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How has the sector responded to the Boots MUR allegations?

Sandra Gidley: Pharmacists should have "professional autonomy" at work

RPS English Pharmacy Board chair Sandra Gidley says pressure to meet targets "directly contradicts" professional standards

Pharmacy Voice has defended the proper use of medicines use reviews (MURs) in the wake of claims made by the Guardian that Boots pressures its staff into conducting them unnecessarily for financial gain.

Pharmacy Voice chief executive Rob Darracott acknowledged that the newspaper's allegations against the multiple – including claims from one Boots pharmacist that they had been instructed to carry out an MUR on a patient with dementia – will raise concerns about the “potential waste” of NHS money.

But MURs are a “highly valuable” way of optimising medicines and their efficacy, Mr Darracott said yesterday (April 13). Pharmacists should be “proactive” in offering the service as often as possible, providing it is “clinically beneficial” for each patient, he added.

Boots responds to allegations

Boots told C+D yesterday that it “doesn’t recognise" the Guardian’s claims. The multiple has reminded its pharmacists of its guidance on providing MURs, which makes clear that they should only be offered if they benefit patients, and should never be carried out for the “attainment of numerical targets”, it added.

PSNC: Targets "a matter for" contractors

Pharmaceutical Services Negotiating Committee (PSNC) has told C+D that how contractors set priorities for staff is "a matter for them". But helping patients optimise their medicines should be the "priority for all involved in providing" MURs, director of NHS services Alastair Buxton said this afternoon (April 14). 

RPS: "Urgent need" to address target culture

The Royal Pharmaceutical Society (RPS) criticised the target culture caused by "unacceptable commercial pressures" in large pharmacy companies. 

English Pharmacy Board chair Sandra Gidley said the pressure to meet targets "directly contradict" regulatory and professional standards, and stressed that pharmacists should have "professional autonomy" at work.

MURs and the new medicine service (NMS) are "important" services, and the RPS is "unequivocal" that the vast majority of pharmacists use "precious" NHS resources as effectively as possible, she said this afternoon (April 14).


How often do you feel pressured to provide an MUR, regardless of whether it will benefit the patient?
More than once a day
Every day
Two or three times a week
Once a week
Once a month
Total votes: 1110

The Twitter reaction

Pharmacists took to Twitter to air their views on the Guardian's allegations.

Read more on the MUR abuse allegations:

C+D's Kristoffer Stewart on how MUR abuse is widespread

Dr Messenger reveals his own pressure to meet targets

Read readers' reaction to yesterday's story

GPhC to look into MUR abuse evidence


Have you ever felt pressured to carry out unnecessary services?

We want to hear your views, but please express them in the spirit of a constructive, professional debate. For more information about what this means, please click here to see our community principles and information


Concerned pharmacist, Community pharmacist

Speak up; don't be afraid. This is the opportunity to return to professional autonomy. Be responsible. If every single pharmacist wrote to their Superintendent spelling out their concerns then there is a chance to eliminate the target culture. MURs themselves are not the issue. The problem lies with the Phamacy contract which has created this culture. PSNC have the opportunity to address this but appear to be suggesting changes where targets will flourish. We need to grasp this at grass root level and force a rethink. Please write to your Superintendent today; there is no personal risk if we all act as one.    

Pill Counter, Pharmacy

Absolutely. And the following day the leaders of Israel and Palestine will shake hands and declare peace.

AJ Smith, Locum pharmacist

I feel embarrassed sometimes having to conduct murs as often the patient feels there is no need for one, especially if they're only on a couple of items and have just seen their gp. the  bonuses given reaching mur targets are hardly a big incentive, when area managers are on 6 figures 

Gursaran Matharu, Community pharmacist

Perhaps, the MUR is no longer fit for purpose and needs to evolve to meet th patient's need for information about their medicines. How many GPs include in their scripts the reason for taking the medicine e.g. "for blood pressure." 

The profession needs to develop the MUR which contains information that is actually useful and perhaps there needs to be training for pharmacists to carry out a MUR.

Our collective leaderhip and schools of pharmacy need to come up with a new MUR format. The NHS needs to promote the concept to the patient so that it is driven by the patient.

Amal England, Public Relations

When we fail to stand untied and strike a blow to those MPs, multiples, independents, individuals, professional bodies, etc, tarnishing and knocking professionalism out of pharmacy, then what do you expect. And in there lies the problem- groups within sub-groups ruled by 'dictators'. When one group sufferers, on the face of it it doesn't seem to affect the other groups. There government's vision for pharmacy has been constructed by the multiples, but it's impact is across the whole profession. If u need any further explanation then look at the monopolies and mergers commission.

