PCTs spending £20m on 'unproven' medicines use reviews
By Lilian Anekwe
PCTs are spending more than £20million a year on pharmacist medicines use reviews, despite the vast majority having no formal means of assessing their quality or effectiveness, a Pulse investigation reveals.
Documents obtained under the Freedom of Information Act reveal that PCTs spent an average of £132,000 on medicines use reviews in the last financial year alone, conducting an average of 5,000 reviews each.
Yet fewer than one in four have conducted any formal evaluation to establish whether the reviews were worthwhile, and in several that have serious doubts have emerged.
The revelation of huge spending on medicines use reviews follows a number of recent academic studies casting doubt on whether they are cost-effective and will add to growing doubts over the planned expansion in the role of pharmacists.
In its audit, Berkshire West PCT admitted that feedback from GPs showed ‘the majority of MURs were not effective because the review of medication was not appropriate or the advice given was inappropriate'.
Documents from Eastern and Coastal Kent PCT reveal ‘a number of anecdotal reports of the inappropriateness' of the reviews. In Walsall PCT, one in every five patient whose medicine reviewed by a community pharmacist was referred back to their GP.
Yet the Government's recent Pharmacy White Paper insists medicines use reviews must be ‘prioritised' despite an admission that pharmacies have focussed on review quantity rather than quality.
The White Paper says because of the commercial nature of pharmacies, in some areas there has been ‘an over-emphasis on quantity of services provided – such as the number of MURs – rather than their quality and relevance to local health needs'.
Under the White Paper proposals, pharmacists will also be responsible for aspects of chronic disease management, public health programmes and immunisation, and will be asked to take on more repeat dispensing from GPs.
Dr Bill Beeby, chair of the GPC prescribing sub-committee and a GP in Middlesbrough, said the lack of evaluation was of great concern. ‘I'm quite concerned they have been introduced without any checks and balances to make sure reviews are being done properly and appropriately. That seems quite perverse in the modern climate of monitoring,' he said.
Dr Lisa Silver, a GP in Nettlebed, Oxfordshire, said: ‘GPs are audited after we do the QOF but there's no assessment for community pharmacists. There's also the issue of the waste of public money – there's no evidence that they add anything.
‘It's just duplicating work – if having reviewed patients they keep referring them back to general practice it annoys patients and GPs.'The growing role for community pharmacy
*An average of 5,187 reviews were conducted per PCT in 2007/8, at a cost of £27 per review
*PCTs spent an average of £132,466 on MURs, and £7,418,095 was spent nationally
* The Department of Health has ‘no immediate plans' to evaluate the effectiveness of MURs or mandate PCTs to
*Under the White Paper proposals, pharmacists will also be responsible for delivering clinical services such as cardiovascular screening, care of asthma and diabetes, immunisations and weight management
*Pharmacists will also be asked to do more repeat dispensing to reduce GP administration.
*White Paper proposals that prevent dispensing by any surgery with more than 3,000 patients, or is within a mile of a have angered doctors who fear the end of dispensing by GP practices.