The Pharmaceutical Journal
Vol 276 No 7384 p72
21 January 2006

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· Vitamin D and Cancer
· Animals in testing
· Out-of-hours services
· Medicines use reviews
· Prescribing
· NEL LPC
· Pharmacy workforce
· Overseas pharmacists
· Statutory Committee

Letters to the Editor

Medicines use reviews

What is the PSNC view?

From Mrs S. Smith, MRPharmS

I have followed with interest the correspondence regarding the length of time a medicines use review (MUR) might be expected to take. I agree with Sue Howshall (PJ, 7 January, p13) that the average duration of an MUR is likely to be about 30 minutes, if it is to be done properly. In addition, as she describes, there will presumably be the need for a certain amount of background information to be collected from the patient’s medication record, which may well result in the total time input being longer than this. Indeed, the remuneration for an MUR, at £23, might lead us to expect this.

The report from the Medicines Partnership (PJ, 10 December 2005, p712) stated that patients whose review had only lasted “a few minutes” thought that the function of the review was to save money. However, I was concerned to read three references to an MUR taking just 10 minutes in the recent booklet “10 steps to success with medicines use reviews”, produced by the Pharmaceutical Services Negotiating Committee and GSK and distributed with the December issue of PSNC News. The most telling of these is step 10, which states: “At the outset of the MUR set the patient’s expectations with regard to both the time available and the purpose of the service. One way of doing this would be to open with a statement such as, ‘Good afternoon Mrs Jones, today we have 10 minutes to talk about your medication’.” To be fair, the booklet implies that the form may be completed outside the 10-minute discussion with the patient so, being generous, we might assume that the PSNC considers that an MUR can be fully completed in 15 to 20 minutes.

I had not previously seen written guidance on how long an MUR should take, but are we to assume from this booklet that the “official” PSNC view is that 10 minutes is adequate? If this is the case, while acknowledging that some reviews will be less time-consuming than others, I find it disappointing and wonder how valuable these will be.
As an ex-community pharmacist, I have long been a supporter of the skills that community pharmacists have to offer. However, if guidance such as this disillusions even advocates of MURs, such as me, how does the PSNC imagine it will be greeted by members of the somewhat more sceptical audience also watching MURs unfold, including many GPs?

Sue Smith
Head of Prescribing and Pharmacy Policy
Northamptonshire Heartlands PCT

ALASTAIR BUXTON, head of NHS services, Pharmaceutical Services Negotiating Committee, responds: The medicines use review service is a key element of the pharmacy contract and the PSNC hopes that all community pharmacy contractors will start to provide MURs over the next 12 months.

Sue Smith highlights a recent publication which endeavours to provide practical suggestions on how to conduct MURs in an effective and efficient manner (copies are downloadable from www.psnc.org.uk/advanced). The guidance has been produced by drawing on feedback from pharmacists who have been providing MURs and from experts in this field of pharmacy practice.

Pharmacists who provide MURs should ensure they maximise the use of their support staff in the provision of the service. For example, a lot of the fields in the MUR form can be filled in by a dispenser, using patient medication record data, before the pharmacist sits down with the patient. Support staff can also be used to explain the service to the patient at the time of booking an appointment, or before the pharmacist’s discussion with the patient.

Inevitably there will be variability in the time taken to conduct a MUR, determined by a number of factors, including the level of experience of the pharmacist, the complexity of the patient’s medicines regimen and their information needs. It is, however, important that all pharmacists should remember that the MUR is not a full clinical review. The review is centred on the patient’s use of medicines and developing their knowledge of those medicines.

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