Regulator to look into Boots MUR evidence

Boots says it "doesn't recognise" the claims

The Guardian has referred to evidence suggesting the chain pressures staff to carry out unnecessary MURs to maximise profits

Latest: Regulator to look into Boots MUR evidence

EXCLUSIVE

The General Pharmaceutical Council (GPhC) has told C+D it is "liasing" with the Pharmacists' Defence Association (PDA) over material it shared with the Guardian in relation to the newspaper's allegations against the multiple.

As well as an unpublished survey conducted by the PDA that it claims was completed by over 600 Boots employees, the regulator is also asking the PDA to provide it with "other relevant evidence", it said this afternoon (April 14).

Update: Boots issues second response to MUR allegations

Boots has reminded its pharmacists of its guidance on providing medicines use reviews (MURs), a spokesperson has told C+D.

Its professional standards make it clear that services “must be for the benefit of patients, not the attainment of numerical targets”, it said yesterday evening (April 13).

The multiple "doesn't recognise" the Guardian's claims, which it said are "not representative" of its 60,000-strong staff.

Boots makes it clear to staff that services should not be carried out "inappropriately", it stressed. All of its staff are "empowered" to use their professional judgement to assess the appropriateness of offering services, it said.

"The drive for strong financial performance has never been to the detriment of our constant priority on pharmacy and delivering the best healthcare services in the communities we serve," it added.

A national newspaper has accused Boots of pressuring staff to abuse medicines use reviews (MURs) for financial gain.

The Guardian claimed it has evidence that Boots managers have instructed staff to carry out unnecessary MURs on each other or on patients who do not need them, so it can make the maximum amount possible from the service, in an article published this morning (April 12).

Pharmacists are currently paid to carry out a maximum of 400 MURs per year. But the Guardian claimed Boots staff are encouraged to treat this number as a "target for individual stores to hit".

An "expectation"

The newspaper claimed one Boots pharmacist in the Midlands said he had been instructed to carry out an MUR on himself, as well as a patient who had dementia. The store entered an incomplete MUR carried out by his manager onto its system, it was also claimed.

Another Boots pharmacist from the north-west of England told the newspaper that he and his colleagues were informed at a recent staff away day that reaching 400 MURs per store is now an "expectation", it is alleged. 

Pharmacists are paid £28 for carrying out a single MUR. The Guardian claims that Boots could earn £30 million annually if each of its stores reached the 400 cap.

The Guardian claimed to have seen an email sent in 2008 from a senior manager stating that, while Boots did not want staff to feel "brow-beaten" by targets, each missed MUR is a "lost £28".

C+D’s Salary Survey 2015 revealed that more than half of pharmacists regularly conduct unnecessary services just to meet targets.

Result

How often do you feel pressured to provide an MUR, regardless of whether it will benefit the patient?
More than once a day
32%
Every day
34%
Two or three times a week
7%
Once a week
4%
Once a month
2%
Never
21%
Total votes: 1110

Regulator's response

General Pharmaceutical Council (GPhC) chief executive Duncan Rudkin told C+D that the regulator expects all pharmacy professionals to meet its standards to practise safely and effectively.

Its standards of conduct, ethics and performance make it clear that pharmacy professionals should make caring for patients their first concern and raise concerns about anything that could affect patient care or public safety, he said this afternoon.

 

 

Have you ever felt pressured to carry out unnecessary targets?

We want to hear your views, but please express them in the spirit of a constructive, professional debate. For more information about what this means, please click here to see our community principles and information

 

100 Comments

Colin Ware, Community pharmacist

As a pharmacist with many years on the register I can only put forward my experience as an employee of a multiple. I did not succumb to the endless pressure put on me by non-pharmacist managers to deliver my "target" of 9 MURs a week but I did have the unpleasant experience of a newly qualified pharmacist - just post Pre-Reg, who was now a manager, telephoning me at home one evening sobbing her heart out as she had been told by her ( non-pharmacist) Area Manager that she was not meeting her weekly target of MURs and had to submit, by the next day, an Action Plan detailing how she was going to meet her targets - including her "missed" targets for the previous weeks. This poor, newly qualified pharmacist, was completely distraught as she understand from her conversation with the Area Manager ( whose qualification for being an Area Manager was being a Gym Equipment Salesman) that failure to deliver her target of 9 MURs a week would result in her being "managed" out of her job on the result of a "Performance Appraisal" - if this was not bullying then words fail me!!!

Pill Counter, Pharmacy

another example of the lovely treatment of an experienced phamracist https://www.pharmacyregulation.org/sites/default/files/determinations/murray_determinations.pdf 

“I am ashamed to admit that the two allegations (falsifying 17 MURs in August 2014 and the two mentioned in September 2014) are true. This came about by constant pressure that was present to perform MURs and reach the total of 400 per year. My actions were wrong to try to improve my monthly figures for a short while.”- Ms A Murray

Pill Counter, Pharmacy

another example of the lovely treatment of an experienced phamracist https://www.pharmacyregulation.org/sites/default/files/determinations/murray_determinations.pdf 

bilal hussain, Community pharmacist

What terrible and irresponsible journalism. Your article makes it out as if pharmacists are financially gaining for these MURs. One example is your claim "Pharmacists are paid £28 for carrying out a single MUR".

