their artifice.

Barry Pharmacist, Community pharmacist

I've now read it. Nothing revolutionary here which is perhaps a good thing? Makes me wonder if the review was intended as a warning shot across the bow of PSNC as they consider legal actions against the cuts? This report clearly scratches the surface of existing services and leaves the door open for further examination when Dr Keith decides to call out the hounds.

Shaun Steren, Pharmaceutical Adviser

I would encourage people to read the whole report as its vacuity makes for a  very short read. Interesting admission that there is no evidence to support 'clinical' services. Interesting omission of anything related to workloads and the profit first culture. An utterly empty document written by those who quite obviously have no experience of community pharmacy. 

Perversely, makes comparison to the specifics of the Scottish model. Scotland being a country focused on developing the independence and autonomy of the individual pharmacist, this the antithesis of English ultra centralisation. 


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