Former Lloyds pharmacist struck off for falsifying 19 MURs

Ms Murray said she was pressured to do "more and more" MURs, the GPhC heard
Aleksandra Murray, registration number 2025005, told the GPhC she was under “constant pressure” to hit target of 400 MURs

A former Lloydspharmacy employee has been struck off the register for falsifying 19 medicines use reviews (MURs) in two months.

Pharmacist Aleksandra Murray, registration number 2025005, admitted to lying about completing 17 MURs in August 2014 and a further two the following month, as well as forging the signature on two forms, the General Pharmaceutical Council’s (GPhC) fitness-to-practise committee heard at a hearing on May 4.

The GPhC noted that Ms Murray, who was not present at the hearing, claimed to have been under “constant pressure” to hit a target of 400 MURs a year. But she had defrauded the NHS by falsifying the MURs, it stressed in a determination of the hearing, published last week.

Mismatched patient signatures

In a Lloydspharmacy investigation into Ms Murray’s actions in September 2014, she was shown the patient signatures on MUR forms she claimed to have carried out that month, the regulator heard. These signatures did not match those on prescriptions signed by the same patients, it heard.

Ms Murray was also shown CCTV footage of a day when she claimed to have conducted two MURs, which did not show her carrying out the service, the regulator heard. 

Ms Murray at first maintained to the investigator that she had made a mistake and thought she had carried out the MURs, before admitting that she had completed the consent forms without the patients being present.

Ms Murray admitted that she had acted in a similar way five or six times in September, but claimed she had not done so the previous month, the GPhC heard. She alluded to pressure from management to have to do “more and more” MURs, although she acknowledged what she did was wrong, it added.

“Absolute stupidity”

Ms Murray was dismissed from the pharmacy after a disciplinary meeting later that month, the GPhC heard. During this meeting, Ms Murray confirmed that most of the MURs she had carried out in August 2014 had been falsified, and put her actions down to “absolute stupidity” on her part.

The GPhC heard that during the meeting, Ms Murray said she was “slightly under pressure” to complete “eight to 10 MURs” a week, although she said she was not struggling to carry out the service and did not think this request was unreasonable.

She blamed her difficulty in doing enough MURs on “footfall and opportunity”, the regulator heard.

Although Ms Murray’s area manager found that she had completed 17 MURs in August, he could not ascertain how many of these had been falsified, the GPhC heard. He explained to NHS England that the pharmacy had over-claimed for these MURs and was advised to “balance the books” by not claiming for 17 valid MURs, the regulator heard.

"Constant pressure"

In April 2015, Ms Murray admitted to the GPhC that she had falsified 19 MURs between August and September 2014 because of the “constant pressure” to reach a target of 400 per year.

The regulator accepted that Ms Murray had enjoyed a “long and otherwise unblemished” career in pharmacy prior to her wrongdoing, and had notified the GPhC of her actions of her own accord.

But it stressed that she was slow to admit her wrongdoing and there was “little on her side to put any sort of favourable context in this situation”. 

“Allowing professional judgment to be swayed by targets is falling short of the appropriate standards of professional conduct,” the regulator said.

It highlighted that Ms Murray had placed “public funds at stake” as well as forging patients’ signatures, and ruled to remove her from the register.

Read the full determination at bit.ly/Murray-ftp

MORE ON MURS:

Today's blog: Deliver quality MURs or don't bother, says pharmacist Claire Field

Read an anonymous pharmacist's stories of pressure to deliver MURs at various companies – and the companies' responses – here

Read C+D's coverage of the Guardian's allegations that Boots pharmacists are pressured to conduct unnecessary MURs

 


Are you under pressure to deliver MURs?

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

73 Comments

James Mac, Community pharmacist

The best thing that can happen to MURs is it goes into the mainstream media and becomes a big, unholy media mess. Then the government and regulator might have to sort the damn thing out, at gunpoint as it were. Remember that pharmacists can get struck off for "bringing the profession into disrepute" so we will see if the standard can be applied to the MBAs who run the community sector.

Rajeev Vasisht, Locum pharmacist

When is someone going to hold the pharmacy companies to account for pressurising pharmacists to hit targets and disband the GPHC it is not fit for purpose.