 

NO WE ARE NOT PAID £28 FOR CARRYING OUT AN MUR. Boots is paid £28, NOT the pharmacists. 

 

Once again, what shoddy and poor journalism. Are you being paid by Boots to write this nonsense?

Sau Sheung Yuen, Pharmacy Area manager/ Operations Manager

This MUR and NMS thing may not be restricted to Boots, could other big multiples are also doing the same?

 

DM X, Locum pharmacist

Does the GPHC actually care? I say this because the Guardian states that the PDA told the GPHC that this was happening but did not illicit any kind of tangible response.

Jay Badenhorst, Superintendent Pharmacist

Would the story have been any different if Boots actually paid their UK tax?

M Yang, Community pharmacist

Whether or not they paid their tax doesn't matter, it's still misuse of public money. The fact they evade tax - legally, but still questionable - doesn't do them any favours especially now that the Panama scandal has been made public. That offshore money includes MUR money that was acquired through misusing MURs. Pharmacy businesses are entitled to make profit but there is the expectation - on a professional and ethical level - for them to invest some of it into providing a decent service for the public. This is a healthcare providing bussiness, not a McDonalds. Boots has a large monopoly over pharmacy, which limits choice for patients and essentially forces a lot of people to use their less than adequate services.

Jay Badenhorst, Superintendent Pharmacist

Would the story have been any different if Boots actually paid their UK tax?

Pill Counter, Pharmacy

All of the above repeated plenty times by Sami, Morein et al but for some reason they were written off as trolls.  I wonder what C&D make of all this now?

SANDRA Clement,

I think it should be made clear that individual pharmacists do not receive any remuneration from completing MURs. The £28 is for the pharmacy company. Perhaps it would have been down to the GPHc to ensure that pharmacists get paid for all the health care services added to their contracts

D F, Primary care pharmacist

On my MURS I always try to write additional notes or points we've discussed - this way I build a picture of the patient and points we've discussed that if needed I can look back on when I next see them to check if they have eg started using their preventer more or are dissolving their aspirin in water etc. Too many mur templates are ticked but no further info on discussions! Pharmacists should be carrying out quality MURs for all patients on at least 2 medicines. There should be no cap and no £28 for the pharmacy company. It should be a given that we provide this advice on medication etc. Perhaps a flat fee per year for the mur service if provided. And qualified pharmacists carrying them out should obtain a fixed % to their salary? Perhaps monitoring the interventions made and quality of those interventions. Eg this week I found someone on two combi inhalers, someone who had stopped their meds for 3 months and another with memory problems whom I will be providing a medicine reminder chart and speaking with his GP. 

James Mac, Community pharmacist

OK when I worked there if you fell behind in MURs you were in SERIOUS trouble and often the punishment was to get transferred to a branch a mammoth commute from where you lived. Then performance contracts came in and, in addition, you didn't even qualify for an inflationary pay rise. This coupled with the long trip both ways to your work meant you lost a lot of $. If the dry spell went on long enough and you were on the "not performing" contact you could be sacked! So in addition to the psychological issues around having a non-pharmacist label you as no good, your chances of finding a new job could be seriously dented. Toxic culture - if you don't believe me, check the employee reviews on glassdoor.

Richard Andoh, Pharmacy

It is a sorry state of affairs especially with non Pharmacist area managers who have no professional duties towards patients forcing and driving MURs just  for profitabilty and their Bonuses. It really makes it difficult for some of us with a conscious not only towards our patients but to the NHS as well. In my view the maximum number should be scrapped for a minmum of say fifty triggering MUR payment for the year. Its better for the NHS and patients involved to have a quality  intereaction which has the potential to benefit the patient. The NHS should go for quality instead of quantity. Conference calls asking for MUR figures should banned hence forth. It puts unnecssary pressure!!!

D F, Primary care pharmacist

Leading up to the year end it was strange how looking at my company league table magically s number of stores suddenly achieved 29, 21 MURS in the very last week to reach their 400 ... Hmm I wonder about the quality of those!!!!

Brian Austen, Senior Management

When I was a GP Practice Manager I reported the local Boots (twice) to North Lincs PCT now CCG for requesting prescriptions using pharmacy prescription counterfoils ticked by Boots staff  because the patients had died! They decided to do absolutely nothing. They said both times must have been unfortunate errors.

S J- Locum, Locum pharmacist

FRANKLY another really bad Multiple

Rowlands are even worse in many ways. Locum Pharmacists are treated like idiots by the staff. False claims and allegations are made against them. Made to work in appalling conditions with virtually skeleton staff. The area managers completely ignore their cries for help. Only 20 Minute break per day no matter how many hours you work. Sometimes not even a chair to sit on for 9 to 10 hour day. Health and Safety flouted openly

Most of the area mangers are 'Pally with the subordinate staff who clearly take advantage of this at the detriment of the Pharmacist and the locum.

