MUR frequently asked questions
MUR frequently asked questions
Click on the headings to view FAQs on Medicines Use Reviews (MURs).
1. General MUR questions
Q. How do I let my local NHS England team know that I am starting to provide MURs?
A. Once both the pharmacy premises meet the requirements for MURs and the pharmacist has become accredited by a Higher Education Institution (HEI) to provide the service (by successfully completing an assessment, based on the nationally agreed competency framework), the contractor needs to notify their local NHS England team using the PREM1 form.
Q. How does the ‘three month rule’ apply to MURs?
A. The Directions require the pharmacy to have provided pharmaceutical services to the patient for the previous 3 months before an MUR. So for an MUR conducted in April you would expect to see dispensing recorded on the PMR to cover supplies during the previous three months, i.e. January to March. Prescriptions do not need to be dispensed every single month, so if prescriptions authorising two months supply were dispensed in January and March that would meet the requirements. If prescriptions for a single month’s supply were dispensed in January and March, then February is not covered and the pharmacy would not be considered to have been providing pharmaceutical services to the patient in that particular month, and therefore the pharmacy will not be deemed to have been providing pharmaceutical services for the previous three months. Note: The three month rule does not apply to prescription intervention MURs.
Q. Can I do an MUR for a patient who is only taking one medicine?
A. Yes, but only in one specific circumstance. The service requirements set out in the Directions only allow an MUR to be conducted with patients on multiple medicines; however, there is one exception to this rule, where a patient is taking a single medicine which falls into the ‘high risk medicines’ category. If a patient is taking one high risk medicine they can receive an MUR; all other MURs must be conducted on patients on multiple medicines.
Q. Does an MUR count if there are no recommendations to the patient’s GP at the end of the process?
A. Yes. The MUR is focussed on developing the patient’s understanding of their medicines. There does not always have to be a change in the patient’s medication as a result of the MUR.
Q. Can I do an MUR for patients in a care home I supply with medication?
A. Yes you can, as long as your local NHS England team consents to you conducting MURs at alternative premises. You would need to conduct the MUR face to face with the patient; it may also be sensible to feed back any recommendations to the Care Home staff, provided you have the patient’s permission to share this information.
Q. Can another individual, for example, a pre-registration pharmacy trainee sit in on an MUR consultation with the pharmacist and patient?
A. The Directions state that the MUR must not be overheard by other visitors to the pharmacy or by any other person including pharmacy staff. However, providing the patient consents to another individual being present during the MUR consultation it would be acceptable for a pre-registration trainee to sit in on the consultation providing all other requirements in the Directions are being met.
Q. Can children have an MUR?
A. The MUR needs to be conducted with the patient in order to comply with the Directions. An MUR could be conducted with a patient who is a child if they are competent (i.e. they have the capacity to give informed consent) and are able to fully engage in the discussion with the pharmacist. Under the current regulatory framework it is not appropriate to conduct an MUR for the parent, carer or guardian of a person who is not competent. Were an MUR to be conducted with a competent child, the pharmacist should be aware of the local Safeguarding (child protection) policy and guidelines and should know where to refer any young person who they are concerned about.
Q. If a patient is unable to sign the MUR or NMS consent form, can their carer or representative sign on their behalf?
The Secretary of State Directions require that all patients receiving the MUR service or NMS must sign a consent form, so signing or making their mark on a consent form is required in all cases.
Q. I have just been accredited to provide MURs, but I am still waiting for my certificate to arrive, can I start performing MURs?
A. No. A condition of the Directions is that the pharmacist has an MUR certificate and that a copy of the certificate is supplied to NHS England prior to providing the service.
Q. I am a locum pharmacist working in different local NHS England teams; do I have to notify each team before providing an MUR?
