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Pre-reg pharmacists conducting unsupervised MURs, C+D poll finds

Exclusive Almost a third of respondents reported being aware of pre-regs conducting MURs without the required supervision, C+D's poll found

Pre-reg pharmacists are conducting MURs on their own in some pharmacies, directly flouting service requirements and leaving the pharmaceutical student body "shocked", a C+D poll has revealed.

Nearly a third of the 243 readers responding to a C+D poll last week said they were aware of pre-reg pharmacists conducting the advanced service without having a registered pharmacist present during the consultation.

Twenty five per cent had heard of the problem and 9 per cent said they said they had direct experience of the practice, which contravenes requirements for MURs to be either conducted or supervised by a qualified pharmacist with an MUR certificate.

Almost a third of respondents reported being aware of pre-regs conducting MURs without the required supervision, C+D's poll found

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Pre-reg pass rate falls as focus switches to practical skills

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A recently qualified pharmacist, who wished to remain anonymous, said locums had asked him to conduct MURs and NMS interventions at the pharmacy where he worked as a pre-reg.

"I said the service specifications required a registered pharmacist and I wouldn't be able to do them, and that was actually a surprise to the locum," he told C+D. He believed the requests were down to a lack of awareness of the requirements, rather than a disregard for the need to have a registered pharmacist present.

Although he refused to conduct the service, he was aware of other pre-regs feeling obliged to agree when asked by their line managers. The responsible pharmacist would sign off the interventions as their own, he reported.

"When it's your line manager who's going to be signing off your competencies, some don't have the confidence to refuse," he reported. "You could, for example, be told that you're not contributing to store performance, which is one of the main factors multiples look at when they take you on [as an employee]."

Raj Jain, pharmacist at W/R Evans (Chemist) Ltd t/a Manor Pharmacy, Burton-on-Trent, said he had heard of pre-regs being asked to conduct advanced services at other pharmacies. "It's dotted around various pharmacies," he told C+D. "All the tutors I know personally toe the line, but I know the practice does happen in some small pharmacies – I don't know about the multiples."

The British Pharmaceutical Students' Association said it was "shocked" to learn of the practice."We were not previously aware that situations such as these were occurring," said president Katy Parsons. "Although a pre-reg may feel clinically ready to conduct MURs, they are not professionally able to do so."

The GPhC confirmed that pre-registration pharmacists can conduct MURs under the supervision of a registered pharmacist as part of their training. MUR forms must be signed by the registered pharmacist, who takes overall responsibility for the intervention.

For more on MURs, visit the C+D MUR Zone, sponsored by Teva.

Have you come across pre-regs being asked to undertake duties that  contravene professional requirements?

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Gerry Diamond, Primary care pharmacist

Perhaps the solution is to allow pharmacy graduates to become accredited during their pre-reg year as they have the academic background comfortably to perform such a task. Then it would be legitimate and allow the pre-reg to become ready for full practice.

Amal England, Public Relations

Old Timer, the world has moved on, corruption is rife, cutting corners is rife, health professionals doing bad is rife, welcome to the new age of survival, welcome to western ideals, welcome to a system of kings and queens,welcome to a system of hierarchy- take your place in the pecking order and do what it takes to stay there or you will go down the ladder faster than you came up.....pre-reg's doing MURs, that's nothing, how about dispensers doing MURs. Smell the coffee- I think it smells better than it tastes.

C W, Dispensing assistant

I can see why it's an issue, but it doesn't seem that big of an issue, really. Fair enough, I may not be able to understand it due to not conducting MURs myself (obviously...) but these aren't pharmacy students conducting these MURs, these are pharmacy graduates who've not only obtained a masters degree in pharmacy, they've also been successful in gaining a pre-reg placement, which isn't exactly easy these days.

Like I say, it's an issue because it's against the rules but not a huge patient safety issue, surely.

Pharmacist Pharmacist, Community pharmacist

I agree entirely with you CW. Its not a patient safety issue. Unfortunately we're just bound by so much red tape that we cannot get out of it.

