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PDA: Sector in 'self-denial' over MUR abuse

"Current MUR scheme must be comprehensively re-engineered"

PDA chair Mark Koziol says pharmacists are "being broken by the culture and business behaviour of their employers"

On Wednesday (April 13), the Guardian published an article accusing Boots of pressuring staff to abuse medicines use reviews (MURs) for financial gain. The newspaper backed up its allegations with references to an unpublished survey conducted by the Pharmacists' Defence Association (PDA), which it claimed was completed by more than 600 Boots employees.

As well as referring to allegations that Boots managers treat the government's 400-MUR limit as a "target", it claimed that more than 60% of Boots pharmacists who responded to the survey said commercial incentives or targets compromise the health, safety or wellbeing of patients 
 or the professional judgment of staff – half or more of the time. This compared to 52% of pharmacists surveyed by the PDA at other major chains, the Guardian alleged.

The PDA today (April 15) provided C+D with its view on the sector's response to the Guardian's coverage.

Read Boots' denial of the Guardian's allegations here.

 

Mark Koziol, chairman, PDA:

Here we go again, the profession is in self-denial.

The Guardian feature dealt with a number of issues, and from these come matters about which the profession needs to have an honest conversation.

We can argue about how good MURs are until we are blue in the face, but no matter how many internal memos from superintendents, warnings from chief pharmacists or statements from the regulator there are about the need to avoid targeting, [as long as] volume produces income, then volume will be driven [by income]. As you read this article, a number of non-pharmacist area managers are eyeing up their bonus entitlements from the sales drives that they managed during the last financial year.

The current MUR scheme must be comprehensively re-engineered to enable it to focus much more upon quality and clinical care. Whether this should be achieved through a community pharmacy contract or through a direct contract with the NHS (or even both), and whether there should be a second pharmacist available in the pharmacy to deliver MURs in a more focused and productive way, are all issues that need to be considered.

There is the issue of regulation. The General Pharmaceutical Council (GPhC) has consistently stated that the best way to protect the safety of patients is by underpinning the professionalism of pharmacists.

The PDA has been providing examples to the GPhC about how pharmacists' professionalism is being undermined by employers for years, and yet the GPhC appears unwilling to go after the miscreants, focusing their efforts instead upon individual pharmacists. We need the GPhC to put a lot more vigour behind its efforts to support pharmacists.

Pharmacists join their vocation because they want to look after patients; are we happy that so many community pharmacies now resemble one almighty 'three for two' offer? 

Perhaps it is unsurprising that a European Court of Justice ruling in 2009 concluded that a pharmacy owned by a pharmacist is a safer place than one owned purely by a commercial operator. Perhaps that is why, in continental Europe, many countries do not allow the corporatisation of community pharmacy and restrict the ownership of pharmacies solely to pharmacists.

Finally, we need to think about the pharmacists, like the individual interviewed in the Guardian's feature, who are being broken by the culture and business behaviour of their employers. Surely, if we want to call ourselves a healthcare profession, then we must not allow this to happen to our fellow professionals.

As members of the profession, we all know that there are very many excellent community pharmacists working hard every day throughout the whole of the UK to try and look after the needs of patients. However, unless we can address these issues, then community pharmacy will find it very difficult to lift its game and provide an improved service to the public.

 

Result

How often do you feel pressured to provide an MUR, regardless of whether it will benefit the patient?
More than once a day
32%
Every day
34%
Two or three times a week
7%
Once a week
4%
Once a month
2%
Never
21%
Total votes: 1110

 


Do you agree with Mr Koziol?

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69 Comments

Former Cist, Pharmaceutical Adviser

I worked for Boots at the start of my career and recall that they set the standards for all other contractors to struggle to match - quality of premises, training, standards of ethical practice and customer service. How could it go so wrong? I have been made very aware by many Boots pharmacists of the pressures they are under to meet targets with the knowledge that there is a reservoir of pharmacists waiting to take their jobs if they don't comply. I suppose  the next story to break will be the total abuse of the prescription repeat ordering systems with Boots taking a lead with their so-called managed repeat service which in simple terms involves ticking to re-order everything on the repeat sheet on behalf of, but with minimal or no input from the patient (and assuming they are not in hospital and still alive). I am confronted on a daily basis by angry GPs and practice staff drawing attention to such fraudulent activity. I feel genuinely sorry for the many superb pharmacists out there having their reputations dragged down. To the ethically bankrupt I say put your house in order and quickly. Ask yourselves why the Government is taking substantial funding out of community pharmacy and putting it into GP practices to support the funding of practice pharmacists. The writing is on the wall.