A. The community pharmacy contractor has the responsibility to provide the local NHS England team with a copy of the MUR certificate of all pharmacists providing the MUR service in the pharmacy before each pharmacist can undertake MUR consultations. However a local NHS England team may accept a copy of the MUR certificate from locum pharmacists, who may work in several different pharmacies, but there is no obligation on the local NHS England team to do so. Because the contractor has the obligation to notify NHS England and produce a copy of the MUR certificate, many contractors may prefer to submit the copy certificate themselves, to avoid NHS England later finding the contractor in breach.
Q. How long do I need to keep a copy of the record of an MUR?
A. A copy of the record should be kept for at least two years after the date on which the MUR took place.
Q. Do I need to get written patient consent each time a patient has an MUR? For example, if the patient had an MUR last year and 12 months has passed, do I need to get written consent again?
A. Yes, written consent would need to be obtained each time a patient has an MUR. The General Pharmaceutical Council’s publication Guidance on Consent states ‘Getting consent is an ongoing process between you and the patient. Consent cannot be presumed just because it was given on a previous occasion’.
2. National MUR target groups
Q. My patient falls within two or more of the national target groups. Does this mean that they are eligible for more than one MUR?
A. No. The target groups should be used to select which patients would be eligible for an MUR. Once a patient is eligible for an MUR then that should cover all of the medicines that they are taking.
Q. What happens if there is a patient who is eligible for a post discharge MUR but has also had a number of new medications prescribed? Can the patient receive both the NMS and an MUR?
A. No. The pharmacist should make a decision based on the information they have about a patient’s medicines as to which of the services would benefit the patient most and therefore which service to offer the patient.
Q. Are patients discharged from outpatient clinics and intermediate services eligible for a post-discharge MUR?
A. No. The post-discharge MURs are for inpatients that have had a change to their medicines while they were in hospital. It is hoped post-discharge MURs will help the transfer of information about patients’ medicines between secondary and primary care, as it continues to be a significant risk to patient safety.
Q. If patients are re-admitted to hospital a number of times and have changes to their medicines can they have more than one MUR per year?
A. The Directions state that a patient may not have more than one MUR service consultation in any one period of twelve months unless in the reasonable opinion of the registered pharmacist the patient’s circumstances have changed sufficiently to justify one or more further consultations during this period. Consequently pharmacists should use their professional judgment to decide whether it is appropriate to provide an MUR in this situation.
Q. Is there a breakdown of the proportion of targeted MURs that a pharmacist needs to complete for each of the four target groups?
A. No. The 70% can include MURs for patients from any of the four target groups.
Q. Does the 70% target deny access to the service for a group of patients that would benefit?
A. Contractors can conduct MURs on patients who are not in the four target areas (70%) at their own discretion where they feel that patients will benefit from the service. PSNC and NHS Employers selected the national target groups on the basis that these are areas where community pharmacy could make a valuable contribution to patient care.
3. MURs initiated as a result of a prescription intervention
Q. What is the difference between regular MURs and prescription intervention MURs?
A. They are the same service but reflect different triggers for provision of the service. A prescription intervention MUR is triggered by a significant adherence issue that comes to light during the dispensing of a prescription; the regular MUR is a routine review not triggered by a problem with the patient’s adherence to their regimen. For a standard MUR, the pharmacy is required to have provided pharmaceutical services for a minimum of three months. This requirement does not apply in the case of a prescription intervention triggered MUR.
Q. Is it necessary to complete the same records for regular MURs and prescription intervention MURs?
Q. Can you perform a prescription intervention type MUR by talking to a patient in the pharmacy, without conducting a patient interview in a consultation area?
A. No. As with regular MURs, a prescription intervention MUR requires a full MUR to be conducted following the requirements laid down in the Directions.
Q. When you perform a prescription intervention MUR do you only have to review the medicines that have highlighted the need for the intervention?
A. No. A prescription intervention MUR is a full MUR conducted on all the patient’s medicines.
Q. Can I perform a prescription intervention MUR for a patient having problems with their OTC medicines?
A. The prescription intervention MUR is triggered at the time when the patient presents a prescription, and there is reason for the pharmacist to believe that the patient may be experiencing significant problems with their use of medicines. The problems may involve OTC medicines interacting with prescribed medication, but problems which arise that are identified independently of a dispensing episode would not trigger a prescription intervention MUR.
