A typical medication use review (MUR), if carried out well, is an excellent service to offer in community pharmacy. MURs allow pharmacists to receive payment for delivering pharmaceutical care. Some would argue that this is great because pharmacists have been delivering pharmaceutical care free for years. I agree, because community pharmacists should be paid in a similar way to general practitioners for positive patient outcomes, and not primarily based on prescription volume.
So, MURs provide pharmacists with an opportunity to explore a more clinical role. This is good, but in my view way below the level of practise we should be delivering via our community pharmacy network.
I think our end goal in community pharmacy should be to manage caseloads of patients who suffer long term conditions.
With this in mind the concept of the MUR is a necessary step towards this broad goal. One thing that must happen before we progress away from volume payment is to appropriately create registered patient populations linked to a given community pharmacy. The advantage of this is that it provides a stable cohort of patients which we as community pharmacist prescribers can begin to manage. The obvious conflict of interest that could perhaps arise for less scrupulous pharmacists or contractors will then start to wane. Moving towards a method of payment for pharmaceutical services that transitions away from volume payment in a slow controlled way must be a necessary goal.
To be clear, by ‘manage’ I mean investigate, diagnose, prescribe and then follow up. The level of competence required to deliver this approach safely is significant, and perhaps beyond most community pharmacists at the moment. That said, if we are looking for an answer to the future of community pharmacy practice, I would argue that this is it and perhaps it’s time to reflect on how we can eventually deliver this approach.
And remember, the Royal Pharmaceutical Society (RPS) is there to support your professional development, and I would urge pharmacists to join the RPS and start their faculty journey. I recently engaged with the Faculty process and am enjoying exploring my own professional development journey with this ultimate goal in mind.
Strategically, I think the move to a more clinical role is the correct one, especially given the threats and opportunities that a move to automation presents. In addition, demographics are dictating that there is a deficit of practitioners able to support and manage those patients with long term conditions. Community pharmacists can help fill that professional void.
In Scotland we are slightly further down the road to a contract that rewards those that deliver excellent pharmaceutical care. The chronic medication service requires patients to register with a pharmacy and this opens up the chance for pharmacists to use their clinical skills. In my view, the next step is the addition of pharmacist prescribing for this registered cohort of patients, supported by access to patient records within the community pharmacy.
Over the years there has been much debate about MURs and how they are delivered. If we are to progress as a profession, we must support our professional body and exhibit excellent professional courage to move this ambition on. With more autonomy, the talented community pharmacists across the UK can be re-energised ultimately for the good of patients.
However the future continues to develop, one thing is certain: professionalism must remain central to our practice as pharmacists. In any service we deliver it is not good enough in my view to flirt with the rules, but instead we must practise in a way that is both transparent and above question.
With this in mind I was delighted to hear Sandra Gidley standing up on behalf of the RPS for core values like professionalism.
So, when you next stand in your dispensary, reflect on what is right for your patients and quietly decide as a professional what you are willing to accept. I’m not saying it is always easy, but once you have decided, have courage to be true to yourself and your profession.
At the end of the day you are the ‘Responsible Pharmacist’.
Johnathan is a practice pharmacist and community pharmacy locum.