We’re all doomed, Locum pharmacist

Take a step back, this all amounts to a broken remuneration model based on payment for process (dispensing, MURs, NMS). It is simplistic, brutal and easily exploited. A more detailed, clinically orientated remuneration model would eliminate this nonsense and more importantly remunerate the profession for the work we really do on a day by day basis. Interference would be eliminated at a stroke and a clearer expectation of all within the profession would put ownership back where it belongs

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.....

Peter Slowey, Locum pharmacist

Obviously psnc and contractors will defend them to the hilt as they represent income they used to make from dispensing pre claw back days.  The system is rotten to the core.  Boots is being made a scapegoat, but having worked for them and saw the way employees are treat I have little sympathy


MURs shouldn't exist.  If we're honest how many of them benefit patients more than the brief interactions we had with patients before they existed.  It's a given that they are beneficial for some but most of the time it's a tick box exercise.  



Frustrated Pharmacist, Community pharmacist


Stuart Nicholls, Community pharmacist

MUR's were not funded by 'new' money, money was taken away from the margin on purchase drugs to fund this service; I believe most pharmacies do not achieve the 400 allowed number so have been worse off

Shaun Steren, Pharmaceutical Adviser

Who has been worse off? Here we arrive at the crux of the matter - employees/locums ought to carry out MURs so that the contractor is not made worse off.

Simon MEDLEY, Community pharmacist

me- I'm worse off and others like me who are single contractors, Not being a masochist I don't set myself impossible targets to regain the money taken out of the contract years ago to fund the service, And I don't harrass or incentivise locums either, 

Shaun Steren, Pharmaceutical Adviser

One thing missing from this debate is the point that most employee community pharmacists are hitting their MUR targets. What are those profit centric people  who talk about it being money taken from the original contract complaining about? Employee/Locum pharmacists are simply disagreeing in principle, are they wrong even to do this? Do they not only have to meet commercial targets but also become that corporate culture in spirit? 

Ian Jenkins, Community pharmacist

Is the debate about hitting the targets, or how those targets are achieved?  

There are many stories from pharmacies, eg:  - where the pharmacist, in an effort to hit the target (for fear of reprisal), will ask a few questions over the counter and then sign off the forms themselves, or ask the patient to sign a form without explaining what is going on.  -Dispensers performing them rather than pharmacists (not even technicians), - staff being asked to sign forms, - NHS numbers being used to input a claim, then the PMR number being used at a later date to claim the same MUR again.........



Shaun Steren, Pharmaceutical Adviser

It depends who you ask. Targets are legal and acceptable to the PSNC and GPhC. The targets can be achieved within the specifications set out by the Drug Tariff with each one being a tick box exercise. The whole thing is about contractors not losing money and the government getting pharmacists to dig holes so that they can create the illusion of providing taxpayer value when they fill them back in. 

Ian Jenkins, Community pharmacist

I have nothing against target setting; as a financial enterprise targets must be set to maximise income and profitability. What is a problem (and is the key point of this whole debacle) is pressurising pharmacists to commit fraud to achieve them.

We put no pressure on our pharmacists, yet we often achieve the target. We staff the branches appropriately, give pharmacists support and occasional cover and extra help where needed.

Whilst it is easy for some to say that pharmacists should stand by their professional integrity and resist the pressure, in reality it is impossible. If you have a career manager (read: bast*#d) putting pressure on you, and threatening your livelyhood, you'll buckle to appease them. I wish I still had some of the "Traffic light" paperwork and emails from my multiple days; The Guardian would love them!

sanjai sankar, Locum pharmacist

In the past, Pillbox Chemist, a large group which owns many Pharmacies outside the M25 made it a point to deduct 2 hours locum wages if 2 MURS were not done for the day....My agency would phone me up and tell me this was in their terms and conditions...I had to print it out and read it several times I just couldn't believe how shameless they were about it...Its a disgrace and this story is not a new one....I really hope something can be done about this and I am not surprised useless MURS are being performed because of pressure  from some multiples AND independents alike... Pharmacists are unlikely to report this behaviour because of fear of losing their job or being punished in some way...Sad state of affairs and a weak regulatory body means it will probably continue...

Angela Channing, Community pharmacist

Surely this is illegal? Or if not illegal, then it is certainly unethical, as the code of ethics says you should not let your work be dictated by targets, etc etc.

