National target groups for MURs
National target groups for MURs
Three national target groups for Medicines Use Reviews (MURs) were introduced in October 2011; a fourth target group was agreed in September 2014 (Cardiovascular risk) and was implemented from 1st January 2015. The national target groups are:
- patients taking high risk medicines;
- patients recently discharged from hospital who had changes made to their medicines while they were in hospital. Ideally patients discharged from hospital will receive an MUR within four weeks of discharge but in certain circumstances the MUR can take place within eight weeks of discharge;
- patients with respiratory disease; and
- patients at risk of or diagnosed with cardiovascular disease and regularly being prescribed at least four medicines.
From 1st April 2015 community pharmacies must carry out at least 70% of their MURs within any given financial year on patients in one or more of the above target groups.
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.
Click on a heading below for more information.
High risk medicines
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 Soctiety and UK Medicines Information. The group was chaired by Martin Stephens, National Clinical Director for Hospital Pharmacy at the Department of Health.
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 medicines identified for ‘high risk’ targeted MURs are those that are listed in the chapters/sub-sections, detailed below, of the current edition of the British National Formulary (www.bnf.org).
|BNF reference||BNF subsection descriptor|
|BNF 2.8.2 and 2.8.1||Anticoagulants (including low molecular weight heparin)|
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.
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.
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 hospital colleagues about engaging with community pharmacy (Updated guidance will be published to reflect the changes to MUR targets agreed in September 2014).
Patients must be prescribed two or more medicines to be eligible for a post-discharge MUR.
In order for patients to be eligible for a respiratory MUR they must be prescribed two or more medicines, one of which must be on the asthma and COPD list for the NMS, i.e. any medicines listed in the sub-sections, detailed below, of the current edition of the British National Formulary (www.bnf.org).
3.1.1 Adrenoceptor agonists
3.1.2 Antimuscarinic bronchodilators
3.1.4 Compound Bronchodilator preparations
3.3 Cromoglicate and related therapy, leukotriene receptor antagonists and phosphodiesterase type-4 inhibitors
Cardiovascular risk MURs
A new MUR target group was added to the service requirements from 1st January 2015 to cover patients at risk of or diagnosed with cardiovascular disease and regularly being prescribed at least four medicines. Patients at risk of or diagnosed with cardiovascular disease can be identified by virtue of them being prescribed one or more medicines for one or more of the following cardiovascular/cardiovascular risk conditions:
- Coronary heart disease;
- Atrial fibrillation;
- Peripheral arterial disease;
- Renal/chronic kidney disease;
- Thyroid disorders;
- Heart failure;
- Stroke/TIA; and
- Lipid disorders.
This means that they must be prescribed at least one medicine from Chapters 2 (cardiovascular), 6.1 (diabetes) or 6.2 (thyroid) of the BNF. To fall into the MUR target group they must also be regularly prescribed four or more medicines in total.
PSNC Briefing 030/15: Services Factsheet – National Target Groups for MURs (June 2015)
Contractors must carry out at least 70% of their MURs within any given financial year on patients in one or more of the national target groups. This Briefing outlines the requirements for patients to fall into the different target groups.
PSNC Briefing 016/14: Advanced Services (MURs and the NMS) (September 2014)
This PSNC Briefing summarises the changes being made to the MUR service in 2014/15 and it covers the re-commissioning of the New Medicine Service (NMS).