Francis Jones, Community pharmacist

Boots have got away for years with flagrant breaches of ethical guidelines and the GHC semms gutless in tackling them.The local branch in Abergavenny has an enormous stand just by the entry with confectionery and sugar-laden soft drinks.This is a gross breach of ethical guildlines.I suppose their defence is that the dispensary is at the back of the store away from all the cariogenic products!I can understand that non-pharmacist area managers pressure pharmacists to carry out needless MURs as Boots consider this this as just another cash cow to be milked as much as possible.Pharmacists are placed in an impossible position-if they fail to toe the MUR line they will forfeit pay rises or be transfered or the unfortunate locum will be blacklisted by Boots.Boot's attitude has brought MURs a bad name and may only lead to a cost-cutting government stopping them.I feel for those pharmacists who are pressured into making needless MURs just to keep their boss happy and their jobs safe.No wonder so many feel extreme stress in their job.As far as I can see the GHC is a tiger when dealing with individual pharmacists but a toothless bulldog in dealing with Boots or any any multiple which abuses the MUR system.

 

R A, Community pharmacist

This is the tip of the iceberg! The number of other questionable activties going in a community pharmacy makes the MURgate scandal a triflling matter! 

Shaun Steren, Pharmaceutical Adviser

This is true, but the posts on here reveal the true split within the profession. Until employee/locum pharmacists come together and act collectively, we will not be able to save the professions reputation from the 'Fox News' types who so often post on here and degrade us with their avarice. 

R A, Community pharmacist

Given the 67% votes against my comment and the 100% vote against your comment the idea of a profession uniting under one banner is very unlikely!

Long Standing, Primary care pharmacist

Financial incentives are undermining patient care where there is a financial gain will never be an advantage for patients. Pharmacy owners sets targets and punishes locum and employed pharmacists for not performing MURs even when they are not justified ... I see this everday

Aryan Butt,

If Boots and others are guilty of such practice then the pharmacists who enable Boots and others to do this are just as guilty and clearly complicit. I see no difference between Boots doing it for profit or an employee doing it for salary.

In the absence of independent evidence I do not believe for a moment this is as widespread as is being suggested. I think most people pharmacist or not are honest

Being a pharmacist and or employee is no mitigation for doing unlawful or unethical acts.          

Shaun Steren, Pharmaceutical Adviser

You give the impression of somebody who has never thought about the arguments against his own position. Have you actually read the Guardian article? It talks of a crooked culture in which employee pharmacists who, in resisting the pressure to cheat, are becoming stressed and demoralised. It talks of unsafe working conditions which pharmacists are constantly trying to reverse. This being the company that has tried to prevent the collective action of employee pharmacists that would energise such resistance. Please read the latest article by Dr Messenger, somebody who has greater empathy with employee/locums pharmacists than the avaricious shopkeepers and corporate apologists who post on here. Are you one of those awful people who wish Britain would become more like

 

America? 

Shaun Steren, Pharmaceutical Adviser

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Yuna Mason, Sales

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Shaun Steren, Pharmaceutical Adviser

The Guardian reporting has reached another level tonight (Sunday), this is slowly moving towards public scandal proportions. Could the shopkeepers amongst us keep this in mind when they post, you are compounding the problem with your avarice and making the rest of us appear crooked. 

Sarah Willis-owen, Community pharmacist

Mark you have made some excellent comments. Thank you. Sarah

Aryan Butt,

I don’t think the sector is in denial at all. Of course there will be incidences across the industry at Boots and elsewhere of unsavoury characters resorting to fraud and dishonest acts. There are good and bad in all industries and sectors. Those that are responsible for these acts should be reported and appropriate action taken against them.

 

Having said that those that are making these allegations should report the incidences and or the companies and refuse to work for such companies. Not stay in their jobs and collude with those that ask them to carry out unlawful or unethical acts collect their salaries and then whine and whinge to the Guardian and PDA. Simply Boots are not holding a gun to your heads to do MUR’s you can resign.  

Shaun Steren, Pharmaceutical Adviser

You sound like a character from Atlas Shrugged. No doubt you will see that as a compliment. 