Ahmed :-), Community pharmacist

Oh and if anyone messages to say that by not speaking up then pharmacy will fail, disappear, never have existed etc I'm gonna go crazy! You don't live in the world of 100's of pharmacists working for multiples who have their jobs threatened if they don't conform! Your views are not wrong just very unhelpful! I hope you enjoy working for one of those 'good pharmacies' but until you're in our position you evidently can't empathise.
Unfortunately Multiples dominate with their vast number of pharmacies. The answer cannot be 'well go work for a good pharmacy' that's missing the point entirely, to ignore them will mean they worsen and descend into even worse practice. We must confront and reeducate them, and I can't bloody do it on my own. That's why I call to respected bodies, respected professionals, respected journals to unite to improve our profession. United we'll stand...divided and they'll win!

Ahmed :-), Community pharmacist

Unfortunately you miss the point Old Timer...I said I have brought things to the attention of my 'line manger' (I hate that bloody term) and was told that I had a bad tone ( my tone hadn't changed one bit, rather he didn't like the content) and that my future employment was can forward thinking, hard working pharmacists with a vision for the future be able to influence pharmacy when the predominant values in Multiples is the QUANTITY over QUALITY, more MURs, more sales, more NMS, more Rxs without the substance. Line managers have been advising pharmacists to counsel pts less as it is hitting the stores wait times! Also told to write quicker in the CD register as writing is too neat meaning they are taking too much time, told they expect ALL their managers and locums to check through their lunch breaks, encourage pharmacy teams to not give owings as they are now measuring how many owings each pharmacy give... the next stick to beat us with, and oh how they enjoy beating. Beat beat beat all day long. And when I approached the 'professional team' ie the superintendent office, I was genuinely told that the Area Managers have a vested interest to protect their own figures ie they are happy to let professional standards slip in order to have their 'business balance scorecard' look better. I don't even blame the area managers, they are doing the job they were brought in to do. I blame the people higher who hired them to do their dirty work for them. Daily pressures are put on pharmacists to improve the business side but nothing on the professional or clinical side except for the complimentary weekly bulletin from the impotent superintendent teams. And the fact is that they do not respect us nor value us at all, as soon as we voice concerns we become a hinderance and they will have another eager young innocent pharmacist, straight of the bulging production line, to fill our spot and for them to bully!! I came out of Uni with near enough £30000 debt and also thrown in was a lovely wife. I have these pressures of my own to continue in employment, but I reiterate for you again Sir that I was threatened when I did voice my concerns...I am considering moving into hospital pharmacy but that is a very sad thing as I actually enjoy a lot of community pharmacy and would love to see us evolve from just Suppliers into something far more interesting and useful to make a real positive impact on the nations health and wellbeing...or instead I can go back to encouraging my staff to sell as much Lipotrim as I can to patients as that is what the Multiples 'Drives' are at the moment...

Julie Goucher,

For someone who is I think newly qualified into the profession the cynical behaviour is saddening, although I completely understand it.

Sadly the behaviours of the multiples does affect moral within the organisation and the profession, although not everyone working for a multiple has poor standards. I understand the remark you made about beating with a stick truly I do.

My view is this and always been. If we traded, we didn't have a serious incident and we were safe then it was a good day. Chin up! and yes one day we will hopefully be more useful to society....oh yes like we used to be!

Philip Sealey, Locum pharmacist

Investigate hospital pharmacy carefully before you jump, Ahmed. It's not rosy there either: once you move up the ladder, pressure from cash strapped managers for you to reduce drugs expenditure kicks in, year on year. This can only get worse as cuts to the NHS budget bite.

Dorothy Drury, Locum pharmacist

Where exactly do we stand on this issue? The RP is signed in and is responsible for the running of the pharmacy at these times stated, when presumably the MUR is taking place?

