Within the community pharmacy contractual framework there are three tiers of services: essential, advanced and enhanced.
- All community pharmacies must provide essential services.
- Advanced services are optional but both the pharmacist and the pharmacy premises must meet certain criteria. Also the pharmacy must already be providing all essential services to a satisfactory level.
- Enhanced services are commissioned locally and funded by Local Health Boards (LHBs) to suit needs of the local population. Community pharmacy Wales are involved in any local negotiations and no benchmark prices are generally set.
Medicine Use Reviews (MURs) and prescription intervention service (PIS)
The aim of MURs is to help improve the patient’s use of their regular/long-term medication and ensure that they are well informed about their health condition(s). With written consent, an MUR can be carried out annually or initiated due to an issue with the patient’s medication regimen raised during the dispensing process. The latter is recorded as a prescription intervention service (PIS) and appropriately claimed.
It is not often patients understand the value or reason behind an MUR. Patients typically say they have done their review already with the GP or primary care pharmacist. This reinforces lack of public knowledge and engagement regarding pharmacist’s role within the community.
MURs are normally provided to patients on two or more medicines unless the patient is taking a high-risk medicine i.e. either an NSAID, oral anticoagulants, anti-platelets, diuretics, lithium or methotrexate. Pharmacists however can use their professional judgement when considering whether to do an MUR on one medicine and may need to justify their decision.
Patients ideally need to have received services from the pharmacy for at least three months to qualify but this is not obligatory like in England. It is best practice to ensure a suitable history is available to rightfully explore and improve the use of the patient’s medicines.
This service (like most others) should be carried out in the pharmacy consultation area. LHBs in Wales however can consent for pharmacists to perform telephone MURs or deliver the service outside pharmacy premises. Named patients and details of why they cannot have a consultation in the pharmacy are considered by the LHB and permission is granted on a case by case basis. A maximum of 40 telephone MURs is allowed for the pharmacy per year. Domiciliary MURs have also been introduced and are currently only commissioned from any contractor within Cwm Taf health board.
I have conducted a handful of telephone MURs within the Cardiff and Vale health board. This option is best utilised in quiet pharmacies where patients are housebound and have their medications delivered. Nevertheless I found it challenging to ensure a two-way conversation because I often had to lead the patient.
Every MUR undertaken must be reported online on the MUR claim form via NECAF. It is also important that the pharmacist undertaking the MUR makes a written record.
At least 70% of the MURs should be among the nationally agreed target groups of which there are five in Wales.
- Patients taking antihypertensive medication
- Patients taking medicines for respiratory disease
- Patients taking high risk medicines
- Patients prescribed a medicine no longer required
- People aged 85 or over who take six or more medicines
When the LHB is informed that a pharmacy would like to provide this service, permission is granted through a self-accreditation process together with submission of a pharmacy listing form. Pharmacists are required to pass the MUR assessment provided by a higher education institute that has been agreed by the Department of Health and Welsh Assembly Government. The pharmacist must then forward a copy of their certificate along with the pharmacist MUR listing form to the LHB where they will primarily work. This permits the pharmacist to provide MURs from any accredited premises in Wales (regardless of LHB) as their name will appear on an All-Wales list.
This accreditation process is necessary only once. If a pharmacist registered in England comes to Wales, they will need to re-register following this process so they can provide MURs across Wales.
You can have a look at what an MUR and PIS form looks like here
Written by Ayah
Community Pharmacy Contract – Advanced Services. Wales.nhs.uk. 2018. Available from: http://www.wales.nhs.uk/sites3/page.cfm?orgid=498&pid=7551
Community Pharmacy Wales. Cpwales.org.uk. 2018. Available from: http://www.cpwales.org.uk/
Health in Wales. Wales.nhs.uk. 2018. Available from: http://www.wales.nhs.uk/