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TaxPayers’ Alliance slams MURs as a “£67m wasteful subsidy to pharmacists”

The TaxPayers' Alliance has slammed MURs, branding the £67 million spent on them annually a "wasteful subsidy to pharmacists" and calling on the government to slash the amount paid for the service.

The TaxPayers' Alliance has slammed medicines use reviews (MURs), branding the £67 million spent on them annually a "wasteful subsidy to pharmacists" and calling on the government to slash the amount paid for the service.

The pressure group has released a two-page report in which it criticises the "expensive" service and claims the effectiveness of MURs has been "called into question".

Citing research from the University of Nottingham, the TaxPayers' Alliance said it had found "little evidence that [MURs] achieved improvements in medicine usage".

"The TaxPayers' Alliance is barking up the wrong tree here, MURs more than pay for themselves" Sue Sharpe, PSNC

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"Pharmacists were interviewed as part of the academic study, and – while many argued the service could be valuable – some of the responses were scathing," the alliance wrote.

The report also said a small survey had found that pharmacists could take anything between five and 15 minutes to carry out an MUR, meaning they are "effectively being paid between £112 and £336 an hour".

"Average funding to a GP, for a patient on their list for a whole year, is £64.59. A pharmacist gets almost half of this just for performing a single MUR," said the alliance.

The document went on to detail the amount of money multiples can receive for MURs each year, pointing out that most were paid millions of pounds for the service in 2011.

Matthew Sinclair, director of the TaxPayers' Alliance, said: "These medicines use reviews are incredibly expensive and achieving very little."

"The government should act to reduce the cost of MURs rather than continuing with a system that encourages national chains to try and squeeze as much money out of taxpayers as possible, to pay for reviews that most doctors don't think represent good value," he added.

Pharmacy leaders hit back at the criticism, with PSNC describing the TaxPayers' Alliance report as "unjustified" and "based on flawed research".

PSNC chief executive Sue Sharpe said: "The TaxPayers' Alliance is barking up the wrong tree here. MURs more than pay for themselves by helping patients to make the most of their medicines, which reduces waste for the NHS and improves patients' quality of life."

"It's clear that the authors didn't bother to pick up the phone themselves and speak to any patients or pharmacists before publishing this misleading note," she added.

Ian Facer, chairman of Pharmacy Voice, expressed similar frustration with the "insubstantial" report, saying: "MURs are in fact highly valued by patients, because they help people to understand their medicines and get maximum benefit from them."


Was the TaxPayers' Alliance's attack on MURs justified?

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22 Comments

Ahmed El-Dabbagh, Community pharmacist

By doing MUR with  the patient I have found that the Professional connection has been made  between us.

A trust and assurance has been built with the pharmacist. Usually the patient can  get overwhelmed and surprised with the knowledge of the pharmacist and how that can help him in looking at his treatment in a positive way.

This encourages him as well to regularly come forward whenever there is any doubt or advice needed. They are no longer hesitant to talk to me about their illness, their medicins or their experice with their doctor or with the hospitals.

They know they will be getting good advice and better assurance. Therefore MUR it never finishes after 15 minuets it actually starts off in 15 minutes and carry on after that for as long as the patient needs treatment. 

Sue Per, Locum pharmacist

So far as multiples are concertned, it is all about the money, and milking the "NHS"cash cow for what it's worth, till its dry. The paymaster PCT should scrutinise a large proportion of MURS and not only withold payment for the inelligible and duplicated ones, under the guise of annual and intervention MUR's but also penalise for any deemed inelligible. The eligibility criteria for the MUR's should be made more stringent, to prevent abuses, and also the pharmacist should be made to justify the review, with plausible explanations based on clinical expertise and experience.As the reviews are remunerated on a unit basis, the pharmacist conducting the review should be awarded a fair proportion of the fee, and jointly accountable for the justification fo the MUR. Finally the eligibility criteria should be increased to five different items, and this will certainly limit / mitigate abuses.