Amal England, Public Relations

Pharmacists have no voice, what they say falls on deaf ears. We have in general become nothing more than a pair of pliers in a tool box.... The tool box of the multiples. We only have ourselves to blame. Only the PDA has regard for the pharmacist as a professional, but they don't have the strength in numbers to prevent the loss of the soul of the pharmacist. But it's not the end of the world, pharmacists can unite and act in synchrony to prevent Mr Lloyds and Mr Boots and the rest of them, cornering pharmacists into doing pointless MURs, falsifying MURs, etc. At this rate MURs will come to a quick end.

Shaun Steren, Pharmaceutical Adviser

Employee pharmacists do, in some respects, deserve what they get. Anybody who has attended managers meetings/training events will attest to the fact that in any given room of 20 employee pharmacists maybe 6 or 7 will be outspoken and strident defenders of professional autonomy. The rest will be a mixture of the dense, the calculating, the cowardly or the indifferent 'this job is convenient for the kids' collective. 

How High?, Community pharmacist

Doing well if you can find that many to speak up....... Try being one of 2.5 in the same room. Mind you, the meetings are usually in the evening after everyone has done a 10 hour day, is tired, hungry and actually just wants a well deserved break and to see their family before starting the daily grind again the next day.

Farm Assistant, Community pharmacist

Bang on the money.

Shaun Steren, Pharmaceutical Adviser

Stefano, thank you for pointing that out.

Ben E, Production & Technical

A lot of people seem to be overlooking a very important section here:

"The GPhC heard that during the meeting, Ms Murray said she was “slightly under pressure” to complete “eight to 10 MURs” a week, although she said she was not struggling to carry out the service and did not think this request was unreasonable."

You can't really launch an investigation into lloyds off the back of a statement like that.

Hadi Al-Bayati, Locum pharmacist

"Allowing professional judgement to be swayed by targets is falling short of the appropriate standards of professional conduct"

That is correct - so why won't the GPhC act against those with the targets in place.
Furthermore that now means you have 2 options - hit your target- you will have to do needless MURs so you may be "abusing" system/falling below standards and risk getting struck off.
Don't do it - lose your jobs.

We need a revolution

Chris Pharmacist, Community pharmacist

She didn't directly profit from her dishonesty, surely the GPhC should be asking why would a seemingly intelligent professional with an unblemished record feel the need to do this? Why would she risk her career by repeatedly forging patients signatures?...mmm, questions that would need directing not just to the pharmacist but also Lloyds regional managers and senior management. Perhaps regional managers/superintendent pharmacists should also be investigated when a situation such as this arises, perhaps then the multiples may reconsider their obsession with targets

Farm Assistant, Community pharmacist

Not their obsession with targets but with money.

Shaun Steren, Pharmaceutical Adviser

Yes, if they didn't profit from each MUR they wouldn't give a damn how many MURs you did. 

Chris Pharmacist, Community pharmacist

Perhaps the C&D should limit the number of comments that can be made on a single blog. This might stop these threads being ruined and taken over by a single trolling commentor who has nothing better to do with his time.

N C, Community pharmacist

This ruling would appear to be harsh indeed, considering two cases for making false claims in March 2012 Regulate magazine got off with suspensions despite falsifying £22,000 of MURs and 308 MURs respectively.

This would appear to be the GPhC reacting to the The Guardians story by coming down hard on the individual pharmacist but very lightly on the companies in question. There is a huge pressure on community pharmacists to perform these  MURs and that's not opinion. It's a fact, I've had many a harassing, demeaning email/phonecall/telling off sent to me when I was in this sector.

So much for a safe whistleblowing culture, pharmacists en masse have blown the whistle on MUR pressures and our regulator has chosen to take the path of least resistance (NB not necessarily the correct one!)

Shaun Steren, Pharmaceutical Adviser

Quite correct. But why is it that pharmacists feel pressured to carry them out? If they can be carried out completely legally as tick box events, surely they can just grind them out without effort? Of course it is because the pressure comes from within. Deep inside the pharmacist knows they are taking £28 from an unknowing patient and giving it to profiteering spivs. Deep inside they understand that many patients do not want the service at that point in time (or ever) but it must be foisted upon them in order to satisfy the unnatural consistency of a weekly corporate spreadsheet. Deep inside they understand that intention is different from outcome and that much of what they do will never significantly affect mortality or morbidity. Deep inside they feel humiliated that they are not acting as independent autonomous professionals but as corporate automatons who dare not rebel. This constant attack on the spirit, sensibility and intelligence of the employee/locum pharmacist is what truly creates the pressure. This will be of little concern (or be unknown) to those whose whole existence revolves around net profit. 

