Should MURs be scrapped and replaced with something different

[TigerSwift]

I think MURs are a good intervention to use when you are not too sure (or can tell the patient is lying...) if someone is using their medications properly, or even knows how to use them and what they do and why they need so many. Therefore i do not think MURs should be completely scrapped.

I think pharmacists should be getting paid for such a service as it takes time and certain skills in order to do one properly - not to mention the acreditation. The big multiples should scrap their tragetting crap as it is forcing pharmacists to do them when they are not needed to get them out of the way and putting pressure on them when they can't meet said target. Yet again we see large multiples turning pharmacy into a money making scheme instead of treating pharmacy as a health care system (or maybe i am dreaming...).

Scrapping the targets would allow pharmacists to focus on those patients that actually need it and will probably do it to a better level - giving better outcomes for the patient. Also, a better and more meaningful MUR would be more accepted by GPs and maybe some value would be brought back to this service.

I think RPSGB and the CCA need to realise what is happening and take action. The PDA has already pointed out the rising stress levels on pharmacists to perform to such targets.

[johnep]

Levels of staff are appointed on those required to do X nbr of scripts. MURS are in addition but no new staff. However, to obtain maximum profit you have to work your assets and this is precisely what the multiples are doing.
johnep

[DavidS]

I've dug out this thread because of a good article I read in "Pharmacy Magazine" (not available on-line, as far as I can see) Feb2009 p41. The writer wants to know why we are wasting time with MURs which are hardly appreciated by patients, doctors or, indeed, many pharmacists, particularly in the way they are being implemented.

The writer feels that instead we should be concentrating on "the costly issue of non-compliance." We must assume that s/he means the costly issue of non-adherence , but the argument that this would bring proven benefits to the patients and the NHS and be much closer to what we are already set up for in the community is hard to ignore.

How we would be paid for this is harder to see, but the benefits would be immense, with 30-50% of patients being non-adherent.

(The era of the Teflon patient, perhaps.)

How can we bring this suggestion to a wider audience? I suspect many of the MURs we do end up focusing on this issue, actually, but the benefits of a more than once-a-year- contact with a non-adherent patient would be much greater, wouldn't they?

[darkstar]

Yes MURs are a good idea, but with money involved it was inevitable we would reach the point we have today. Unfortunately multiples have led the way in harrassing pharmacists to churn out the numbers, without regard for how they are achieved - a 2 minute chat over the counter will suffice apparently. Of course they are clearly concerned about patient safety when placing pharmacists under additional pressure.

What started out as a noble concept has been corrupted to the point where those in charge don't even see MUR as a quality outcome....simply a number. I remember when i was first accredited, and the multiple i worked for then (Lloyds) held meetings to discuss how to support pharmacists accomplish them. Gradually it became apparent no extra staff or support would be provided and all they did was raise the targets and heap on the pressure. What a joke that meeing turned out to be....except i'm not really laughing that much.

So it's clear i'm a cynic, but i still try to recruit MURS on a daily basis and i enjoy doing them when i get the opportunity. I believe MURs should be a complete medicines review with a larger fee attached to it and be done in conjunction with surgeries on a scheduled appointment lasting 20-30 mins. I think that smaller scale interventions and counselling around when to take medicines (typically done over the counter) should attract an additional small fee in the region of 2 pounds with a simple system for recording on PMR and an appropriate endorsement. This way we are getting some renumeration where we have provided additional counselling on specific points i.e. a simplified MUR, but to the benefit of our patients whilst being easy to incorporate in everyday working environment.

Well i think i've ranted enough....

[howe928]

I'm guessing here - the main reason why a lot of us are less than willing to do them is that we are conscious that prescriptions and MDS are stacking up while we are absent, and once that happens it creates stress on the dispensary team to catch up. One lapse of concentration and....

agreed with what Jeff said

yes, i agreed, it takes about 20 minutes to do one and best not to be interrupted, a report to finished after this which takes another 15 minutes unless you rush but rushing around could lead to poor MUR paperworks or even MUR error? There was an article in PJ, a boss of pharmacy chain was interviewed and i agreed with what he said, there should be another pharmacist there to do MUR while the other get on with checking scripts (tried and tested, it works)

Should the goverment scrap MURs and replace it with a similar scheme but integrate it into the current FP10 and the future we've been promised!

Box to be ticked if intevention has been made ....this could include our day to day interventions or lifestyle interventions(public health role) '

The pharmacist initials/reg number should also be on script , once the clinical check etc has been done .

Dispenser and ACT signature should also be on script to ensure that the ACT doesn't disp and check

This should be for all prescriptions , mot just for a certain limit, so perhaps a fee of £4 -5 per script would suffice ,and the current MUR pressure would be off

MUR £27 /400 = £10,800

but if the above method is adopted (PSNC would have to negotiate)
£5x 4000scripts(av) =£20,000, more expensive but this would include our public health role/clinical role etc;

Does anyone think its a workable idea

i think the idea is good as an addition to current script layout , intervention should attract a bigger fee as that's pharmacist expertise comes in

'What about if there was a box asking the patient to tick and sign if she has recieved appropriate advice from the pharmacist/dispenser' <----- DO NOT LIKE THIS IDEA

preventing wastage is a very good idea but how to do this successfully? you will not know how much a patient got at home, a patient once said 'if you run out of stock, my home got plenty'

[Pharmanaut]

agreed with what Jeff said

yes, i agreed, it takes about 20 minutes to do one and best not to be interrupted, a report to finished after this which takes another 15 minutes unless you rush but rushing around could lead to poor MUR paperworks or even MUR error? There was an article in PJ, a boss of pharmacy chain was interviewed and i agreed with what he said, there should be another pharmacist there to do MUR while the other get on with checking scripts (tried and tested, it works)



i think the idea is good as an addition to current script layout , intervention should attract a bigger fee as that's pharmacist expertise comes in

Agree with that.
Several interventions have led to 'don't dispense and send the patient back'. Good pharmacy, bad business.

[blogger]

hello, new to the forum

i have wrote this


LINK MUR THE STRESS

www.mur-the-stress.blogspot.com

[spartacus]

Hello everyone. i qualified this year and have recently accepted a job with a multiple. After doing a few locums and reading this thread, I am worried that my working life will be made difficult because of MUR targets. I am starting to feel that I have made the wrong career choice. I didn't go to university for four years to put up with this on a daily basis. What do I do? Is there a way of getting out of doing them? Any advice will be really appreciated.

[LeftArm]

Done correctly MUR's are a good use of your 4 years education and provide benefits for patients.
There is no way of getting out of doing them but think of it this way. Some Pharmacists on here are moaning because the multiples expect them to do their full quota of MUR's. If these pharmacists were independent owner pharmacists do you think they would refuse to do them or do you think they would do them because they are beneficial for patients (when done correctly) and provide much needed revenue.

and my piece of advice is don't listen to everything that the grumpy old men on here say.

[Pharmanaut]

The grumpies would like some extra support so that there isn't a backlog of EVERYTHING. For most of us there isn't enough time in the day especially as we already do... script chasing, collection and delivery and ever increasing MDS for homes and Community MDS, minor aliments, chasing short supplies and one thing interrupting another continuously. All this has to be done NOW NOW NOW for waiting patients as all their expectations of what we can do has been raised.
Because we can't do everything NOW NOW NOW does that make us useless at time management?

Guess who is feeling stresed even on day off.