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Letters to the Editor
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Medicines use reviews (MUR)
The value of MURs must not be undermined by greed
From Anonymous
I read with interest the letter by Kieron
Donlon (PJ, 26 April
2008, p505) about the quality of medicines use reviews (MURs). The notion
that “profiteers
will maximise their revenue from MURs and that will, and probably already
has, debased their value” is only too true.
I work for a large chain and the pressure to deliver MURs is intense. Every
branch with a consultation room is set a non-negotiable target of 400 MURs
per year. We have been urged to tell patients after 12 months that their annual
MUR is due, even if their medication has not changed. I have grave concerns
over the worth of this kind of MUR and would feel uncomfortable conducting
one.
The emphasis is on quantity rather than quality. It would be easy to achieve
high numbers if I offered an MUR to every patient who only has two regular
items (such as levothyroxine 25µg and 50µg), but I doubt that the
NHS had this type of patient in mind when the service was launched.
Advice for these patients can be, and usually is, given at the counter and
I would feel dishonest if I took them into the consultation room to check how
they are getting on and then made an NHS claim for doing so. However, I have
no doubt that, to achieve targets, some MURs are performed on this kind of
patient. My bosses have indicated that I should approach patients such as these.
When someone is selected for a review purely because the pharmacist knows the
review will be quick and easy, and he or she correctly suspects from the outset
that there will be no action plan points, I can see no difference in principle
between making a claim for this kind of MUR and making a fraudulent prescription
endorsement.
I would certainly be interested to know the views of pharmacy bodies on this.
Such an MUR would allow every one of us to achieve our annual target of 400
(and I remind employers that the figure of 400 is not a primary care trust
target, but a PCT maximum for which payments can be claimed).
At a time when many pharmacists are feeling pressured by their employers, I
urge others to stick to their guns and continue to concentrate on the quality
of MURs. It is difficult, particularly when pharmacists are being put under
enormous pressure, not to succumb. I have no doubt that it is possible to deliver
good quality MURs in high volume, provided the correct level of staffing support
is in place.
If the average MUR, including discussion of over-the-counter medicines and
completion of the paperwork, takes 25 minutes then we need to find the equivalent
of more than 20 working days to achieve that 400 goal.
If the only way to achieve this is to take less time and cut corners or to
start targeting inappropriate customers then we as a profession will do ourselves
no favours.
The Society needs to act now by issuing guidance both to individual pharmacists
and to organisations so that this worthwhile and rewarding role is not undermined
by greed.
Anonymous
298/7 |
The
Pharmaceutical Journal