Our Strategy
MUROnline is owned by Pharmangelist Limited. At Pharmangelist Limited we fundamentally agree and believe that input by pharmacists is valuable in enhancing patient care. We are determined to share our vision and inspire our colleagues to achieve their full potentials.
The publication of the pharmacy white paper in England represents ‘one of the most significant opportunities ever for pharmacy to step into its rightful place as a clinical profession’(1,2). Paul Bennett, the chairman of the English Pharmacy Board writes ‘If we dither and get it wrong, we will only have ourselves to blame’(2).
The White Paper
Dawn Primarolo MP, Minister for State for Public Health says: ‘The white paper reflects the views, ideas and innovative working of pharmacists across the country and demonstrates our support and commitment to working with pharmacy and others to deliver a practical, achievable program for the future of NHS pharmaceutical services’. The document describe MURs as providing ‘the opportunity to improve people’s use of their medicines, reducing wastage, improving their health and reducing unnecessary hospital admissions. The government proposes two areas within the current structure of the service that should be addressed: (a) To make stronger provision for PCTs to prioritise MURs to meet their health priorities locally, including health improvement, and to monitor service delivery more effectively. and (b) The funding structure should better ensure that the service is delivering to those who might best benefit, and reward the health outcomes that are achieved.
At MUROnline, we see MUR as an opportunity to develop some of the key points highlighted in the white paper. Through MUR, pharmacists can help:
- Support the promotion of health and help more people take care of themselves.
- Provide specific support for people who are starting out on a new course of treatment for long-term conditions, such as high blood pressure or high cholesterol.
- Support the screening of patients at high risk of certain diseases.
- Support the broader ‘NHS journey of improvements and move from an NHS that has rightly focused on increasing the quantity of care to one that focuses on improving the quality of care’(3).
The Challenge
At MUROnline, we believe that number of quality MURs delivered in England and Wales still falls significantly short of the target. The current PSNC figures demonstrate that we are simply not delivering enough MURs in England and Wales (4). If the target of MURs per pharmacy is 400/year, then each pharmacy must be delivering an average of 30 MURs per month. Table 1 below shows the average number of MURs conducted per pharmacy claiming MUR payment and average number of MURs conducted per pharmacy in England (Source PSNC website(4)).
|
Month |
MUR/Claiming Pharmacy* |
MUR/Pharmacy^ |
|
April 2007 |
13.00 |
5.60 |
|
May 2007 |
15.78 |
7.24 |
|
June 2007 |
15.83 |
7.27 |
|
July 2007 |
15.60 |
7.16 |
|
August 2007 |
14.81 |
6.54 |
|
September 2007 |
14.69 |
6.73 |
|
October 2007 |
16.50 |
8.22 |
|
November 2007 |
18.19 |
9.27 |
|
December 2007 |
14.05 |
6.31 |
|
January 2008 |
18.93 |
9.93 |
|
February 2008 |
19.25 |
10.28 |
|
March 2008 |
16.84 |
8.75 |
*Number of MURs per pharmacy claiming MUR payments
^Number of MURs per pharmacy in England
Table 1
In March 2008, only 16.84 MURs payments were made to pharmacies conducting MURs. More depressing however, to us at MUROnline, is the figure of 8.75 in the same month across all pharmacies in England. These figures imply that there are still pockets of pharmacies not conducting MURs. This is an unacceptable state of affairs to us at MUROnline. So what are we going to do about it?
If we dither and get it wrong, we will only have ourselves to blame -
Paul Bennett, chairman of the English Pharmacy Board
MUROnline Response
The stated objective of MUROnline is to increase the number of quality MURs implemented by pharmacists in the United Kingdom. We aim to achieve this through the motivation and empowerment of our colleagues and by the collating and sharing of the evidence of the benefits of MURs. At MUROnline, we acknowledge a number of good quality works being produced by different organisations to drive the delivery of quality MURs. Notable amongst these are:
- The PCPA-NPA MUR Support and evaluation program(5): The program has been designed to evaluate how effective MURs are at improving patients understanding of their medicines and subsequent compliance under prescribers’ direction. We await the outcome of this program with anticipation at MUROnline.
