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MUR fees could be reviewed as part of efficiency drive

Keith Ridge: Review will assist in redesigning services

NHS England says it is "possible" its upcoming community pharmacy review will look at funding for MURs and NMS

EXCLUSIVE

NHS England has not ruled out reviewing funding for medicines use reviews (MURs) as part of a wide-ranging assessment of the "value” of community pharmacy services, C+D has learned.

The review, due to start later this month, was requested by England's chief pharmaceutical officer Keith Ridge to advise him on how clinical services can be “modernised” to ensure pharmacy meets the “changing shape and demands of healthcare”, NHS England said. 

The contractual framework, and all clinical pharmacy services commissioned by NHS England, are up for review (see below).

The commissioning body told C+D yesterday (May 4) that it is "possible" that this will include looking at how these services are funded, but stressed that it is "too early to say" and that no decisions had been made. 

"Value for the taxpayer"

The review is intended to ensure that community pharmacy commissioning models "deliver good patient outcomes and optimal value for money for the taxpayer", NHS England said in the review's terms of reference.

The independent review will be led by Richard Murray, director of policy for the think-tank the King’s Fund. Recommendations from the review are expected in October, and will be consulted on before Dr Ridge makes a decision on which proposals should be implemented.

The impetus for the review comes from NHS England's Five Year Forward View document, and the need to make the NHS “sustainable and better”, the commissioning body said. Pharmacy should see itself as “no exception” to this wider policy drive, it added.

Dr Ridge said the review will provide an “additional source of information on how clinical services provided by pharmacy teams could be redesigned,” and is part of “broader action to help modernise NHS pharmacy services".

Separate to funding cut consultation

The review is separate, but will run alongside, NHS England and the Department of Health's consultation on the planned 6% funding cut in England, NHS England told C+D.

Last month, Pharmacy Voice warned that the Guardian's allegations about the abuse of MURs for profit had done “significant harm” to the reputation of the sector, and could undermine the sector's argument against the planned cuts. 

Which services could be up for review?

  • Medicines use reviews (MURs)
  • Prescription intervention service
  • New medicine service (NMS)
  • Appliance use reviews (AURs)
  • Stoma appliance customisation service
  • Minor ailments services
  • Palliative care services
  • Care home services
  • Headlice management services
  • Gluten-free food supply services

 


Do you think funding for pharmacy services should be reviewed?

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31 Comments

Farm Assistant, Community pharmacist

If the chief pharmaceutical officer does not know the state of affairs in community pharmacy then he is not fit for purpose. These people are either incompetent or they know exactly what is going on and chose to ignore it for obvious reasons. These people are not pharmacists, they are politicians.

Barry Pharmacist, Community pharmacist

Time for C&D to look at this story again perhaps? where is this review up to?

 

R A, Community pharmacist

Just another excuse to cut funding! 

Stephen Eggleston, Community pharmacist

So, most comments here appear to read as "take away our funding. Let us work for free. Open up the market. Let the weak die." Before running to commend these ideas, the funding removed won't suddenly reappear jut because you open up the market. Once funding is removed it is gone FOREVER! Voting to provide services for free "because you are a professional" is both naïve and self-defeating. Pharmacy is a business. Business needs profit. And one more thought - where do patients get their medicines? By delivery? OK - but that just means more cost and less income for owner (large or small (

Stevie C, Pharmacy Asistant/ Medicine Counter Assistant

 

 

 

At times i despair with comments on here, so let me get this right the majority of the posts suggest that they would like to see the end of MURS because of the guardian expose, and most people are horrified with the cuts to funding, so does anyone actually think the expose was good fir pharmacy or just another excuse to say why not lets remove that funding as well kerching another 40 million to add to the 6% cuts or do you honestly think it will just be divided up into the dispensing fee not. Or should we focus on the really good MURs that prevented my 80 year old mother from a serious gastric bleed from ibuprofen, or the elderly gentlement that could not sleep and after spending 10 minutes with the pharnacist was rushed to hospital with a suspected heart atrack but could not get a doctors appointment. You may not always no an mur is worthwhile until you sit the patient down and lusten to what they have to say. Be carefull we do not comp,ain rhat much we becone a profession of turkeys vitung for xmas

 

 

Alan WHITEMANN, Communications

We Are not turkeys voting for christamas, we are already lambs to the slaughter because of malaise and apathy.