Afroz Farooqui, Community pharmacist

I think we need to tell patients how much we are going to get paid for the service, and then let them decide whether they want to go ahead with it. I am sure as soon as you mention £28.00 of tax payers money they will runaway or at least they will make it worthwhile. If I have to be a patient in some of the pharmacies where pharmacists are doing MURs left right and centre who don't even know the difference between a grapefruit and grapes, I will not only refuse for the service but also report it to the concerned people.

How High?, Community pharmacist

Tell that to 2 of the guys I did MURs with this week.
One was taking 4 paracetamol at a time to top up his 6-hourly tramadol "that's what the consultant said, I'm sure of it". One phone call later and consultant confirms that he actually said take four times a day.
The other was taking 3 Asacol 400mg three times a day instead of reducing to three a day after a similar misunderstanding, plus he was taking naproxen just once a day as he had raging dyspepsia and heartburn but not bothering with his omeprazole as he didn't want to take too many medicines. For some reason his sciatica was also worse.......
Patients remember very little of what they are told. GPs and consultants do not issue "stop taking" notes or provide any written literature during consultations. This leaves patients confused and doing daft things such as those I've outlined above.
You don't know until you actually start asking open questions if an MUR is going to benefit a patient or not and I agree, many don't. However some do really make a difference, potentially saving lives and surely that's why we have them.
So many patients take the opportunity to ask questions and clear up their own understanding and all of them comment that they don't like to bother the doctor as he always has so little time to talk to them.
I work for a multiple and yes the company wants me to achieve 400 in a year and I'm proud to say I have delivered for the past 4 years in a row.
I have to say all this talk of bullying and pressure is a red herring. I know many employee pharmacists who use non-completion of MURs as a way of protesting, but all you are doing is depriving your own customers, those that pay your wages, of a valuable service. If some of you employees put as much effort into your work as your whining, your employers and area managers would probably leave you alone and actually help you. Yes I'm in the PDA too and I know how tough the job is.
Don't talk to me about pressure. I work a 58 hr week, 4000+ items, 18 MURs, 11 NMS, 3 EHCs last week.
Get help if you need it. The PDA are superb but so are most employers if you talk to them openly and honestly and put a well argued case together. Ask peers for help if you need it.

Sue Per, Locum pharmacist

I trust you will agree that statistically the number of eligible annual MURs that can be conducted would be directly proportional to the volume of "Normal" dispensing excluding 7 day dosettes, and on that basis alone on the fact that once a person has had an "Annual" MUR they are reluctant for another one within a year, unless there has been a signigicant change in the medication. This is bourne out of experience, and on that basis it would be difficult to maintian yester year targets, let alone achieve an increase.Your comments would imply a pharmacy with exponential growth in dispensing volume, or an extaordinary client base who constantly and consistently need mur's, or MUR's waiting to walk through the front door!!! Readers form your own judgement, based on your own experiences, and vote

How High?, Community pharmacist

You are right, exponential growth, outstripping the local surgery's script output by a decent percentage. Also a huge client base as testified by the 4000 items last week. Is this to do with the fantastic service myself and my team offer or just the great positive attitude we demonstrate. As you say, Readers you decide and vote.
Oh and to clarify, I work 48 hours, not 58. Let's hope my labelling is more accurate.....

Barry Pharmacist, Community pharmacist

Greg you obviously have a tremendous work ethic. You're doing 48 hours a week in a busy pharmacy with 4,000 items dispensed. You're doing 18 MURs a week which must take you around an hour a day. There's EHC and NMS and although you say you get help if you need it could you explain just how you do this? We all want to provide these services as well as you so what's the way you suggest?

Do you have ACTs? Is some dispensing done offsite? Do you have a second pharmacist for your 15,000-16,000 items a month?

What staffing do you have?

Sue Per, Locum pharmacist

18 MUR's . 3 EHC, 11 NMS , 4000 items and other incidentals & intterventions, all in 2880 minutes would certainly earn you a title as the "King of the dispensing Sweat shop", and certainly beats the notional time of 6 minutes for clinical, legal and final accuracy check, for all dispensed items. Is this on Planet earth???/

Chad Harris, Community pharmacist

One of my friends left a company because of MUR bullying. Phone calls on the hour every hour, like SKY news!!! Another colleague involved the PDA and had the area manager moved he was such a bully.
Although I do agree with much you say.