Any locum who performs several MURs is a BRILLIANT pharmacist. no matter Parmacists' clinical knowledge or professionalism. Otherwise they are useles

If they don't like you for being assertive with regard to legal requirements or are taking your responsibility seriously, you will be reported to the area manager and the locummboard and hence removed from their locum list without your knowledge

That is the respect they have for you. Yet without us they cannot run their business.

Most of their Area Managers and managers lack management training and are arrogant and opinionated whether they are Pharmacists or Not. Thae staff know that and take advantage.

They pay Locum dispensers £13 per hour plus and Pharmmacists from £16. That is how much they value and respect Pharmacists

Any idiot can become a manager or area manager with Rowlands. No one respects them. Most of their managers can hardly speak good english and the patients get frustrated. The staffs lives are made hell.  Some are very good and work hard.  WHAT A HAPPY WORPLACE ROWLANDS IS NOW. MONEY....MONEY.....HA MORE MONEY. 

 

Farm Assistant, Community pharmacist

Does the GPHC really not know the truth about MURs? They are either corrupt or useless (or both). If they do not know the situation then the inspectorate should be hauled in front of the Statuatory Committee and judged by the real members of this profession. It is amazing how many people cannot handle the plain truth.

martin gibson, Locum pharmacist

I forwarded an area manager's email, insisting each branch did two MURs daily, to the GPhC in 2012. They did NOTHING! 

 

Hadi Al-Bayati, Locum pharmacist

I would prefer to see MUR's capped at 100 in exchange for the 6%. It would mean only the patients who really need it would have them done.

(Not expecting many to agree with me)

James Mac, Community pharmacist

Exactly - or a one off payment for providing the service regardless of number as part of the yearly audit (submit at least 5 for analysis for example as part of clinical audit). Stops it from being a "target chase".

Abdul Kaddour, Pharmacy

"Pharmacists are paid £28 for carrying out a single MUR"

We wish...

David Taylor, Pharmacy

It is interesting that Boots are reminding pharmacists of the criteria for MURs. It is the non Pharmacist Management who threaten pharmacists with losing their jobs if they do not meet their MUR targets. Boots went rogue when they retired there last Pharmacist Managing Director years ago.

Pillman Uk, Non Pharmacist Branch Manager

I really don't see why there is a big issue around MURs.

I totally agree that they should be for the benefit of the patient and shouldn't be a target to be achieved at all cost BUT having said that, I believe that the 400 can be achieved easily and professionally. I have colleagues (who I have the most regard for as professional in their approach to pharmacy) achieve the 400 in a low footfall pharmacy.

Sometimes it's just down to a pharmacists not engaging with the concept of the MUR so they don't buy in to their delivery.
I bet you if the pharmacy technicians were empowered/permitted to do these, they snap our hand off, but that's a totally different discussion.

If MURs aren't the vehicle to deliver patient outcomes and financial income, then what is?

Has someone a better idea?

Chris P, Community pharmacist

A multiple I worked for made me put a HAND WRITTEN sign up offering a short dated glucose monitor to anyone who had a quick chat to the pharmacist. The NPM made me do these even if someone was not suitable for them as they had seen this sign I was made to put up and they wanted the free monitor.

Pill Counter, Pharmacy

What does Kirit(Day Lewis) think?

S J- Locum, Locum pharmacist

 

Didn't you know? They are rip offs as well. Do you know how they squeeze more money out of Locums?

The rate you get is including expenses. You are left with practically very little at the end of the day and are also expected/must to perform at least one MUR. Only do what you get paid for but give all your help to the patient care where there is no financial gain to the company

Pill Counter, Pharmacy

Mr Waldron are you going to press Boots for a little more details on this defrauding of the NHS?

Andrew Christopherson, Community pharmacist

This has been mentioned a few times before but http://www.theguardian.com/news/2016/apr/13/how-boots-went-rogue#sthash.IqNKc4nd.dpuf is definitely worth a read.  

I worked for Boots between 2001-3 and again between 2010-12.  The company I went back to was unrecognisable to the one I haad previously worked for.  Everything was about meetig targets and cutting costs.  Items numbers, till takings and pharmacy services went up in my store, but each year my staffing budget was cut.  The day I realised that speaking to patients was interferring with me running the store was the day I realised I had to leave.

Meera Sharma, Community pharmacist

Ditto. I qualified with this company and loved working for them at the time, it was a good professional atmosphere. The company I joined almost a decade later was unrecognisable. Boots responses are the "corporate" spiel that all the pharmacists who've worked there will recognise. It is utter rubbish - there are league tables circulated by area managers to point out where your store was in completing the MURs. And you had to commit to a number that you were going to do, not to mention the number of repeat Px sign-ups, satisfaction surveys, item numbers etc. The list goes on in addition to taking in store deliveries, setting up their promotions and doing the dispenser's job beacuse there's no staff! My final straw came when I was asked by a manager why I had refused to send out a CD delivery when the Px was on it's way from the surgery - any pharmacist worth their registration will understand this. I handed in my notice the next day.

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