Jay Badenhorst, Superintendent Pharmacist

Dear Keith
Why don't you close all the pharmacies and open one centralised dispensing hub for all prescriptions. And while you're at it allow remote supervision and sit in your ivory towers and supervise all transactions.
Actually you won't need any other person to help take the strain off primary care as you can get robots to do the work for you and drones to deliver medication for you. And don't think patients will be seen by GP's as they will all be retired early due to stress. Oh, and if they go to hospital they may not be seen as the junior doctors may be on strike asking for a new contract.
Maybe all pharmacy team members should go and work elsewhere in Europe. But then there is Brexit.... Passports at the ready! But the US won't have us either.
Meanwhile in the real world 26 schools of pharmacy produce graduates with pharmacy degrees because it is still highly funded by our Government.... great stuff all round.
Regards
Jay
PS wipe that smug smile off your face. Please.

Ava Denuff, Locum pharmacist

I can remember when the MUR first surfaced. It was touted by its supporters as the next big thing for us to be able to demonstrate our 'worth and value' to the wider healthcare community. It could have been too.... but here we have a clinical service where there is financial 'reward' attached to chasing a targetted quantity with no requirement to prove any quality of outcome. It's farcical how it all works really isn't it? That corporates can apply such downward pressure on pharmacists to get the MUR's done without so much as a whisper from the GPhC is an 'offence' to profession. I have experienced such 'pressure' -  with some companies much worse than others, tempered by those few that offer some reward for carrying out  MUR's. I think the sooner that paid MUR's are scrapped and the funding channelled into something worthwhile, the better. It might even be something that might actually benefit public health too. But let it not be something else that pharmacy can use/abuse for profiteering. MURs were meant to be an opportunity to show our worth, not demonstrate our greed.

Angela Channing, Community pharmacist

I agree, Dave. I was a very big supporter of MURs at the beginning. Now I find I wrestle with my conscience every day now, doing them on people who don't want them, or don't really need them. I am also concerned with outcomes. Is there any evidence out there over the last ten years that they make any difference, or add value, and I don't mean anecdotal, I mean hard, published articles in respected journals? If they aren't reformed, then I think that they should at least be cut back to 200 to give us more time perhaps, to find people they are better suited to. And the remaining money from the other 200 used in part toward the 6% cuts. 

Angela Channing, Community pharmacist

I agree, Dave. I was a very big supporter of MURs at the beginning. Now I find I wrestle with my conscience every day now, doing them on people who don't want them, or don't really need them. I am also concerned with outcomes. Is there any evidence out there over the last ten years that they make any difference, or add value, and I don't mean anecdotal, I mean hard, published articles in respected journals? If they aren't reformed, then I think that they should at least be cut back to 200 to give us more time perhaps, to find people they are better suited to. And the remaining money from the other 200 used in part toward the 6% cuts. 

Janet NQ, Community pharmacist

I say remove payments for Mur and nms. If you're a professional you will deliver the quality service either way

Matt G, Community pharmacist

What? Why would you want that? Don't do these services for free, you are a professional, your time is valuable and you should be compensated for that time. Even if the payment doesn't directly land in your pocket. If payments are stripped, do you think the contractor is going to take that hit? No, its coming out of your paypack.

MUR/NMS are a good thing when delivered in the correct way, to the correct patients. The problem lies with the multiples, with their greed and with their inability to provide decent staffing levels. Don't sacrifice your value as a professional for the sake of shanking a few quid out of Boots' profit.

PoPeYe- Popeys Car Wash, Community pharmacist

Couldn't be said any better. +1. 

Chris Cairns, Academic pharmacist

I don't work in community pharmacy so you can disregard my opinion if you wish. Although I agree that in some circumstances the provision of MURs and NMSs is being abused, do remember the money to fund them was not new money but was taken out of the dispensing fees. Removal of these potentially valuable services would mean a significant reduction in remuneration for community pharmacy as I don't see the DoH handing it back as dispensing fees.

Angela Channing, Community pharmacist

When the 6% cuts happen, the pressure to do 400 MURs will only get worse.  When I retire, and the sooner the better.....the only thing I am going to remember about community pharmacy is the numbers 2 and 400 !  (that is, if it were brought to you by Sesame Street!)

Farmer Cyst, Community pharmacist

I say remove payments for dispensing medicines, and any reimbursement for costs incurred in procuring and supplying the medicines. If you're a professional you will put your patient first either way and deliver the service; you certainly wont ask for any money in return for doing this.

Dave Downham, Manager

Not if you don't get paid paid to provide a quality service, you won't.

