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Letters to the Editor
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Medicines use reviews (MURs)
Employers applying pressure to conduct MURs
From Mr J. A. Murphy, MRPharmS
The issue regarding employers applying pressure on pharmacists to conduct
medicines use reviews (MURs) has been raised through your columns before.
A worrying development has now occurred.
We are aware of a pharmacist who has been disciplined by his employer
for “insubordination” and “failure to follow company
procedures” because he was, in their opinion, not achieving the
targeted number of MURs. He has also been further warned that if he does
not perform a minimum number per week he faces dismissal.
A carrot and stick approach has been used by many organisations to increase
the pressure on pharmacists to perform MURs, either by creating incentives
or by imposing significant financial penalties at salary review time.
Disciplinary action is often threatened for MUR underachievement and
is now being implemented against employees.
Setting a target for commercial
reasons may be appropriate if it is “aspirational” and achievable,
but totally inappropriate if this forces a pharmacist to take into consideration
the impact on his or her pay packet or job security when deciding if
this professional service should take priority over others.
Internal communications within certain companies focus almost exclusively
on quantitative targets and these are communicated and monitored in such
a style that they are likely to engender behaviours which are not conducive
to good pharmacy practice. Business managers who set these targets are
only interested in income and profit and it is worth pointing out that
we have not seen any evidence of targets that focus on patient outcomes
or of a qualitative nature.
In our experience, pharmacists believe that the MUR is an important part
of their role when done appropriately and effectively, and when, in their
professional judgement, in the best interests of the patient. The judgement
of the pharmacist is also key when assessing whether by performing an
MUR on any single patient he or she is putting at risk the safety or
the quality of service to other patients. This is a dilemma most face
as a consequence of balancing work load and the resources that are at
their disposal.
With this new departure whereby pharmacists are being unreasonably disciplined
or threatened for non-achievement of MUR targets, the Pharmacists’ Defence
Association is of the opinion that the time has come for the Royal Pharmaceutical
Society to decide whether superintendent pharmacists are allowing business
managers to override professional judgement in the interests of commercial
gain.
This issue has now escalated beyond the point of being merely parochial
employment disputes. The PDA may need to test our contention that the
setting of targets for MURs and the commercial and job security pressures
being placed on the pharmacist to perform them as a consequence, are
contrary to the Society’s code of ethics. John Murphy
Director
Pharmacists’ Defence Association
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LYNSEY CLELAND, former head of professional ethics
at the Royal Pharmaceutical Society, responds:
John Murphy’s letter
raises some potentially serious issues. While the terms and conditions
and performance targets
set by employers will generally fall outside the scope of the jurisdiction
of the Society, there are circumstances where this is not the case.
The Society does have relevant guidance that should be applied in
the circumstances outlined in Mr Murphy’s letter.
Principle 2 of the code of ethics requires that, as a pharmacist or
pharmacy technician, one must “exercise your professional judgement in the interests
of patients and the public”. In meeting this principle the code states
that one must “make sure your professional judgement is not impaired by
personal or commercial interests, incentives, targets or similar measures”.
In addition, principle 7 of the code of ethics should be considered. This principle
requires that as a pharmacist or pharmacy technician one must “take responsibility
for your working practices”. In adhering to this principle the code requires
that one must “ensure that you are able to comply with your legal and professional
obligations and that your workload or working conditions do not compromise patient
care or public safety”. It also states that one must “make sure that
your actions do not prevent others from complying with their legal and professional
obligations, or present a risk to patient care or public safety”.
The Society has also recently developed separate guidance entitled “Professional
standards and guidance for pharmacists and pharmacy technicians in positions
of authority”. This expands on the principles of the code of ethics and
sets out the professional requirements of those with managerial responsibilities.
Section 4.2 states that, as a pharmacist or pharmacy technician in a position
of authority, “you must ensure that financial or other targets do not compromise
the professional services you and your staff provide”.
If there are concerns that the Code of Ethics or the Society’s supporting
standards and guidance documents are not being complied with then this should
be referred to the Society with full supporting information for consideration. |
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The
Pharmaceutical Journal