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Community pharmacy services

Claims that leading pharmacy chain conducts unnecessary MURs prompts call for review

Carrying out medicines use reviews on patients must be driven by patient need not targets, say pharmacy organisations in response to a report in The Guardian about Boots.

Storefront of a Boots pharmacy

Source: Martin Good / Shutterstock.com

An investigation by The Guardian focused on Boots, claiming that the company puts pressure on its pharmacists to hit targets for completing medicines use reviews

Pharmacy organisations are calling for changes to the way medicines use reviews (MURs) are conducted after an investigation by The Guardian claimed that a leading pharmacy chain was performing them unnecessarily to maximise profits.

The NHS pays £28 for each pharmacist-conducted MUR, up to a limit of 400 per pharmacy per year, and pharmacists working for leading pharmacy chains have complained in the past about feeling pressurised to deliver them by their bosses.

The investigation by The Guardian focused on Boots, the largest pharmacy player in the UK with more than 2,500 pharmacies. The newspaper claimed to have evidence to suggest that managers at the company were directing employees to see the figure of 400 as a target rather than a cap for MURs and encouraging pharmacists to carry out MURs on customers who didn’t need them so the chain could claim the maximum amount possible from the NHS. If a pharmacy carries out the maximum number of 400 MURs it will earn £11,200.

However, a Boots UK spokesperson said: “We don’t recognise the claims… our pharmacists are empowered to use their professional judgment to assess the appropriateness of a clinical service, and we make it clear to our colleagues that these services should not be undertaken inappropriately.”

Sandra Gidley, chair of the English Pharmacy Board at the Royal Pharmaceutical Society, believes target setting by pharmacy chains needs to be addressed. “The reports of unacceptable pressures that pharmacists are working in have been raised with us by individual members, in various settings, and there is an urgent need to address the issue of target setting and unacceptable commercial pressures within large company settings,” she says.

Mark Koziol, chairman of the Pharmacists' Defence Association (PDA)

Source: Pharmacists’ Defence Association (PDA)

Mark Koziol, chairman of the Pharmacists’ Defence Association (PDA), says the PDA has been providing examples to the regulator about how pharmacist professionalism is being undermined by employers for years

But Mark Koziol, chairman of the Pharmacists’ Defence Association (PDA), points out that “while volume produces income, then volume will be driven”. He is calling for the current MUR scheme to be “comprehensively re-engineered in a way that enables it to focus much more so upon quality and clinical care”. This could be achieved through a community pharmacy contract and/or a contract that pharmacists have directly with the NHS, he says, and that there was also an argument for a second pharmacist to be available in the pharmacy “to deliver them in a more focused and productive way”.

Ash Soni, president of the Royal Pharmaceutical Society (RPS)

Source: The Pharmaceutical Journal

Ash Soni, president of the Royal Pharmaceutical Society, says “anything which undermines the confidence of the public in that quality of care needs to be challenged and addressed”

Ash Soni, president of the RPS, told The Pharmaceutical Journal that pharmacies need to deliver the highest standards of professional care and that “anything which undermines the confidence of the public in that quality of care needs to be challenged and addressed”.

“For pharmacists to feel they are required to provide inappropriate care, in the same way, needs to be recognised as undermining their professional credibility and the confidence of the public,” he says.

While the regulator for pharmacists - the General Pharmaceutical Council (GPhC) - has consistently stated that the best way to protect the safety of patients is by underpinning the professionalism of pharmacists, Koziol says: “The PDA has been providing examples to the GPhC about how pharmacist professionalism is being undermined by employers for years.

“The GPhC appears unwilling to go after the miscreants, focusing its efforts instead upon individual pharmacists. We need the GPhC to put a lot more vigour behind its efforts to support pharmacists.”

In a follow up story published on 17 April 2016, The Guardian says the GPhC is “calling in evidence on the allegations” and says that the regulator has approached the newspaper for information.

Duncan Rudkin, chief executive of the General Pharmaceutical Council (GPhC)

Source: General Pharmaceutical Council (GPhC)

Duncan Rudkin, chief executive of the General Pharmaceutical Council, says it expects pharmacists to make the care of their patients their first concern and to raise concerns about any issue that may affect patient care 

In a statement issued on 15 April 2016, Duncan Rudkin, chief executive of the GPhC, said its standards for registered pharmacies set out the standards that pharmacy owners and superintendents must meet in each registered pharmacy, and the standards of conduct, ethics and performance set out what is expected of pharmacy professionals “including that they make the care of their patients their first concern and raise concerns with the relevant authority about any issue that may affect patient care or public safety”. 

