On September 1, changes were made to pharmaceutical services that govern the provision of advanced services by community pharmacies in England.
These changes were brought into force to enable services to continue during the COVID-19 pandemic by allowing for a more flexible delivery model for certain services. This will be welcome news for pharmacists and patients alike, but pharmacists should be aware of potential downsides to the new rules and how they can protect themselves.
The medicines use review (MUR) was introduced 15 years ago and has undergone some changes since then. For example, there have been changes to the number of MURs that could be undertaken, and the requirements for MURs to be targeted towards patients with certain conditions.
However, a couple of the central provisions remained: the need to hold an MUR in a consultation room in the pharmacy – except with the specific consent of NHS England and Improvement (NHSE&I) – and the need to obtain signed consent from patients to receive the service.
With controlling the spread of COVID-19 taking priority over physical contact and form-filling, those two core elements of the MUR service have been swept away.
Pharmacists are now free to conduct MURs by telephone or video without obtaining specific consent from NHSE&I beforehand. This will no doubt benefit patients who are unable to – or do not wish to – physically attend the pharmacy. Patients may feel more comfortable having a consultation from their own home rather than in a more “clinical” setting and, of course, saving travel time.
However, as any healthcare practitioner will appreciate, providing clinical services at a distance does have some potential drawbacks and requires some additional planning and skills. By way of an example, it may be more difficult to communicate effectively using the telephone or video conferencing because non-verbal cues can be more easily missed, particularly where the connection is unreliable or the user is not comfortable with more modern technology.
Pharmacists should therefore carefully consider whether a remote consultation is appropriate having regard to the particular needs and vulnerabilities of the individual patient. Just because MURs can be carried out remotely does not always mean that they should be.
As always, appropriate records must be kept of the consultation, including that it took place remotely, in case the context of the consultation becomes relevant at a later date.
Where patients are attending a consultation remotely they cannot, of course, sign a consent form to participate in the MUR. The Department of Health and Social Care (DH) has therefore removed the requirement to obtain written consent, whether the MUR is taking place remotely or in the pharmacy. It has been replaced with the obligation to obtain verbal consent that must be recorded on the pharmacy’s clinical record for the service.
Obtaining consent for the provision of an MUR is important for two reasons. Firstly, the pharmacist will discuss the patient’s health and medication history with them and may share the outcome of the MUR with the patient’s prescriber. The pharmacist must therefore take extra care to ensure that this is explained to the patient where only verbal consent is to be obtained.
Secondly, NHS Business Services Authority (NHSBSA) carries out periodic audits of pharmacies to ensure that where claims for payment for the provision of services have been made, those services have been carried out. As part of such an investigation, it is not uncommon for them to review signed patient consent forms*.
Having a completed MUR record and being able to point to a consent form signed by the patient is good evidence that the pharmacist carried out the MUR and is entitled to be paid. In the absence of the signed consent form, pharmacists should consider what other information could be recorded on the patient’s record to demonstrate that the MUR took place and that the patient provided appropriate consent.
Noel Wardle is a partner and head of healthcare regulation at Charles Russell Speechlys
*Correction, October 6: The original article incorrectly said NHSBSA contacts individual patients to check whether they received an MUR.