Anyone know anything about pharmacies & prescriptions? Specifically MUR (Medicines Use Review)

[VladmirsPoutine]

Google tells me that a MUR is effectively an opportunity for a patient to discuss their medication with a qualified pharmacist - particularly patients on multiple medications and/or those with long-term conditions.
But how is this different if I for example just want to have a chat with my pharmacist about the medication I or my relative is taking. Is a MUR something more comprehensive that can result in a change of prescription whereas a casual chat with my pharmacist might not?

I'm trying to work out the significance of a MUR, if anyone can help.

I think the pharmacies get funding for them, I’ve had two.

One at Boots where they knew me (sort of) as I’d got my scripts there for a few years. Took me into a private room, reviewed things and pointed out that a new med would interact with an antibiotic I’d had a few times (I am an infection risk due to my LTC). I hold a back up antibiotic script at home and GP had missed it.

The second was a Lloyds in the supermarket. I didn’t get regular meds there but had gone to get an antibiotic script whilst I did my food shop and GP had done my repeat too (and reviewed it herself while I was there). Insisted on running through each med with me in the middle of shop, how many I took per day for as needed. Wouldn’t give me my meds until I answered even when I said “I’ve literally just come from discussing it with my GP.” Insisted I sign a form to say they’d done it.

An MUR can only be done if you're taking certain medications (NSAID's/various inhalers/anti-coagulants etc) and is generally more comprehensive than a pop in chat you'd have.

We're supposed to do them once a year for people to check that they know how they should be taking things and why they're taking it. You'd be amazed how many times we discover someone has been taking things at the wrong time/in the wrong way for months because the GP told them what it was for but not how to take it! (The pharmacist I work with checks that patients know how to take any new medication too regardless of an MUR)

It absolutely should not happen the way it did for Hat! You ask the patient, explain what the MUR is, and get them to sign the consent form BEFORE you start; and it should always be in a private room/cubicle!

Thank you both!

TheHatOfDoom What the actual fuck. I'm not a HCP but I'd bet my house on your treatment at Lloyds being in contravention of a few procedural policies!

@CaptainCallisto As a general rule would it be you that would make the initial invite to a patient to have a MUR? Or could the patient request one? Given that for example I've only just learned what it is about 30mins ago...

Generally we make the offer if we see that the person is taking the right meds and hasn't had one this year, but I can't see any reason why you shouldn't ask your pharmacist if you're eligible for one. They'll probably be grateful if you're ok to have one as we get paid for doing them!

They are a huge con for the NHS, pharmacies push them because the amount they get paid to do one is roughly what a GP surgery gets paid for looking after a patient for 4-6 months!

The GP gets £146 per patient per annum; a pharmacist gets £28 for an MUR, so whilst it's a decent chunk it's a bit disingenuous to say it's the same as six months worth of GP budget! And there's a limit on the number of MUR's a pharmacy can do in a year so it's not an endless money pot. To be honest, the budget cuts in pharmacy have been so extreme over the past few years that a lot of independents are only managing to stay afloat because of the extra services they can offer.

Most GPs get nothing like £146 per patient per annum, basic is about £80 and with things like QOF it goes up to about £120. So an MUR, which takes, what, 15 minutes, is paid about the same as what a GP gets to look after a patient for three months. And the ones I've seen (as GPs we get a copy) have added the square root of sod all to the patient's care and have said useful things like "warfarin needs to be monitored" - goodness, I'd never have thought of doing that!

I think the £28 is too much, I agree with you there, but I really do think they're worth doing. We have picked up so many issues through doing them! Probably 15 out of 20 there'll be nothing; the pt knows what they're doing and why; but those five people taking things wrong/ineffectively need picking up on.

Issues that the GP wasn't already aware of? I'm not doubting you, but I see loads of these and without exception they either 'pick things up' that we were already managing, or they pick up complete non-issues that then take our time to explain to the patient that it's not a problem.

@prentedingtowork1 - GPs get paid regardless of if they see the patient or not. I don’t see many offering to pay it back when they haven’t seen a patient for 20 years.

MUR funding was top-sliced from the pharmacy budget when they were introduced in 2005. Funding is OK (but far from fantastic) when you cost a pharmacist at the total cost to the business - pay, holidays, pensions, employers NI etc

Here is a nice infographic from PSNC explaining the different risks group:

psnc.org.uk/wp-content/uploads/2013/07/CPN-MUR-Poster-Target-Groups-Jun-2015.pdf

Mostly it's been the way they're actually taking their meds. Last week we had a lady who was taking her thyroxine with her morning coffee and breakfast. There was a woman a while back who was complaining that her clenil inhaler wasn't working properly. Turned out she didn't like putting it in her mouth so was squirting it into a mug and trying to inhale it from there. There have been numerous people taking things together that ought to be separated by a few hours, at least two people taking alendronic acid on different days each week... They're things that would be flagged to say 'Mrs X has been doing this, we've explained how to take them correctly' and make sure the patient is confident and comfortable with things before they leave. It's very rare that we're referring back to the GP for further action.

I do have a very old school pharmacist though, so it may well be that he's approaching things differently than other people do! He has a lot to say on how modern pharmacy leaves less and less time for actual patient care and interaction, and refuses to compromise on that, so there's a constant backlog of paperwork and what he calls 'box ticking PSNC bollocks'

It’s not PSNC bollocks - you do realise that they are our national negotiator?

Yes I'm well aware thanks. If you read my earlier comments I've been quite strenuously defending MUR's - I think they're very much worthwhile.

The pharmacist I work for is bloody brilliant, but hates all the extra things he's having to do that take him away from the face-to-face interaction with patients. He spends as much time as possible doing that - frequently taking twenty minutes with someone to go through stuff that we can't claim for because he cares about the patients and the community he works in, far more than he cares about the money. He calls things box ticking bollocks, not me, and he has issues with the PSNC in recent years. He feels they're not supporting pharmacists in being able to keep the balance. I don't necessarily agree with him; I think they see very much the way modern pharmacy is going and are trying to help people manage that the best they can. I threw in the comment and the grin as a (perhaps badly judged) attempt to lighten the tone on the thread...

We could debate all day if PSNC have done a good job with our contract - but I do think it is a little unfair to blame PSNC for the paperwork when the entire NHS is drowning in it.

As for providing a good service to our patients - I would imagine that the majority of us do that; I just do the paperwork bollocks unpaid in my own time.

GPs get paid regardless of if they see the patient or not. I don’t see many offering to pay it back when they haven’t seen a patient for 20 years.

yes. we get £120 per patient per year. How do you propose that we look after elderly patients with multiple co-morbidities, palliative care patients dying at home and needing regular visits, those with fragile mental health etc etc for £120 per year if it wasn't subsidised by those who never come? That is the problem with cherry picking by companies like Babylon, they take all the straightforward patients whose care subsidises those who are actually unwell.

Have you ever tried to insure a pet for £120 per year? you won't get very far and would have to pay an excess, have limits on your cover etc.

I didn't know that MURs had been top-sliced from the pharmacy budget, so sympathies for that. I stand by my opinion that they are largely a waste of time - neutral at best, take my time to explain errors at worst.