Number of Medicine Use Reviews provided in first year substantially lower than expected says new study
A study published today sheds light on the reasons why a new service, Medicines Use Review, has been slow to take off. One in three pharmacies claimed payments for providing the Medicines Use Review service in its first year as part of the new NHS community pharmacy contract. Although the study indicates that progress is being made with the provision of the new service, the numbers of MURs provided represented less than 7% of the allocated maximum funding. The study also shows that two thirds of the way through its second year, MUR provision is at 8% of its allocated budget and there are signs that uptake is gradually beginning to increase. Pharmacy multiple groups were the quickest to get involved in providing the new service. The percentage of pharmacies claiming payments in the surveyed localities ranged from 13% to 60%. The research also identified that multiple pharmacies undertook over 80% of all MURs within these localities.
Medicine Use Reviews (MURs) were introduced into the NHS as part of the new community pharmacy contract. It is the first national service in which community pharmacists are paid to provide a consultation to a patient specifically to discuss their medicines.
The study, led by Alison Blenkinsopp, Professor of Pharmacy Practice at Keele University School of Pharmacy was part of the national evaluation of the pharmacy contract commissioned by the Pharmacy Practice Research Trust and looked at the development of MURs during their first year as a community pharmacy service.
The results, published in the Pharmaceutical Journal, indicated a seven-fold difference in the mean number of MURs per providing pharmacy, with a mean of 35.7 (8.3 to 61.2). The over-representation of multiple pharmacies was illustrated by 71% contractors claiming payment for MURs whereas the national percentage of community pharmacists that are multiples is 57%.
The research has shown where action is needed to make more effective use of the MUR service. A number of barriers to provision were identified including:
· lack of clarity about what constitutes an MUR;
· complexity of the documentation required for MURs and the fact that the confidential information could not be transmitted electronically to GPs;
· a lack of integration of the work of community pharmacy and general practice;
· a substantial gap between the number of pharmacists accredited to provide MURs and the number claiming payments; and
· only half of the Primary Care Organisations surveyed had a strategy for medicines review and just over a half of these included community pharmacists in their strategy.
“For many years, commentators have argued that the knowledge and skills of community pharmacists are under-utilised” says Professor Blenkinsopp. “MURs provide an opportunity for community pharmacy to develop a service providing direct care to patients. This will make better use of their skills and knowledge and should develop relationships with GPs. Our results show that MURs are working well in some places and that the number of pharmacists accredited is encouraging so early in the life of the service. This research has highlighted what the current situation is across the country and allows us to identify how this new development can be improved even further.”
“Our study, part of a wider national evaluation of the community pharmacy contract for England and Wales commissioned by the PPRT, indicates that the numbers of Reviews provided in the first year of the new contract were substantially lower than expected. Most Strategic Health Authorities and Primary Care Organisations involved in the research viewed MURs as having considerable potential but the research team concluded that further action is needed to support and embed the service.”
Hemant Patel, President of the Royal Pharmaceutical Society of Great Britain said: “Pharmacists are becoming increasingly valuable to public health through embracing increased levels of responsibility as clinicians, with MURs being a significant development. The results of this report illustrate that although pharmacists are stepping forward to develop their roles, more can be done to fully realise the potential of MURs and the multidisciplinary relationships they promote. Pharmacists need to be aware of the financial and strategic imperatives in embracing MURs, and greater support is needed for them to take forward this initiative. The Society’s leadership programme aims to develop the potential of pharmacists to lead and shape the improved health services of the future.’’
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Notes to editors:
1. Blenkinsopp A, Celino G, Bond C, Inch J. Medicines Use Reviews: the first year of a new community pharmacy service. Pharmaceutical Journal; Vol 278; 218-223. No. 7440
2. A Medicines Use Review aims “with the patient’s agreement, to improve his knowledge and use of drugs by in particular - (a) establishing the patient’s actual use, understanding and experience of taking drugs; (b) identifying, discussing and resolving poor or ineffective use of drugs by the patient; (c) identifying side effects and drug interactions that may affect the patient’s compliance with instructions given to him by a health care professional for the taking of drugs; and (d) improving the clinical and cost effectiveness of drugs prescribed to patients thereby reducing the wastage of such drugs.” (DH, 2005)
The study analysed data from a 10% random stratified sample of primary care organisations (PCOs) in England and Wales, 31 in total and covering over a thousand community pharmacies. Surveys were conducted in May 2006 with the lead pharmacist in these PCOs and in over 90% of Strategic Health Authorities.
4. Background to the Trust
Pharmacy Practice Research Trust
The Pharmacy Practice Trust was established in July 1999 as an independent research charity with a broad objective to promote and develop the field of pharmacy practice research. Its trustees are drawn from senior health policy makers, leading academics, industrialists and retailers.
The Medicines and People programme is a major initiative by the Trust. As an independent research charity, the Trust aims to promote research that will enable policy makers, manufacturers, prescribers and others to better understand the people and the contexts in which they use and take medicines. Further information from firstname.lastname@example.org
This study was commissioned by the Pharmacy Practice Research Trust with a grant provided by the Royal Pharmaceutical Society of Great Britain.