I am standing at the reception counter of my local pharmacy, waiting for my monthly prescription that the pharmacy ordered a few days ago. Janine, the technician, gets the bag from the storage area and shouts to the regular pharmacist:
“Hey! Tom! Do you want an MUR? Says here that she last had one eighteen months ago.”
…comes the response.
“I reached my 400 about six weeks ago. I won’t be doing any more until April. Is there any new med on the prescription?
“Eh! Let me see …”
“No, doesn’t look like there’s anything new this month.”
“In that case just hand it out,’ is the final response. “Let me go and check some blisters,”
as Tom wanders off…
Janine then hands me my bag with her usual courtesy and practised efficiency. However, I can’t help thinking about the short interchange between her and the pharmacist…
I know enough about pharmacy to be aware that an MUR is a Medicines Use Review and, having had several over the years, that it can be very useful in identifying problems with medicines use, side effects and other issues related to my health as a patient.
It seems strange that the pharmacist should be reluctant to have a discussion with me about my health and medicines. After all, a lot could have changed in the eighteen months since my last review.
But then I remember that pharmacies are paid for only 400 MURs annually. My annual review appears to have been noticed at the wrong time, when the pharmacist had reached his quota for the year, and was no longer interested in conducting MURs.
Of course this leads to other questions. Why exactly do pharmacists do these MURs?
Is it because of the financial benefits? (I can imagine that in order to generate a net profit equivalent to the £28 they get for each MUR they would need to sell goods worth a few hundred pounds; or dispense several prescriptions.)
If this is the prime driver then it leaves a bit of a sour taste in the mouth, as it makes them appear as little more than mercenaries using whatever financial incentives there might be in the health service to make money.
I would like to think that there are altruistic motivations for the provision of the service: that the pharmacists conduct MURs because they genuinely care for the health of patients.
However, if this were the case, would pharmacists stop doing them once they got to four hundred, as seems to have been the case in this instance?
I’m also fascinated that Tom completed his quota in early February. Was this because there was such a massive demand for the service that he couldn’t stretch it until the end of the year, or simply because he had some form of race to the line to get to the 400 as quickly as he could?
In all honesty, I have to admit, I have never personally requested an MUR from the pharmacist, nor have I heard anyone ask for one on all the occasions that I have been in pharmacies; hence I am inclined to believe that the pressure to get to 400 comes more from the pharmacist than the patient side. I stand to be corrected on this (and I hope I will), especially since my analysis is based on just my own experience.
There are, however, other factors that lead me to think that my experience might not be as isolated as I wish it to be.
Tom works for one of the large multiples and has, in previous conversations, expressed how target-driven the culture is within the overall organisation. He has told of the pressures he faces to meet daily, weekly and monthly targets around prescription items, services, sales and costs.
I fully appreciate that community pharmacies are businesses that need to turn a profit, but I think it is possible that in some instances the profit motive could override the genuine patient-care outlook. The premature completion of the quota and – perhaps – the withholding of the service from potential beneficiaries because there is not financial reward are suggestive of this.
Perhaps this is all symptomatic of a bigger trend: what I like to refer to as the commodification of health.
This is the propensity to value patients and health parameters in economic and financial terms rather than the perspective of lives saved, improvements in quality of life or some other tangible, practical measure of health. The value of the patient consequently becomes measured in terms of the financial benefit or cost to the professional.
It is a malady that afflicts not just some in the pharmacy profession, but doctors and politicians as well.
The GP contract, for instance, rewards patients according to the number of patients registered (patient-units as a cynical observer might argue) as well as whether certain parameters about those patients have been recorded.
For GPs therefore, the value of each patient-unit is in the income it brings in relation to QOF points plus flu jabs etc. Politicians, on the other hand, will view each patient-unit as a cost/liability, hence the current talk of crisis in the health service over an ageing population in the UK.
I am not so naïve as to be ignorant of the fact that community pharmacies and GP surgeries are private businesses that need to generate a profit for the owners. I believe health professionals perform an important role and should be fairly compensated for the work they do.
I do, however, think that it is important to have a reward system that places patient care at the forefront of the service, so that no patient that genuinely needs medical or pharmaceutical intervention is ignored because the pharmacist or doctor has reached some arbitrary target. Perhaps I shall offer some suggestions on such a reward system in a future post.
Pharmapatient is an anonymous patient based in England. She has written the book, “Life at the Receiving End: The Experiences and Views of an NHS Patient”, available on Amazon in both Paperback and Kindle format.
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* The above opinion piece is a result of a Twitter conversation between Pharmapatient and Johnathan Laird(@JohnathanLaird). Pharmapatient would like to thank Johnathan for reaching out to hear the views of a patient and for kindly hosting this guest blog post which is an excellent blog for all things pharmacy-related in the UK.