RB Pharmacist, Community pharmacist

In a way, TPA is right! Ask pharmacists who work for some companies and you will soon find out that it is just about reaching magic number 400 by 31st march each year regardless of whether patient needs an mur or not. you get emails from area managers every day asking how many MURs have been done. so, it is a waste of public money even if it is not new money for pharmacy.

Nuria Laiglesia, Community pharmacist

All the employers have targets, at the end of the day this is a business. Like pharmacists expect to be paid for working, companies want to get paid too so the multiples will ask to do 400 MURs a year. The quality of MURs depends of the pharmacist.
I do 400 MURs a year, mainly interventions and when I do an annual MUR, I won't know if the patient needs it or not unless I do it, if the patient is taking the tablets correctly I will be giving lifestyle advise or referring to other services.
This week, one patient was using her ventolin bd and her clenil PRN, other patient was not taking simvastatin because his last cholesterol test was a good reading so he thought he won't needed it anymore, other patient has had his ramipril increased from 2.5mg to 5 mg and he thought he needed to take both strengths, other patient was ordering GTN tablets, not using them that much but needed to keep reordering them because GTN expires in 8 weeks, I sugested to his GP to prescribe the spray that last longer, I have also seen several patients on warfaring that needs more information, I have seen a really slim old lady not taking alendronic acid for her bones because she was already taking calcium and she couldn't be bothered to take the weekly one... These are all examples of this weekmin my store, I dont think this is a waste of money.
Valued MURs will depend of the pharmacist, nothing to do with the employer, The PDA doesn't need to ask pharmacists to do MURs when we do them daily as part of our job description which is not just supplying medicines, we also help patients and give advise on how to take them.

RB Pharmacist, Community pharmacist

rv

Middle Way, Community pharmacist

Clive thats a brilliant point.

Everyone agrees about the value of MURs - we've all positively affected patients' lives through them. However, the concern is that we are at the mercy of the paymaster who could pull funding overnight for the service. That is also the case for many of the other services we currently provide or will be expected to in the future. Added to this is that it costs large amounts of money and time to set up many of these services. When so many other HC professionals are completely against these services and very vocal in that regard, it is a treacherous situation to be in.

As for the Taxpayers' Alliance...their presentation of the statistics made me grit my teeth. It was 1 of 2 things: 1) an embarrassing interpretation of the data which I would expect from a 15 year old GCSE student who was really bad at maths. 2) a more malicious intentional misrepresentation of selective information designed to make the service look bad - we'll give them the benefit of the doubt and say it was the former. In conclusion it's not worth even discussing the Taxpayers' Alliance's baseless opinions.

2 quick examples for a bit fo fun:
1) £64/patient/Gp versus £28/mur/pharmacy...how on God's green Earth does an intelligent person even compare these 2 random pieces of information hahaha.
2) £336/hour...I'd be in heaven. That'd mean I must earn £1m/year. Taking a single payment for a service and converting it into a rate/hour to make it look scary is something I'd expect of a child, not a statistician.
Who do these people hire for this work?

Chad Harris, Community pharmacist

What the article in the SUN today doesn't tell the punters is that the £70million we are given for doing them is not NEW money! The issue that seems to have been taken is that chain chemists are clocking up millions for getting £28 for doing very little as has been shown on her by the guy who saw another pharmacist do 13 in one day, all lasting less than 5 mins and the manager thought he was marvellous!!! It is all about the money to the Big companies and when I think of this, then I begin to AGREE with the TPA!! 400 MURs , 400 good MURs is not achievable every year. Most people don't want one every year. Some people don't want one at all! I think they shold be reduced to 200 per yr. Then we could do ONE good one per day. A more manageable limit, and hopefully less of the rubbish ones produced.
Beware though. David Cameron listens to the TPA, he is quite friendly with the guy who runs it. And the GPs who were interviewed were not keen saying they binned them! I wouldn't be surprised as the financial screws are tightened over the rest of the decade if MURs cease to exist in 2020 as they do now!