Soni says he hopes that “what has been described is not normal company policy” and that Boots has ways of identifying where undue pressure may be being exerted and ensuring it does not continue. “In any cases identified I would expect the pharmacists to be supported as whistleblowers and not castigated for bringing these to the attention of senior managers,” he adds.

“With the introduction of the new standards by the GPhC, [in instances] where pharmacists felt their professionalism continued to be undermined, they should be able to report it to the GPhC, which would then need to investigate and ensure that the company was not failing the public in providing appropriate care at individual pharmacy or organisation level.”

 

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2016.20201022

Readers' comments (8)

  • They are not the only one. Unfotunately many managers don´t understand the meaning of MUR sand they just focus on the 28 pounds

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  • I'm surprised that this investigation hasn't happened sooner!! As a locum at weekends (full time hospital pharmacist) many MURs that are requested for me to complete are purely paper exercises and would not benefit the patient in anyway and a number of times, despite pressure from managers, I have refused to perform the review as I believe it would genuinely be a waste of the patients and my own time. They are a superb clinical tool however when they capture the correct patient.

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  • MURs can be extremely useful when the right patient is targeted but it is becoming purely a tick box exercise. I believe the eligibility requirements need to be changed so that patients are not targeted every 12 months for a review they don't need. I also wonder where all this money is going to in pharmacies as it is not resulting in extra staff or pharmacist cover to help enable the delivery of services such as MURs and NMS.

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  • It is a shame that this story focuses on the MUR issue. The real story is the poor management culture and treatment of pharmacists, which the MUR outcome is symptomatic of. No other profession would have allowed this situation to fester for years. We need only to look at the concern for junior doctors to see how other professions attempt to create a professional environment where an individual can flourish, rather than merely survive.

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  • Totally agree, Mr Cox. And a lot of the blame lies with the multiples taking over pharmacy, and the proliferation of non-pharmacist area managers who have had little or no training in pharmacy law and ethics. I was a big supporter of MURs 10 years ago. Now I find them a burden and a source of conflict between being a professional and keeping my job!
    400 is a limit and nearly every company treats it as a target, not just Boots. The code of ethics says we should not let our work be influenced by targets. Why did the GPhC not stamp this out over the last 6 years when those cases of MUR abuse came before them? We will never be taken seriously by the government or the public as a clincial profession, when stories like this appear in the media. I hope the 'big whigs' in pharmacy take note of this now. I think a lot of community pharmacist employees would not really care if MURs were axed tomorrow. This is a pity, as they can be very useful in the right patient; treating them as a money spinner is just plain wrong.

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  • MUR, should be at the discretion of pharmacist, and based on each professional feeling, this should be conducted. Unfortunately is become among companies a bad habit in forcing the pharmacist to produce, without a reason, by area managers, who have been pressured by others.
    The problem at the end is the lack of backbone, metaphorically speaking.
    Pharmacists needs money to survive, therefore they are rarely opposed to their manager.
    Unfortunately, PDA, NPA, are not even close to their pharmacists, because there are contractual obligation with big or medium companies.
    We arrive at the same position with GPs, majority hates their jobs.
    This should be a wake up call alarm, for the whole NHS, to rethink the influence and to empower the professional, rather than company.

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  • To what extent do doctors find MUR reports useful, anyway? I suspect the doctors just throw them in the bin. So is this REALLY a good use of a pharmacist's time, especially when he is so busy dispensing/checking that he can hardly get a cup of tea, or a lunch-break? Is there any evidence of genuine usefulness out there?

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  • CO is right about MURs being target driven, and that the problem applies to other multiples as well as Boots. I described my own experiences of an MUR on the RPS site about a year ago, so will not repeat it here. Suffice to say there was a very lively discussion about it then from retired pharmacists who had developed the system originally.
    Henry Linderman hit the nail on the head by asking if GPs use these MURs. As a primary care pharmacist, I found MURs were rarely input to the practice system. When this task was allocated to me, I found most of the content of MURs, with rare exceptions, was indeed hardly worth the effort, and that the motivation for submitting MURs was simply to generate income. We needed to see a much more clinical level of input.
    I can foresee a situation where pharmacists working in general practice may be spending their time validating and recording the efforts of other pharmacists, without any real input to patient care.

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Supplementary images

  • Storefront of a Boots pharmacy
  • Mark Koziol, chairman of the Pharmacists' Defence Association (PDA)
  • Ash Soni, president of the Royal Pharmaceutical Society (RPS)
  • Duncan Rudkin, chief executive of the General Pharmaceutical Council (GPhC)

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