Has the GPhC been knocking on the Pillbox door??!! 

sanjai sankar, Locum pharmacist

Thats what I thought Angela....But I didn't bother take it any further, just stopped working for them...Code of ethics says not letting work being dictated by targets...?-)...That would be a lovely dream would'nt it? 

Amber Sattar, Pharmacy Undergraduate

I've been a locum pharmacist and then a permanent pharmacist for many companies all of them have equal Mur pressures also have worked for boots sad to say that they get the blame for unessary Murs when it's the same everywhere. Companies will put pressure however it's the pharmacist fault for not using there own judgements. 

Shaun Steren, Pharmaceutical Adviser

Quite right about it being everywhere. It is also true that it comes down to an employee pharmacists judgment - they must make judgement as to whether they meet their commercial targets or refuse and enter performance management and disciplinary procedures. Nearly all employees choose the former. In this sense there is no scandal - Boots et al are not doing anything illegal nor (according to the drug tariff specifications) anything unethical. This can all be distilled down to a culture of compliance. There are those pharmacists who still believe they ought to be professionally autonomous in all things relating to judgment of patient benefit and those who believe pharmacists must comply with the values of those who pay their wages. Whether you see this as a Faustian pact or legitimately 'just business' is the judgment that defines whether you are likely to survive in modern pharmacy. You can refuse the pact and no longer be employable, you can accept the pact and hang up your soul on your way through the workplace door or you can see no pact to be made. 

Sam Patel, Community pharmacist

Why do locums think contractors can take a massive funding cut, with the outcome to cut pharmacy numbers and this not affect them or their remuneration ? Wake up this cut will affect all working in pharmacy and we should all pull together. With regard to MURs, whilst not all have a benefit, some do and until you speak to the patient you have no idea. Those that say they are all a waste of time are generally pharmacists who are are also a waste of time who don't really care about the patients only their pay at the end of the day.

Chris Pharmacist, Community pharmacist

Sam, it isn't ordinary pharmacists that have turned MURs and NMS into targets, the vast majority of pharmacists want to support and help their patients use of medicines (and are not a waste of time silly!)...Ironically, being bullied into achieving daily/weekly MUR/NMS targets takes our attention away from the patients who need us - the housebound, multiple health conditions, irrationally prescribed medicines, medicines not synchronised, etc...both the PSNCs creation of these flawed services and the multiples obsession with targets to control staff have taken the attention away from what our interventions should be about.

Farm Assistant, Community pharmacist

The real issue is employee pharmacists being forced to do them under the threat of being "managed out of the business".

Sam Patel, Community pharmacist

Why do locums think contractors can take a massive funding cut, with the outcome to cut pharmacy numbers and this not affect them or their remuneration ? Wake up this cut will affect all working in pharmacy and we should all pull together. With regard to MURs, whilst not all have a benefit, some do and until you speak to the patient you have no idea. Those that say they are all a waste of time are generally pharmacists who are are also a waste of time who don't really care about the patients only their pay at the end of the day.

Pill Counter, Pharmacy

Bear in mind Locums/employees have had their wages frozen for 10 years. In real terms a pay cuts year on year.

Clive Hodgson, Community pharmacist

How about this as a possible replacement for the current MURs which would appear to be increasingly (and perhaps fatally) compromised and discredited due to abuse for financial gain.


CCGs appoint and directly pay the salary of Pharmacists to perform MURs. There are now no numerical targets or financial incentives to perform tick box reviews.


MURs are performed in community Pharmacies. The Pharmacy receives a fee for hosting the CCG appointed Pharmacist. The location, frequency and targeting of these MUR visits can be decided by the CCG who can take into consideration the demographics and health issues of a particular area.


Patients get proper reviews, Pharmacists get paid and Contractors get paid. Fraud and bullying eliminated.


Stephen Eggleston, Community pharmacist

MURs are funded from money withheld via DT changes - are you suggesting that money is handed to CCGs to spend? - be very careful what you are suggesting; CCGs would already like to have full control over pharmacy funding locally and that is only likely to result in money flowing in one direction - and it won't be towards pharmacy!

Clive Hodgson, Community pharmacist

The finance would have to be ringfenced for Pharmacy. I agree it could not just go into the CCG funds otherwise. I was just floating an idea as the current situation in regards MURs really cannot continue. Anyone else have a suggestion?

Julia Bognar, GP

Is it not something where the Practice Pharmacist-route could potentially lead to?




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