National target groups for MURs

National target groups for MURs

New targeting requirements apply to MURs conducted from 1st October 2019; these changes were agreed as part of the 5-year Community Pharmacy Contractual Framework agreement.

Seventy per cent of MURs conducted from 1st October 2019 to 31st March 2020 must be within the following two target groups:

  • patients taking high-risk medicines; or
  • patients recently discharged from hospital who had changes made to their medicines while they were in hospital.

From 1st October 2019, patients with respiratory disease and patients at risk of or diagnosed with cardiovascular disease and regularly being prescribed at least four medicines are no longer target groups for MURs.


Click on a heading below for more information. 

High-risk medicines

A high risk medicine, for the purposes of targeted MURs, is a medicine which is of one of the descriptions referenced in the table below and is on the list of medicines that are high risk medicines that is published by the NHSBSA.

Descriptor
NSAIDs
Anticoagulants (including low molecular weight heparin)
Antiplatelets
Diuretics

If a patient is prescribed one high-risk medicine they can receive an MUR; all other MURs must be conducted on patients who are prescribed two or more medicines. All patients who receive an MUR should experience the same level of service regardless of their condition, i.e. MURs cover all the patient’s medicines, not just those that fall within a target group.

How were the high risk medicines chosen?

In June 2011, PSNC and NHS Employers convened a high-risk medicines reference group which included representatives from the National Patient Safety Agency, the National Prescribing Centre, the Royal College of Physicians, the Royal Pharmaceutical Society and UK Medicines Information. The group was chaired by Martin Stephens, National Clinical Director for Hospital Pharmacy at the Department of Health and Social Care.

It was agreed that the following principles should determine the list of high-risk medicines:

  • the medicines should be associated with preventable harm, for example, avoidable hospital admissions;
  • medicines should be selected where harm can be caused to the patient by omission, overuse or incorrect use and where the benefits of not taking the medicine are foregone; and
  • the type of harm caused by the medicines could be prevented by an MUR and the pharmacist will have the skills, knowledge and information to deliver it.

The group considered the evidence from recent data and a literature review on medicines that cause admissions to hospital to help inform their decision on the list. There were a number of other high-risk medicines discussed at the meeting; however, the group was clear that the focus should be on medicines where an MUR could improve patient safety and that the purpose of an MUR was not to address problems associated with dosage but with medicines use.

Post-discharge MURs

Guidance was published in January 2012 showing how the New Medicine Service (NMS) and post-discharge MURs can be used to provide a seamless care pathway for patients who transfer from hospital to the community setting. It was developed and published by NHS Employers and PSNC working with a hospital and community pharmacy reference group. The guidance has been endorsed by the Royal Pharmaceutical Society.

Guidance for community pharmacy about engaging with hospital colleagues

Guidance for hospital colleagues about engaging with community pharmacy 

Template national referral form

Template patient information leaflet

Patients must be prescribed two or more medicines to be eligible for a post-discharge MUR.



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