N A, Non healthcare professional

There is self denial in the sector. Some people are focussing on the lower level MUR debate, but there are much bigger issues (as mentioned). Pressure in pharmacy, focus on volume in healthcare, lack of action from the regulator, should a non-pharmacist run a pharmacy etc. European Court of Justice: 'the operation of a pharmacy by a non-pharmacist may represent a risk to public health'. So let's not spend too much time just talking about MURs.

S Morein, Pharmacy Area manager/ Operations Manager

This is the sad effect of closing a market to new entrants coupled with poor policing of the validity of MUR's. The Stalinist idea that a closed market controlling entry is good for both patients and the NHS is clearly shown to be fundamentally wrong.

The DH now needs to urgently consider opening the market to new entrants without increasing the global sum. This way the most efficient pharmacies, providing outstanding innovative service will thrive and those that just operate for their own greed and self interest will quickly wither.

This will be to the benefit of patients, the taxpayer and the profession. 

A Hussain, Senior Management

When you open your pharmacy as control of entry has been abolished, what will you do when Lloyds, Boots, Day Lewis etc. all move in around you?  One of those companies could see you off, no matter how hard you work as they have MONEY.  You'd probably do an MUR on your cat! Is that what you mean by innovative.  You'd have to spend more time with patients than you do on here to stand any chance of surviving.

Pill Counter, Pharmacy

How presumptious. I don't recall Shaun mentioning he was about to open a community pharmacy and why would he necessarily resort to fraud because a multiple opens up round the. I think this all tells a little bit more about your own principles.....

Shaun Steren, Pharmaceutical Adviser

No, Mr Hussain, many of us would rather line up at the job centre than commit fraud in relation to carrying out MURs. Stop projecting your own importance of money on to others, some us (including myself), find this avaricious shopkeeper mentality distinctly embarrassing. 

A Hussain, Senior Management

Get yourself down there as moaning about it using a fake name isn't really helping much.  I don't commit fraud, but I am not naiive enough to pretend that money doesn't matter.

Shaun Steren, Pharmaceutical Adviser

Could you put that in English please? Preferably in prose befitting of a professional for whom the public gives their trust. 

 

 

A Hussain, Senior Management

Owning a pharmacy has given me a lot of personal and professional satisfaction.  Much the same as your ownership of a Thesaurus.

Shaun Steren, Pharmaceutical Adviser

That is better Mr Hussain. See, you can do it when you try, but yes, leave the 'big words' to me. 

Pill Counter, Pharmacy

Mr Hussain has finally revelaed his true colours. He'll come back with some insults now about being lazy.....

John Randell, Non Pharmacist Branch Manager

LETS BE GROWN UP ABOUT THIS ISSUE..... fact is if we dont meet the mur targets that £11200 lost income.. where do you think  the contractor will take that money from if you dont  make this youor budget...ADULT ANSWER: YOUR WAGES.....some of the chatter on here is very naive.....

Sue Per, Locum pharmacist

Its not only about the revene stream, but about the manner in which the pharmacists are made to run around like headless chickens, for a paltry remuneration. It is true to say that the pharmacists wages and locum rates have not kept up with the increase streams enjoyed by the contractors, and coupled with skeleton staff, a greater proportion of profits are retained by the greedy contractors. This is evident in their behaviours - increased profit margins by whatever means, (including  fraud) high goodwills for the pharmacies, a desire to increase their estate. Time for a radical change with the contracts.

Shaun Steren, Pharmaceutical Adviser

.

Pill Counter, Pharmacy

You don't sound very grown up John. In fact you sound like you work for Boots or you condone defrauding the NHS.

John Randell, Non Pharmacist Branch Manager

The problem is how can you defraud the NHS if there is no quality consensus... You might have an idea of what a good mur constitutes but ..the NHS does not pay on quality...it pays on quantity...the fact is murs are lost income...do you have a business brain at all....the best pharmacists understand business..otherwise you will probably struggle in the retail space..all murs of course need to be done legally anyone not complying to requirements leaves themselves foolishly exposed.
..but we can't be naive to the business aspects of RETAIL pharmacy.

John Randell, Non Pharmacist Branch Manager

The problem is how can you defraud the NHS if there is no quality consensus... You might have an idea of what a good mur constitutes but ..the NHS does not pay on quality...it pays on quantity...the fact is murs are lost income...do you have a business brain at all....the best pharmacists understand business..otherwise you will probably struggle in the retail space..all murs of course need to be done legally anyone not complying to requirements leaves themselves foolishly exposed.
..but we can't be naive to the business aspects of RETAIL pharmacy.

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