Q. Can you perform a prescription intervention MUR for a patient who has not received their prescribed medication from your pharmacy for the last three months?
A. Yes, as the three month rule does not apply to prescription intervention MURs. N.B. this is not the case in Wales.
4. Consultation areas/rooms
Q. Does a consultation area have to provide visual privacy?
A. No. The MUR requirements do not require visual privacy to be provided; however, some degree of visual privacy will normally be provided by materials that are commonly being used in the construction of consultation areas.
Q. Can NHS England stop me from using a consultation area that is unsuitable for wheelchair access?
A. A contractor must ensure that there is no discrimination against people with disabilities. If the consultation area is not accessible by people with a disability, the pharmacy should make suitable alternative arrangements. This could include carrying out the MUR in the shop area when the premises are closed to the public, or on alternative premises convenient to the patient. The consent of the local NHS England team will be needed to use alternative premises.
Q. Could a consultation area be upstairs?
A. Yes it could, but a contractor would have to be ready to make alternative arrangements for patients who could not access the upstairs area of the pharmacy. The contractor would have to ensure that he did not discriminate against disabled people when selecting patients to undergo an MUR. The contractor may wish to discuss the proposal with the local NHS England team and agree how patients who could not manage the stairs would be dealt with.
Q. Can I conduct an MUR on the counter or another quiet area of the pharmacy, if the patient does not want to go into the consultation area?
A. No. The Directions require the consultation to be carried out in an acceptable location, and patient consent to carry out the MUR elsewhere cannot overrule this requirement. If the patient does not want to go into the consultation area, the consultation could be carried out in the public area of the pharmacy when the pharmacy is closed. Or the local NHS England team may consent to the consultation being carried out in the patient’s home or by telephone.
Q. Some of my housebound patients would like me to conduct an MUR at their home. When I asked NHS England for permission to carry out the MUR away from the pharmacy, I was asked if I had a Criminal Records Bureau (CRB) certificate. Is this required?
A. Almost all NHS staff are CRB checked, and whilst not mandatory for community pharmacists, it is a sensible precaution to require a check for anyone who has unsupervised access to a child or vulnerable adult. When being asked to approve a pharmacist to conduct MURs in a patient’s home, it is an appropriate point at which NHS England could require a CRB check. In this circumstance PSNC believes the cost of the CRB check should be paid for by NHS England.
5. Fees and funding issues
Q.Why are the numbers of MURs that each pharmacy can undertake capped each year?
A. This is so we do not go over the annual budget for the MUR service.
Q. When will I be paid for providing an MUR?
A. You declare how many MURs you have provided during the month on the FP34(C) submission form. The Pricing Authority will make the payment for these MURs at the same time as the payment is made for the month in questions prescriptions.
Q. If the local NHS England team claims the pharmacy does not comply with the Essential Service requirements, can it withhold payments for MURs undertaken or claw back payments already made?
A. The only sanction available to a local NHS England team which believes the pharmacy did not meet the requirements, is through the procedures for breach of the Terms of Service or through action by the NHS Counter Fraud Service if it believes that fraudulent claims have been made. This cannot be done administratively.
Q. If on a monitoring visit the local NHS England team decides that the Essential Service requirements are not met, what action follows?
A. The local NHS England team will notify the contractor, informally or formally, of the areas of non-compliance. If the non-compliance is substantial and clear, the local NHS England team may advise the contractor not to undertake further MURs until the problems have been rectified. In such circumstances, if the contractor does not accept that it is non-compliant with the requirements, the contractor should request formal written notification of the defect to be remedied if the local NHS England team has not already produced a report in the course of the monitoring exercise. The contractor may consult the LPC for advice, and it may be able to arbitrate in cases of dispute. Once a written notice identifying non-compliance is received, the contractor should not provide further MUR services until it has remedied the defect notified by the local NHS England team.