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Kristoffer Stewart on MURs: Dishonest practice surrounds us

"I am often offered a higher locum rate depending on the number of MURs carried out"

The issue of unnecessary MURs is found across pharmacy, says C+D's clinical editor

The allegations that Boots is encouraging pharmacists to carry out unnecessary medicines use reviews (MURs) is as much of a revelation as millionaires dodging tax. This behaviour is most definitely not confined to Boots. It just happened to be the biggest – and arguably one of the easiest – targets.

I can’t speak for all my peers, but I feel confident most pharmacists have felt under pressure to carry out additional services at some point – a view reflected in C+D’s 2015 Salary Survey. This pressure can have a number of causes. Some pharmacists may want to prove their worth, show that the sector can make a difference, and that they should be considered on an equal footing to doctors and nurses.

However, there are also less noble pressures – usually financial. I’m not arguing against reimbursement for providing services, but in some pharmacies, the management see service funding as their right, rather than a privilege.

As a locum, it’s not uncommon to be told that you need to carry out MURs to ‘help’ the store reach their targets. This is something I have come to consider the norm.

I have been part of “Friday morning reviews” to discuss how “we” haven’t reached service targets for the week. In one independent pharmacy, I received a talking-to because I gave advice on inhaler use to an elderly patient, but didn’t get an MUR consent form signed. I have also worked in a pharmacy that was run as if it were a coffee shop. MURs were treated like latte sales – just another target.

The pressures I feel personally as a locum are twofold. Firstly, this is my livelihood. If I don’t perform as expected I may not be invited back to work. Secondly, I am often offered a higher locum rate depending on the number of MURs carried out. Although I have scruples, how am I to resist the temptation to earn more money just by saying a few words and getting a signature on a page, regardless of whether the patient benefits?

Actually I do care, just like the majority of pharmacists I have worked alongside. They work tirelessly day in and day out to ensure their patients have the best possible care. They certainly do not do it for praise; they do it because they feel both morally obliged and because they get a sense of satisfaction from helping people.

I think the allegations brought against Boots – regardless of their accuracy – are a stark reminder that dishonest pharmacy practice surrounds us. It lingers in corners and the ‘bad apples’ in the profession gives all of us a bad name. It is no wonder that when new services – such as the national pharmacy flu service – are introduced, we find GPs opposing us. Many still see us as health professionals hoping to turn a profit, at a cost to both the NHS and the quality of patient care.

To reassert our moral authority, we each have a responsibility to ensure patients come before profit.

Kristoffer Stewart is CPD and clinical editor of C+D, as well as a locum community pharmacist. Email him at [email protected] or contact him on Twitter at @CandDKristoffer

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

Read readers' reactions to the MUR abuse allegations here.

 


Do you agree with Kristoffer?

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19 Comments

Valentine Trodd, Community pharmacist

Quite shocking that 66% of over 1000 pharmacists admit to being coerced into defrauding the NHS on a daily basis and the powers that be don't bad an eyelid?

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 problem. 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.    

Shaun Steren, Pharmaceutical Adviser

How do you resolve a dishonest culture when the lawmakers and governing class are cut from the same cloth as the corporate monopolists? To hear a politician talk with their normal politicians speak is indistinguishable from corporate management using their management speak. Read this magazine and compare the output from The Area Manager and anything by a government minister - same content, same language. 

Tom Jerry, Community pharmacist

Normally its the lower hanging fruits that get a rough time, never known someone going for a chop straight at the trunk!!!
The climate of change has finally approached us and its all about being ethical in what we do. It might have been right yesterday but its wrong today, it might be right today but wrong tomorrow, the aim is to do what we do, timelessly right all the time....

Bal Singh, Locum pharmacist

Shame on you for not reading the full article about boots.

You've beautifully skipped over the claims about being short staffed and patients safety being endangered. As a true locum you would have seen that trend get very bad at boots over the years, so why have you not commented on that as well?

Leon The Apothecary, Student

It's pretty universial. Well, at least I have witnessed it in several of the large multiples. Independants not so much to their credit.

