Features

Why many GPs ignore MUR forms

For the past six months, the All Party Parliamentary Group on Pharmacy has been carrying out a major inquiry into the future of pharmacy. One of the issues that the inquiry has been looking at is the state of the relationship between pharmacists and other front-line primary care professionals, particularly GPs. The ability of community pharmacists to deliver the advanced and enhanced services envisaged in the new pharmacy contract, such as medicines use reviews (MURs), depends heavily on the strength of these relationships and the degree of connectivity between pharmacies and GP surgeries.

It is apparent, however, from some of our recent evidence sessions that although doctors approve of pharmacists’ enhanced role in principle, poor communication and a lack of integration between surgeries and pharmacies to a certain extent is undermining this role.

MURs are a case in point: pharmacists have taken to the idea enthusiastically, and undertook nearly 150,000 of MURs in 2005/06. Patients, too, have responded positively to their introduction with a number of surveys showing that they value the opportunity to discuss their medicines use with their pharmacist and think that it has a positive impact on their care. GPs, on the other hand, have been far more cautious and many pharmacists have found it difficult to get GPs to engage with the idea. Why is this? One would have thought that GPs, given their current workload, would have welcomed the opportunity to devolve much of the responsibility for educating patients about their medicines onto pharmacists. Most GPs admit that they find it difficult in the limited time that they have with each patient to help them to develop the knowledge they need to enable them to make informed decisions about the medicines they use.

The main reason is that far from taking the pressure off GPs, the introduction of MURs has in fact increased GPs’ workload in many cases or, at the least, led to them receiving information that they do not have the time or resources to use in any meaningful way. GPs’ main concern is about the format in which the information is provided. At present GPs receive a lengthy and detailed paper form, which is time-consuming to interpret and contains information that cannot easily be entered into their practice IT systems. It is hardly surprising, therefore, that many MUR forms are either discarded or ignored by GPs.

Improvements needed

This clearly cannot be allowed to go on: not only is it a waste of pharmacists’, patients’ and GPs’ time, but it is also wasting a considerable amount of NHS resources. A streamlined MUR model, one which has been endorsed by GPs as well as pharmacists, is essential if we are to move forward and ensure that the undoubted potential that MURs have to improve patient care is realised. One improvement, in my opinion, would be to condense the current form to a one-page document that contains a set of fields that have been mutually agreed. This should make it easier for GPs to pick up any necessary action points and incorporate any relevant new information or data into their IT systems. The key change that needs to be introduced, however, is to make the MUR form available in an electronic format so that it can quickly and easily be appended to patients’ records. On the face of it, this would seem to be a rather distant prospect, given the current problems that the NHS is facing with its IT systems. If the Department of Health is serious, however, about making the most of the new community pharmacy contract and ensuring that the NHS makes more efficient and effective use of its medicines budget — both of which are things that ministers say are priorities for the department — then it needs to push this issue much further up its agenda. Without proper IT support, MURs will continue to interest only a relatively small percentage of GPs.

This is not to say, of course, that there are not some good examples of pharmacists and GPs working together effectively to make best use of the MUR process. A number of practices, for example, ask patients to go for an MUR with a pharmacist before asking them to come along for their annual medicines review at the practice. This helps to improve compliance among patients, GPs argue, and also improves the quality and value of the GP’s review. Other GPs have encouraged pharmacists to go into practices and to see patients on site, having agreed between them beforehand what it is they want the MUR process to achieve and how they can use it to improve patient care. The challenge now, therefore, is to encourage other practices to follow this lead. Once again this is something that is likely to require the intervention of the DoH. It is a challenge that the DoH, in conjunction with primary care trusts, has to take on if MURs are to be a success in the long run.