 

Angela Channing, Community pharmacist

Shaun, you have perfectly described how I, and many pharmacists feel every day. 

Mr Pharmacist!, Pharmaceutical Adviser

What a fantastic summary!!  Anyway, it's time pharmacists demonstrated their absolute disgust for the GPhC, by not paying their subscriptions.  I've said many times, our profession which was once noble and highly regarded is now just a sh§t show.  Devalued, dismembered and degraded. You just got to look at the hourly rates with some working for £13 per hour, my cleaner gets more than that! Plus they dont have the overhang of a nasty regualtor and threat of criminal prosecution.
 

Pillman Uk, Non Pharmacist Branch Manager

Thanks for posting the link to the full determination. I strongly suggest that people take the time to read and digest the process and the outcome, then post comments.

Fundamentally the pharmacist fell short of the high standard that we must uphold, in order that the public can have faith / confidence in our profession.

Shaun Steren, Pharmaceutical Adviser

Are they standards which include pharmacists only supporting evidence based interventions? Interventions that have an overwhelmingly strong evidence base for clinical outcomes and cost-effectiveness? If so, could you provide me the evidence base upon which you make your claim for high standards? As it stands, the public has no clue that they pay £28 for each little chat they have foisted on them, they do indeed enter that little room on blind faith. I strongly suggest you bother to read all the relevant papers relating to pharmacist interventions and digest the complete absence of evidence for 'clinical' interventions carried out in community pharmacy. The failure of this particular pharmacist was to not realise the whole system to be a scam and that it is just as easy to carry out the tick box exercise that is nearly all the MURs I have ever reviewed.

linda hameed, Community pharmacist

I think all services should be carried by pharmacist that work at gb surgery. That will save money to the nhs and avoid problems like this one.

Shaun Steren, Pharmaceutical Adviser

With respect your suggestion is premised on what is clinically optimal for the patient. In reality opinions in community pharmacy are premised on what is best for net profit. We must keep MURs because otherwise it would be money lost.  It is then said to follow that employees must agree or it will be their wages/job opportunities that will be on the block. 

Pill Counter, Pharmacy

Very patient centred indeed....

Yuna Mason, Administration & Support

In light of recent developments the GPhC ought to be postponing fitness to practice hearings like this pending a review of pressure to do MURs across the sector. Then, when it finds that pressure plays its part, it ought to be reviewing all its previous cases with a view to changing the sanction imposed (if the person was struck off). Given that it hasn't done that, it's response to this whole issue is going to be very weak. By not challenging employers who bring the profession into disrepute, the regulator becomes complicit.

Angela Channing, Community pharmacist

Absolutely! Someone should send this story to the Guardian. Let them help this lady fight her case. I bet she never even made any personal money from them either. 

Chris Locum, Locum pharmacist

It will always wash its hands of the real issue. Big business putting profit first and the pharmacist ( with professional judgement crushed ) a cog in the machine with no say in the matter.The biggest problem is the fact there are too many of us. A shortage of pharmacists would see no such cases. No one would work in such an environment.

 When the day comes that a pharmacist attempts to take their own life over this, there will be endless navel gazing and verbal diarrhoea over the supposed how and why of it all.

Someone needs to contact the Guardian and keep this in the spotlight - forget your professional body as you will be fed to the wolves

Clive Hodgson, Community pharmacist

Spot on, Yuna.

Reeyah H, Community pharmacist

The main problem here is she lied. If she had come clean at the start, the GPhC may have looked at it differently. However, I still think the decision was too harsh! 

Farm Assistant, Community pharmacist

Er no. The GPHC is the multiples enforcer and will do what it is told.

Reeyah H, Community pharmacist

The main problem here is she lied. If she had come clean at the start, the GPhC may have looked at it differently. However, I still think the decision was too harsh! 

Hadi Al-Bayati, Locum pharmacist

"Allowing professional judgement to be swayed by targets is falling short of the appropriate standards of professional conduct"

That is correct - so why won't the GPhC act against those with the targets in place.
Furthermore that now means you have 2 options - hit your target- you will have to do needless MURs so you may be system/falling below standards and risk getting struck off.
Don't do it - lose your jobs.

We need a revolution

Pages

Job of the week

Pharmacist Manager
Horsham, West Sussex
Up to 50,000 plus bonus