Dipesh Patel, Community pharmacist

We as pharmacists must abide by our 7 principles, the first of which is 'make patients your first concern'. Conducting Medicine Use Reviews reflects this by enhancing patient compliance while also reducing potential harm. I think many pharmacists conduct this service with that exact thought in mind.

Community pharmacy is and always will be a business for its respected owners and like any business they must look to maximise their profits, but this should not be at the expense of patient safety. It is unfair to highlight Boots to be the only chain or independent pharmacy with targets in mind, it's a known fact that targets are a goal in any business. This does not mean that responsible pharmacists should feel pressured into conducting useless MURs at the NHS's expense. This will not help you to secure the commissioning of services which you desire in the future.

In my opnion the lack of funding in other areas of pharmacy as a business with increased workloads for pharmacies is causing potentially quality lacking MURs to take place.Having targeted MURs introduced has made it easier for many pharmacies to reach their maximum of 400 within a year. So I think the question should not really be why are you claiming for 400 MURs so easily, but why do they lack quality?

Stephen Eggleston, Community pharmacist

I admire Kristoffer's suggestion that patients should come before profit - but let us not forget - 1. Pharmacy is a business; business survive because of profit 2. Do you honestly believe GPs provide a service out of the goodness of their heart, or is it because they get paid to do so by the NHS? Or didn't you know they were also contractors?

The main point here is there is a balance - be paid for the services you provide but provide those services appropriately

Harry Tolly, Pharmacist

 

"I can’t speak for all my peers,"

 

I would contend that you cannot speak for ANY of your peers given the apologist stance you have taken for Boots.

P M, Community pharmacist

we used to do it for free and now we get paid... whats the problem?

Pill Counter, Pharmacy

P M it's called fraud. Sounds like you're very aware of it too

M Elnemy, Non healthcare professional

How much did you get paid to write that article....

PIYUSHKUMAR PATEL, Community pharmacist

I am community pharmacist working for big chain company.

What I see doing MUR is an opportunity to refresh our knowledge on medicine. Many times we come accross questions from patient regarding medicine and their present lifestyle. Some patient do think that there is something which they feel is discomfort in daily life but can not share it to right person to get it resolve. This is where pharmacist comes in the picture to help such patients. They feel confident on their health and the same way they spread their experience in the community how well we pharmacist doing for them. In reality there is huge pressure in health care sector where patient do not get to see right person for their health. So I do not understand why MUR all sudden become money making policy.. ??

I think MURs is the way where pharmacist can prove that they can bring diffrence in someone life along with their regular work of checking prescription. It takes seconds to minute to analyse doctors prescriptions then what else they do for the patients ??

Is it not good that we get chance to refresh our knowledge what we gained in the university and keep improving it by doing MUR..??

There are lots of scenarios where we need to use diffrent sort of subject like biochemistry, pathophysiology etc. So there is nothing as such that we making money out MURs still we are thankful to NHS that they pay £28 for spendibg such time with patients.

My company never had put pressure on me regarding services. It was me and some other pharmacists in my company who thought to make diffrence in patients lives. What our company see is a contribution to good customer care which builds up their profits eventually.

Thank You

Raluca Chisu, Community pharmacist

Far to be naive...just passionate, unfortunately, one a few...

 

Bob Dunkley, Locum pharmacist

You're very naive.

Robert Rees, Manager

 Can somebody explain to me what  an inappropriate MUR is please?  Pharmacists only add value to the dispensing process by spending time with the patients, MURs help patients to Use their Medicines correctly, to obtain the best possible outcome for the patient. If you don't REVIEW with the patient that they know how to USE their MEDICATION you are being negligent. But the government will only pay you to do that 400 times a year., and then only in certain circumstances. We recently performed an unofficial, unpaid MUR on a patient just using salbutamol inhalers. He hadn't had an asthma check in 9 years and had terrible inhaler technique. Was our intervention in appropriate? Or was it ok because we didn't get paid?

Harry Tolly, Pharmacist

Why did you not do an MUR ? A MUR is allowed for asthmatic patients.

Leon The Apothecary, Student

Omeprazole. Just Omeprazole.

Career Miss Take, Locum pharmacist

increased risk of osteoporisis with unregulated prescrbing,inapproriate use of otc medication,lifestyle issues, cancer.... there is a point to every mur !!

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