The Pharmaceutical Journal
Vol 280 No 7506 p731
14 June 2008

Society summary

These reports are of debates at the Royal Pharmaceutical Society’s branch representatives’ meeting on 22 May 2008.
Further reports

Society should help make MURs more professional

The branch representatives’ meeting called on the Royal Pharmaceutical Society to find ways of helping pharmacists carry out medication use reviews in a more professional manner, not driven by targets and costs.

Proposing a motion to that effect, Shaheen Bhatti (Harrow and Hillingdon) said that patients should gain from the MUR experience, and doctors should be able to appreciate the value of pharmacists in the overall care of the patient. Most pharmacists wished to expand their professional role and saw MURs as an opportunity to deliver a relevant service to patients who would benefit.

But pharmacists working for multiples had reported that company emphasis was on quantity, not quality. Their professional judgement was overridden to maximise financial income without consideration of benefit to the patient.

Companies set MUR targets without considering workload. Pharmacists were repeatedly harassed to deliver the required number. Some companies send out e-mails “naming and shaming” those not reaching their targets. Some companies threatened disciplinary action if pharmacists did not meet their targets.

Some forced their pharmacists to carry out unnecessary MURs on patients who did not need them while overlooking those with complex polypharmacy issues. Senior managers told pharmacists to do the easy MURs because they took less time. Some pharmacists were forced to perform MURs without patient consent and write up the forms later.

MURs were supposed to add value to patient care, but unless the outcome was followed through and the GP made aware, there might be no benefit to anyone. The selection of MUR patients should be up to the professional judgement of pharmacists.

Rather than choosing patients randomly to meet the set targets, pharmacists should make a clinical assessment of every prescription and target those patients who might need clarification and explanation.

Many companies had lost focus on the purpose of MURs and viewed them as a financial rather than a professional activity. MURs empowered patients, raised awareness of their condition and medicines they take. Remuneration should not be the issue. MUR should be patient-focused and not target-driven.

Seconding, Stephanie Bancroft (Harrow and Hillingdon) endorsed what the proposer had said and added that locum pharmacists were often in a difficult position when it came to medicines use reviews. They might not be employed if they were not accredited to carry out MURs. They might not be re-employed if they did not meet MUR targets.

They did not know the patient well enough for an annual MUR, so could only do intervention MURs. They might arrive at work and find that MURs had been booked without any regard for the preparation required or the work planned for that day, and they often had to work with insufficient support staff.

Doctors did not want to be inundated with minor issues and could not deal with all the extra paperwork if pharmacists were forced to carry out unnecessary, irrelevant and unimportant MURs.

Paula Wilkinson (Chelmsford) said that her branch appreciated the sentiment of the motion but was concerned that the wording suggested that the Society should help pharmacists to carry out MURs in a more professional manner. Pharmacists should always carry out MURs in a professional manner.

Amy Lepiorz (South Cheshire) said that her only problem with the motion was that it was not the pharmacists who were “driven by targets and costs” but their area managers.

Ken Gledhill (Harrogate) said that the problem was a political one in that the Government did not adequately remunerate the service of medicines management.

Maybe the Society should consider making representation to the Department of Health.