How to make a success of MURs

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The Pharmaceutical Journal
Vol 278 No 7443 p315-318
17 March 2007

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Continuing professional development

How to make a success of MURs

Lin-Nam Wang, The Journal's senior contributions editor and community pharmacist, recently attended an event organised by Barnet Primary Care Trust and run by UniChem, where community pharmacists shared their experiences and tips for improving medicines use review services. This article is based on the presentations and discussions

Continuing professional development articles

Chris Rose

MURs are a good opportunity to build relationships with patients

More MUR tips

• Practise doing MURs with your staff. That way, you build confidence and your staff have a better idea of what the service is.

• Build confidence gradually — start slowly, with uncomplicated patients or with friendly regular patients.

• Keep details like patients’ telephone numbers so that you can telephone them after 12 months to invite them for another MUR.

• Look for opportunities. Take advantage of switches. For example, GPs who are switching patients from atorvastatin to simvastatin might not not have time to explain the change to their patients. Pharmacists could do this as part of an MUR.

• Use a large diary to keep details in.

• Think laterally — if you are doing other services, such as smoking cessation, you can offer to do an MUR.

• Persevere! Do not be put off by those who say no. Do not let that dent your confidence. If your offer is refused, you can always get them the second time round — you can break the ice on your first offer and get them on your second offer.

• Focusing on a condition (eg, hypertension) can help you pick out good potential candidates for an MUR.

• Offer to do an MUR while the patient is waiting for his or her prescription to be dispensed.

• Prepopulate the MUR form.

• Use the resources available — there are lots of organisations willing to provide support, including the PSNC and wholesalers.

SUMMARY

Unlike many GPs, who have reaped maximum financial rewards under the general medical services contract, pharmacists seem to be in danger of missing the boat, according to the latest medicines use review (MUR) figures from the Prescription Pricing Division.

MUR is an advanced service that community pharmacists in England and Wales have had the option of offering since April 2005. This financial year (2006/07), £15m is up for grabs across England and Wales and, at £25 each, pharmacies can claim between £5,000 (those who did not have arrangements to provide advanced services in place before October 2006 will be paid for up to 200 MURs) and £10,000 (400 MURs for those who had arrangements in place).

However, figures for November 2006 indicate that only about 40 per cent of contractors in England are claiming any MUR payments. Many are nowhere near the 400 mark.

Why do pharmacists seem to be having difficulty? According to Meera Sharma, professional services manager at UniChem, the three main barriers to MURs are time management, staff training and gaining GP “approval”. Research by UniChem also shows that lack of confidence is a significant factor.

What an MUR is
An MUR is not a clinical medication review, as defined by the Medicines Partnership. That requires the reviewer to have access to the patient’s medical notes. An MUR, rather, establishes a picture of medicines use with a patient and should normally not take more than 20 minutes.

Another term that has been used with MUR is “prescription intervention”. This is when an issue is raised during the normal dispensing process and, through talking to the patient, the need for an MUR becomes apparent. Interventions made during dispensing can lead to MURs.

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