Antony Cracknell, Community pharmacist

The funding for MURs has been stripped off the global sum anyway, so taxpayers needn't worry. Unless everyone achieves the maximum per year, we're subsidising the NHS. Maybe we should scrap this 'wasteful' service and have the funding back without the need to jump through 400 hoops to get it, except we wouldn't get it. As a taxpayer I think the public are getting a good deal. Pharmacy funding has dropped like a stone, MURs and NMS are both being provided by redistribution of previously existing funding and regardless of how many MURs are truly beneficial, if they provide a relatively modest reduction in hospital admissions they will be more than worthwhile from both a social and economic perspective.

Julian Al-Mushadani, Community pharmacist

Notwithstanding the value or otherwise of MURs, they are in any case effectively performed free as the funding was top-sliced from the global sum and was not new money.

Christopher Plail, Community pharmacist

A MUR well done especially an intervention MUR is good value both for the patient and the Doctor. Apart from saving the NHS a lot of money by preventing life threatening incidents they often reveal incorrect medicine usage or even non- usage again saving the NHS.
On the negative side an this was eventually going to come out, non-pharmacist managers have pressurised many pharmacists into doing them solely to obtain targets which are basically financial in nature and not pharmaceutical. I followed a locum into a pharmacy one day he managed to do 13 MURs in one day (8hrs) as well as the methadone, checking etc (no ACT) approx 300 items dispensed that day, each of those 13 MURs read "No issues." According to dispenser many were in the consulting room for less than 5 minutes and of course the non-pharmacist manager thought he was wonderful and was going to request he be given preference when booking locums for future vacancies.
In cases like that I would have to agree with the taxpayers alliance that they weren't getting value for money.

Pillman Uk, Non Pharmacist Branch Manager

I don't think we should let this "report" dissuade use from providing what is a great service, when delivered correctly.
This isn't to be used to "cling" on to the dispensing process to the exclusion of all other "avenues" where a pharmacist's skills and expertise can be utilised.
We must expect to be challenged at how we utilise tax payers monies, and to be honest, we're in credit on the "efficiency" and "savings" front.
Just look at how our business models have brought an efficient and effective dispensing service and saved the tax payer millions (Cat M)

So what we need to do now, is show how our MUR and NMS interventions are bringing in benefits, both financially and socially to the patients we serve.

Hopefully the research being undertaken around the NMS will highlight some of the benefits that Pharmacy can bring to the "medication" process.

We all know what we bring to our communities and patients, we just need to sing louder that the other groups who "think" they know us, but are clearly "clueless".

John S, Locum pharmacist

Maybe someone should remember that for multiples this is just a target to reach no matter what an mur is useful for..

Clive Hodgson, Community pharmacist

Perhaps a report like this does illustrate the danger to Pharmacy if we do move away from the supply function to the provision of “services” as advocated by some including the PSNC.

Regardless of the true effectiveness or value of services like MURs or NMS, the funding for them could easily be shut off by the paymasters who I suspect will far take more notice of the impact of a published report like this (or others in the future) than any other evidence.

Gerry Diamond, Primary care pharmacist

Clearly this group of non experts that have no appreciation of the value this brings to patients in terms of taking the time out to specifically engage with patients as part of the medicines management cycle. Community pharmacists procure, dispense, (some even prescribe), give information, REVIEW, dispose of medicines, liaise with prescribers, reorder repeats, deliver, provide public health services, give specialist to end of life patients, homecare, residential care and all the free advice at no cost already.

Please advise the tax payers alliance to get free advice from a barrister or solicitor, no way jose,

Tax Payers alliance get real!

Barry Pharmacist, Community pharmacist

I agree wholeheartedly - intervention MURs are an excellent way to get paid for dealing with prescribing incidents or mix-ups. GPs constantly say they rely on us to pick up their errors. Well this pays for it.

However I do think that NMS is a far better use of public money and I dearly wish we could provide NMS on virtually ALL new medicines and if that means taking money from MURs then so be it. All too often MURs are about getting the numbers done.

A GP gets paid £64.59 for not seeing patients. In fact there is a perverse incentive to have long GP waiting times so that patients go to walk-in-centres and GPs get paid for doing nothing.

Perhaps PSNC should agree to patient registration at a community pharmacy for a set fee per year and then everyone is entitled to an MUR - for 'free'!

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