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Letters to the Editor
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Medicines use reviews
The service is evolving
From Mrs S. Coyle, MRPharmS
I do sympathise with the points made by David
Willcocks (PJ, 5 November,
p575) about the challenges faced when trying to undertake medicines use
reviews.
I also began to provide this service at the beginning of October, working
one day per week in a local supermarket pharmacy. Some patients have
failed to turn up and one or two have cancelled on the day, but I have
also had some good feedback. Most of the patients I have spoken to have
said that they found the process useful and have learnt something they
did not previously know about their medicines.
I have been fortunate in that the pharmacy staff have been careful about
who they invite in for MUR and numbers of those failing to attend have
therefore been low.
I think that Monty
Goldin (PJ, 22 October, p512) is missing the point:
an MUR is not a full, clinical review and should not be regarded as one.
This is one of the most important issues raised in the MUR accreditation
training and one which, as an experienced clinical pharmacist, I have
struggled to manage. It may well be that, in the future, we are asked
to provide full medication reviews as an advanced service but, at the
moment, we must stay within the limits of a simple MUR. It really is
not necessary to have all the patient’s medical history available
when conducting an MUR and, in fact, going too far into this could cloud
the issue. What is important is the patient’s understanding of
and ability to manage their medicines.
So far I have found that clinical issues do arise during the MUR and
I have attached a note to the GP raising these issues (with the patient’s
agreement) but have not included them in the MUR reporting form. Since
this a new service, I do not know whether this is the right thing to
do but it is what seems to work for me.
I think we are all feeling our way with this new service, and that it
will evolve. My experience has been mainly positive so far and it is
certainly satisfying to hear patients say that I have helped them in
some small way.
Susan Coyle
Powfoot,
Dumfries and Galloway
Issues with GPs
From Miss I. Irshad, MRPharmS
In response to David
Willcocks’s letter (PJ, 5 November, p575)
I have been carrying out medicines use reviews since April 2005 and have
found that patients appreciate the service and find it useful. I am fortunate
to work in a store with two pharmacists, hence I can spend a reasonable
amount of time with patients (my colleague is able to check prescriptions
in the meantime). The pharmacist is easily accessible to patients, there
is no waiting time and patients have often raised issues with me which
they “did not wish to bother their doctor about” but were
important issues because the patients were not receiving maximum benefit
from their therapies.
I have been able to address non-compliance with medicines due to lack
of information and understanding and I have dealt with side effects and
interactions, lifestyle issues and blood pressure monitoring etc. I have
made referrals to GPs and nurses and the patients know they can come
back and see me any time. I have had much job satisfaction in the sense
that my relationship with my patients is stronger.
So everything sounds perfect up until this point. However, it all falls
apart when the “action plans” are forwarded to the surgeries
because the GPs and nurses do not reply to them. I have reviewed over
30 patients and I know that the GPs have only acted upon the action plans
for two of these patients. Another surgery is recording the information
on patient medication records but I have not heard back from the GPs
about specific problems. The GPs were fully aware that MURs would be
taking place because, before April, I conducted surgery visits to inform
them of forthcoming changes. I received positive feedback from the doctors
and practice managers at the time.
Ultimately, as pharmacists, we are providing an excellent clinical service
to patients and we will be paid by the local health boards for the MURs
that we complete. However, it would probably be fairer to patients to
tell them in advance that the GPs will ignore the results of the MURs.
From the feedback I get from many patients, it would appear that some
GPs do their best to ignore their patients anyway.
The sooner all pharmacists qualify as supplementary prescribers and put
us on a par at least with nurse prescribers, the sooner GPs will stop
regarding us as the inferior health care colleagues they think we are.
And the sooner independent prescribing comes into effect for pharmacists,
then we may finally see the GPs alight from their high horses.
It is time for the pharmacy profession to show them how a good job is
actually done.
Irram Irshad
Cwmbran,
South Wales
Support this new service
From Mr P. Antenen, MRPharmS
At last a discussion has been started on medicines use reviews (PJ,
22 October p512 and 5 November p575). This has got to be the biggest
challenge facing community pharmacy under the new contract. Contractors
have had £300m taken from them and are expected to earn it back
by undertaking MURs.
In response to David Willcocks: yes, they are professionally rewarding
and the majority of patients that I have seen are grateful and have found
the service beneficial. I completely agree that it is hard work. Both
I and my support staff are finding it difficult to promote and recruit
patients to this new service; they are not exactly beating a path to
my door. This is hardly surprising considering the near complete lack
of any meaningful advertising or publicity on the subject.
By way of sharing best practice, the only way to make MURs profitable
is to fit them in during the “quieter” parts of the day and
limit them to 15–20 minutes per review (a second pharmacist is
a luxury that few will be able to be afford). In terms of “no-shows” I
have found that taking a telephone number and giving a reminder call
on the morning works.
I was shocked this week when attending a PCT-run meeting to discover
how few of my colleagues are accredited to do so, let alone conducting
reviews. I hope that, following this letter, the PJ will be deluged with
replies from pharmacists who are actively involved in MURs. I regretfully
doubt it, however.
If, as a profession, we do not get fully and swiftly behind this new
service, the NHS will soon lose faith in our willingness and ability
to take on new roles. What then of the £300m taken from us?
Paul Antenen
Brighton, East Sussex
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The
Pharmaceutical Journal