M Elnemy, Non healthcare professional

If NHS England wants to save money, they should do the following :

1. Open up the market to allow anyone to open a pharmacy

2. £3 per item dispensed

3. Remove establishment payment/practice payment. 

4. have a late night pharmacy in every town/city across the UK 

 

 

Chandra Nathwani, Community pharmacist

I don't get this. At the moment the Global sum is £2.8 billion. Pharmacists dispense            1 billion  scripts for this sum and throw in "some added value" like free collection and delivery, free MDS, and MUR & NMS and some late nights ( mainly  100 hrs contracts) for whatever it is worth. You are asking for £3 per item! That is £3 billion Global sum! 7% INCREASE IN GLOBAL SUM! What is on offer is a 6 % CUT. AND THAT IS JUST THE BEGINNING. With £2.6 billion and further cuts to come you can open the market as much as you want but I cannot see how you would balance your books.

 

 

S Morein, Pharmacy Area manager/ Operations Manager

I agree with all your suggestions which would certainly aid the profession , patients and the taxpayer. I would additionally only award an NHS contract for a defined period e.g 10 years. That way poor performing contractors can be easily removed by the contracting authorities. Good performing contractors, of course, would have nothing to fear.

Mr Pharmacist!, Pharmaceutical Adviser

Couldnt agree more with the above.  What the government is doing is in effect stopping the subisidy for low dispensing pharmacies and opening up the market anyway.  In effect, the abolition of grouped fees designed to support small dispensing pharmacies (Anything at or below 4000 per month) should encourage local mergers or allow those that dont, to die.  If they then allow the market to fully open up, this will drive innovation in the sector and challenge the monopoly of the incumbents, who lets face it, are lazy and protective of the status quo.  None of that is actually good for the end consumers.  I'd like to see a battlefield open up which allows vibrancy in our sector and the ability to see new "kings" being made.

Mr Pharmacist!, Pharmaceutical Adviser

Pharmacists should join in the consultation and let Ridge know that the MUR and NMS has no value in the community pharmacy setting.  It should be provided in surgeries, where pharmacists are employed by the NHS.  At least that way the system cannot be abused.  All these multiples, who incidently direct the PSNC along with their "yes sir, how much sir" independent colleagues, should be put to task over how they have abused the system by using it as a cash cow, rather than to improve public health.  The PSNC along with their contigent of multiples had there chance to make services a real centre point for community pharmacy, but they just royaly blew it!!! It was always a smokescreen for extra profits.  Glad when its all pulled.

Freelance Chemist, Pre-reg Pharmacist

Excellent!!

Harry Tolly, Pharmacist

Well, the VERY first thing the review needs to address is that it actually takes a SECOND pharmacist on the premises to actually do a thorough and meaningful MUR (especially for those on 5-10+ items each day) or NMS.

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The SECOND thing the review needs to do is engage with PATIENT facing pharmacists and NOT our self appointed "leaders" (especially "Pharmacy Voice" .. which is really "Big Contractors Voice") and who have to date, led us to the cliff edge. IT is ONLY US that can guide the review on what OUR patients value.

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The LAST thing the review needs to do is redeseign the NMS and MUR forms. They really are NOT fit for purpose and are more of a box ticking exercise. ANYONE who has actually used these forms will understand the need for a thorough redesign.

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Hope this helps.

Harry Tolly, Pharmacist

So 25% (to date)  of readers who voted on my comment disagree with my suggestions. Suggests to me that a large proportion of readers who vote are NOT patient facing grass root pharmacists and maybe do not have the professional interest as a priority.

Mark Ashmore, Superintendent Pharmacist

Now only 16% :-)

Paul Miyagi, Information Technology

Well said Harry. We've been accused of being trolls for pointing out Boots insidious practices but I too wonder who these other trolls are who vote against our views Harry. They don't seem too come up with any other suggestions , and are certainly not community pharmacists with direct contact with patients everyday. Secondly who in the C & D passage belongs to the "think tank". Who are they? What qualifies them??

Pill Counter, Pharmacy

Yes you're a well known troll together with Sami, London, Morein et al. All pointed out the obvious on this site.

Alan WHITEMANN, Communications

.

Paul Miyagi, Information Technology

I,ve been pointing the obvious out for  almost 40years Chauhan , to RPS,  GPhC , Fraud Squad, NHS Protect ,Serious Fraud Office ( Good results on that One ) MP's ( good result there too) and now i'm retired it baffles me why there seems such aquiescence and obedience on the part of employees just accepting everything they are fed . I never did and it served me well. Nobody ever sacked me. So have a go yourself, you might surprise yourself what you can do if you complain properly and not just disrespect others Chauhan.    Ohhh and I see that your not too popular on your feedback!!

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