- Pharmacy Magazine and Chemist & Druggist Magazine publish a range of tools on a regular basis to support the delivery of MUR. A set of notable resources includes a CPD module published in June of this year entitled: MURs-getting the essentials right(6) and MURZONE on the C&D website, with contributions from pharmacists(7).
- There are other initiatives supported by the pharmaceutical industry. GSK Plus produced a document entitled: Communication Skills: effective patient communication skills for Pharmacists(8)
- Local MUR initiatives. The Hampshire and Isle of Wight LPC has been very pro-active in promoting the values of MUR amongst its contractors. To support the evidence needed to justify the benefits of MUR, the LPC recently published the results of its asthma project. This provided evidence which demontrated the value of MUR in asthma patients(9)
At MUROnline, we have our own strategies for delivering quality MURs. We aim to deploy these strategies in Hampshire, Southampton City and Portsmouth City PCT regions.
Current Position
In April 2008, Hampshire LPC published a staggering figure of £2,500,000 in their monthly newsletter(figure 1). The amount represent the total amount of funding lost to pharmacies in Hampshire and Isle of Wight in 2007. From our viewpoint, this figure represent a significant amount of patients that were not helped to make the best use of their medication in 2007!
Figure 1: LPC News Newsletter April 2008 (10)
If we are still working on the general assumption that each pharmacy need to be achieving an average of 30 MURs/month, then in March 2008: Out of 9,570 possible MURs, only 2,738 was completed in Hampshire, Southampton City and Portsmouth City PCT regions. In percentage terms, this is only 29%!
We however believe that fundamentally, the pharmacist in charge must want to help his patient get the most out of his medication, otherwise, the whole notion that we are medicines experts will start to unravel.
MUROnline does not like this and we are determined to do something about it. Between now and December 2008, we will embark on a road to make significant positive impact on these figures. Our emphasis is on quality MURs and is in line with the theme of the latest Lord Darzi report on the vision for the NHS. We aim to do this with the help and support of all the stakeholders in the Hampshire, Southampton City and Portsmouth City PCT regions. Please watch this space.
Summary
We know at MUROnline, that there is a vast array of reasons why a single pharmacy may not be delivering quality MURs. There is no single solution to these barriers. We however believe that fundamentally, the pharmacist in charge must want to help his patient get the most out of his medication, otherwise, the whole notion that we are medicines experts will start to unravel. We have introduced the concept of an MUR Evangelist and we believe we can make significant contribution by motivating our colleagues to deliver quality MURs. We are going to aim to increase the percentage of quality MUR delivered across the stated PCT regions from 29% to over 50% by the end of this financial year. We can only achieve this if we get the full unequivocal support of all stakeholders. We will come knocking on your doors and we hope you will respond positively.
References
(1) Pharmacy In England: Building on Strengths - delivering the future DOH White Paper ISBN 9780101734127 - Link
(2) Pharmacy Now: From the Chairman of the English Board: Board considers White Paper Issue 7 Summer 2008 - Link
(3) Lord Darzi of Denham: High Quality Care for All - NHS Next Stage Review Final Report: Full report (ISBN 978-0-10-174322-8) - Link
(4) PSNC MUR Statistics - Link
(5) PCPA NPA MUR Support and Evaluation Programme – Pilot sites chosen - Link
(6) MURs - Getting the Essentials Right: Contributing authors: Jennifer Archer MSc, HRD, FCIPD, FHEA, DipTM, consultant in education and development; Hassan Hajat, MRPharmS, MSc, senior commissioning manager and clinical adviser, Derbyshire County PCT: cpd module pharmacy magazine CPD1 June 2008.
(7) MURZone - Link (http://www.chemistanddruggist.co.uk/murzone)
(8) GSK Communication Skills (ref PLS/CDR/05/17633/1-FP - CD Rom). Obtain a free copy from GSK on Freephone: 0800 221441 or email: customercontactuk@gsk.com
(9) Community Pharmacy Asthma Medicines Use Review Project - Outcome Report: Authors: Dr Jane Portlock, University of Portsmouth; Michael Holden, Chief Officer, Hampshire & IOW LPC, Shailesh Patel, Brand Manager, GSK UK Ltd. - request a copy via the Hampshire and IOW LPC website - Link
(10) LPC Newsletter April 2008 - Link
Tags: Our Strategy