Now, let me make myself abundantly clear. I am not condoning any fraudulent activity. And I am definitely no great fan of medicines use reviews (MURs). But I do feel that the current furore over pharmacies ‘exploiting’ MURs for financial gain rather misses the point.
And it’s a point which for me, as a GP, is very close to home. Because, to be honest with you, I find myself undertaking a lot of dubious tasks for reasons which are as much financial as clinical.
Such as when I write up a new care plan for a patient to keep the number on our ‘vulnerable’ list above the critical ‘2% of our adult list’ threshold. Or when I offer a dementia review to a perplexed elderly patient at the end of a routine consultation about something else entirely, on the basis that our contract requires us to maximise our coverage. Or when I tick a bunch of quality and outcomes framework (QOF) boxes, having half-heartedly checked blood pressure and smoking status, offered anti-smoking advice, etc etc.
Three things are going on here. First, I’m not exploiting patients for financial gain – I’m trying to earn back money the government has taken away from me in one of their familiar ‘now you see it, now you don’t’ financial sleights of hand. Second, in this process, I’m being reduced to the level of disaffected tick-box monkey. And third, it’s dawning on me that I’ve been thrust into a game – and playing any game ultimately means maximising opportunity while not breaking any rules, even if I bend them a bit.
It’s exactly the same for pharmacists with MURs. The funding was taken out of your global sum and the government is making you dance to their tune to re-earn it. I feel your pain and I understand your position.
And that’s the point. When pharmacists and GPs aren’t treated in a wholly professional way, then it shouldn’t be a great surprise that they might not appear to act wholly professionally.
Read Boots' response to the Guardian's allegations about MUR abuse here.