Floccinaucinihilipilification: The action or habit of estimating something as worthless.
“Worthless” is a very emotive word. It is cold, sterile and unproductive. Do I really think it is fair to refer to MURs as worthless? Am I not diminishing the role of the pharmacist, perhaps even the profession, by suggesting as much?
While I genuinely do believe MURs are worthless, I should start by saying that last year, in the process of conducting an MUR, I made an intervention which saved a patient's life. Surely, the above two statements are hugely contradictory? How can both be true?
Well, essentially it is my belief that patients should be comfortable enough that they feel able to discuss all issues, but particularly those surrounding their medication, with their pharmacist. If your patient needs inviting into a private room, to first sign a form and then have a formal, often rigidly-structured discussion, in order for you to find out how they are getting on with their medication, you are doing something fundamentally wrong in the way you practice pharmacy. As has been suggested so many times, MURs need to change.
Asking for a signature devalues the MUR
I work as a locum, meaning often I never see the same patient twice. Despite this, I like to think I am approachable enough for patients to come and have a chat about their medicines, even if they do not know me from the locum who was working last week. This requires you to be present, attentive, patient and compassionate.
For someone to tell a stranger, albeit a professional, that they are bleeding rectally since taking aspirin, takes a huge amount of courage. I always feel that asking for a signature, so that the contractor gets their £28 and you get booked again, horribly devalues the whole process. It makes me cringe, and I often think patients feel the same sense of unease.
One of the big problems with MURs is their huge variability in delivery. As a locum, patients have told me they have never been asked about their medication by the pharmacy's regular pharmacist. I've also seen the manager of a chain of pharmacies 'conduct' an MUR by simply asking a patient, at the counter, if they are getting on okay with their medicines. "Do you need anything ordering?" was the only addition, before a consent form was thrust at the patient for them to sign, the whole process over in under 10 seconds.
Lack of evidence of cost-effectiveness
Another issue with MURs, in their current form, comes from the lack of evidence of cost-effectiveness and clinical benefit. While admittedly the quantity and quality of evidence is not substantial, it seems that MURs do not have much empirical value and this, during a period of austerity, makes it all the more difficult for pharmacy as a whole to prove its worth.
Many pharmacists feel pressure from management to get the forms signed, due to patronising financial incentives or the worry that you might have employment repercussions should you not be seen to be pulling your weight. This perpetuates the problem of poor quality MURs and undermines the profession. The patient should be our first concern, not just their signature.
In conclusion, while I am a huge proponent of the value of a well run, service-led community pharmacy, I would consider the recent announcement that MURs will only be funded for the first half of the year, pending review, to be good news. Contractors will of course be worried by the potential for this all-too-welcome financial contribution to vanish forever.
However, I would hope that the powers that be have the insight to realise that properly-funded pharmacies up and down the country add value, reduce harm and save lives all day, every day. It's what we do. It just so happens that 95% of the time, we don't have a consent form handy.
The Locum has worked as a community pharmacist in more than 200 pharmacies