Boots fiddling its profits by carrying out unnecessary medicine reviews

BOOTS-Pharmacy-500x292[1]Boots has been accused of boosting its profits by telling its staff to carry out unnecessary medicine reviews – which are paid for by the NHS.

The UK’s biggest pharmacy chain has ordered some staff to carry out medicine-use reviews (MURs) for people who do not need them – including its own staff – a Guardian investigation has revealed.

MURs, carried out by pharmacists, tell patients how to manage their medicines, including possible side effects.

They are intended for patients who fall into key groups, including those discharged from hospital and those taking high risk medicines.

The reviews are also offered to people with respiratory disease, and those with heart disease who are prescribed four or more medicines. 

But Boots is accused of pressuring pharmacists to review its own members of staff as well as members of the public.

The NHS pays pharmacies £28 for every MUR, which are also known as medicine check-ups (MCUs).

There were 2.38 million reviews across England’s pharmacies in 2014/15, worth £66.5 million, official figures show. The scheme runs on trust, with pharmacies expected to faithfully record patients given MURs.

NHS England, which supports it, said pharmacy contractors for MURs are required to keep full records which can be checked during monitoring visits.

The NHS caps the number of MURs per pharmacy at 400 per year but critics suggest some pharmacies see this as a target to bump up profits.

Pharmacies in England that run MURs each carried out 340 of the reviews on average over the last year.

If a pharmacy performs the maximum 400 MURs, it will earn £11,200, which could earn Boots almost £30 million every year across its 2,500 UK stores.

The Guardian said it has seen a 2008 email from a senior manager at Boots which urges its staff to carry out the maximum 400 MURs.

The email said: ‘I personally don’t want colleagues to feel “brow-beaten” but we do need to deliver our targets of 400 MURs per store this financial year for two reasons.

‘Delivering 400 MURs is a measure of Excellent Patient Care.

‘The company can make £28 profit for each MUR, so each one we don’t deliver is a lost £28.’

One Boots pharmacist in the Midlands told The Guardian he was directed by his managers to carry out an MUR on a man with dementia, and on himself.

His manager also began an MUR but walked out before completion – yet the store still entered the review on its records.

Another Boots pharmacist in north-west England said at a staff away day he and his colleagues were told: ‘400 MURs is an expectation now. We don’t need to tell you that.’

A number of Boots pharmacists responding to a survey by the Pharmacists’ Defence Association (PDA) – the union for pharmacists – also reported being ‘pressurised into conducting MURs whether or not patients are eligible to receive the service’.

They also agreed ‘Boots keeps asking me for more MURs’, the Guardian reports.

John Murphy, general secretary of the PDA, said Boots is using the scheme – intended to help sick patients – to boost its profits.

He said: ‘Pharmacists at Boots are clearly being forced to treat MURs as a profit-making scheme for the company.

‘Either they stick to their ethical standards and ensure that the right people get the service irrespective of their financial targets or they satisfy their employer by achieving their profit objectives and keep their job.’

An NHS England spokesman said: ‘All patients deserve to get the best possible outcome from their medicines.

‘That’s why NHS England is supporting the principles of medicines optimisation, which is a person-centred approach to medicines use, and includes reducing medicines wastage, helping patients to avoid taking unnecessary medicines and improving medication safety.’

Advice to pharmacists on the Pharmaceutical Services Negotiating Committee website says: ‘Claims made by pharmacy contractors for MURs are paid on trust.

‘However, NHS Protect have confirmed that as with other systems where remuneration is paid based on a self-declaration, the NHS has monitoring arrangements in place to detect fraudulent activity.’

Source:  The Guardian

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