Ahmed :-), Community pharmacist

Well the rules state that pre-reg cannot perform MURs. Therefore we cannot let pre-reg students do MURs. HOWEVER, from my experiences on my travels, I have noticed the general slip in professional standards. Pharmacists tend to be very busy at work what with being managers, checkers, sign-posters, answering phones, CDs, deliveries, services, paperwork, queries...etc So something has to give, whether that's letting pre-regs earn the 2x£28/day (MURs), dispensers doing NMS, not giving owings as area manger wants you to reduce these, reduced time to counsel patients, reduce time to clinically check Rxs. Unfortunately the multiples are making life difficult for pharmacists who stick to their professionalism and are hiring a lot of pharmacists who like to say 'yes'. If you are a professional pharmacist working for a multiple then I apologise as I know you exist...but for how long?

Another Pharmacist, Community pharmacist

Eloquently put my friend. I have a suspicion that I work in the very organisation that you allude to. They may talk about their ethical stance & doing things differently, when in truth it is all about profit and imitating the aggressive corporate management tactics of PLCs. I could move on, but the glut of young pharmacists and locums (understandably) looking for permanent positions has driven down the salaries offered by companies, meaning that I have to stay put & tolerate the management pressures put upon me. Nothing to be proud of I know(!!!), but that's the way it is for a good percentage of employee pharmacists & locums with long-standing regular bookings. That mortgage needs paying every month!

Jack Daniels, Community pharmacist


Pillman Uk, Non Pharmacist Branch Manager

I also believe this is hyped up reporting, a storm in a tea cup, and I am disappointed that when such incidents present themselves the pharmacists feel unable to respond appropriately. Are we a neutered profession?

Pillman Uk, Non Pharmacist Branch Manager

The only thing necessary for the triumph of "bad pharmacy" is that good pharmacists do nothing.

Old Timer, Manager

Correct Pillman ,do nothing and we only have ourselves to blame, a wrong is never right ,who would want to compromise their standards in order to have a quite life .
Good pharmacies will continue to employ good pharmacists .

Er Ds, Superintendent

absolutely agree with ahmed. well said

Ahmed :-), Community pharmacist

Maybe ok for you to blow the whistle old timer but the I'm a young timer, and the last time I tried to blow the whistle, my 'line manager' threatened to take away my locum work from me. As a highly professional locum, I've seen all sorts of bad practice on my travels and letting locums do MURs is the tip of the iceberg. I KNOW that the denigration of our profession is due to the Multiples and the ever increasing quantity of non-pharmacy personnel employed by them. Yet no-one listens as the people who can make a difference dont want to rock the lucrative boat and are all happy to go to work and bring home their hefty pay checks! I'm wasting my time right now writing on this website that seems to carry zilch clout, with zero effect on anything that matters. Front line pharmacists with great ideas and values all pouring their hearts out, bringing up great ideas and views on this site but no change...nothing.... Enjoy ur retirement old timer, I doubt I'll be a pharmacist by the time I retire...I'll have been struck off by the incompetent GPhC for falsifying MURs due to aggressive bullying
cut-throat tactics of the multiples whilst Superintendents with more clout(and better lawyers) get a slap on the wrist for lying, stealing, procuring medicines illegally and selling them on for profit...oh happy days!!!

Adina Brown, Community pharmacist

Young timer, I share your views/sentiments 100%.

Old Timer, Manager

I feel for you and understand what you are saying ,but you can not claim to be Highly professional if you turn a blind eye to illegal activity where would you draw the line ,things are black or white in law not grey or invisible .

Old Timer, Manager

Any Pharmacist who has evidence of this should blow the whistle and blow it loudly ,if the above is true and people dare not report then Pharmacy as a profession is well and truly
FINISHED !!!!!!!!

Arrey TATAW, Community pharmacist


Reeyah H, Community pharmacist

It already has finished I'm afraid. One has to look at the bigger picture here.. why are the Pre-reg's being made to do this? The pharmacist has no time, and is probably desperately trying to make ends meet. They then try to get the best person to do it without a cost factor..I'm afraid that's the pre-reg!

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