Saturday, November 21, 2009

Earning Your Pharmacist An Honest Crust

May I tick your boxes?

As we may have mentioned before, Tyler is a major league drug user. And not all of them are for recreational purposes: he routinely ingests an amusing cocktail of prescription drugs to keep a lid on his wayward immune system.

So the other day he's visiting his local chemist to pick up the latest crateful, when he's accosted by the pharmacist (see here for previous pharmaceutical encounters). Would Tyler care to enter her consultation room for a quick word?

Consultation room?

"Yes, yes, it's a bit more private in there."

Private? Why private? Is she going to break bad news? Has there been some horrible mix-up? Has Tyler inadvertantly been taking those drugs they use to chemically castrate elephants? No wonder he's been feeling a little lacklustre of late.

"Mr Tyler, we've noticed that you've never had a medicines use review." The keen young pharmacist brandishes the form she's holding. "If I just run though this with you, we can make sure you're getting the right medication."

"But I already have an annual review with my GP, and I'm also under a consultant."

"Ah yes, but they look at your body - we look at your medicines. We can advise you on them."

"Hmm... well, OK."

"Fantastic! Now, these first pills, how do you take them?"

"I... er... swallow them."

"Fantastic!" She ticks a box. "And how often do you take them?"

"Well, once a day, like it says on the instructions."

"Fantastic!" She ticks another box. "And do you have any side effects?"

"No... otherwise I'd have gone back to my consultant."

"Fantastic!" Another box ticked.

I could go on, but you get the idea. By the end of my 3 minutes, she must have ticked a dozen boxes. And what advice did she have for me?

"Well, you seem to be taking all your medicines correctly, and there's nothing I can suggest in terms of lifestyle to help your condition."

So no advice.


But what was really going on?

The pharmacist was earning herself - or at least her company - £28 from the NHS. Which for 5 minutes work isn't bad (£336 per hour). That's what she gets paid for conducting a Medicines Use Review (MUR) under a scheme set up by the NHS to make sure patients comply - yes, that is the word they use - with the instructions they've been given.

You can sort of understand how the commissars dreamed up the scheme. After all, they spend well over £8bn pa on prescription drugs in England alone, and that bill has doubled in ten years. The last thing they want is for we punters not to be taking them properly.

But is 5 minutes with Sharon ticking boxes in her consultation cupboard really going to help?

Seems unlikely. In fact from what Tyler saw, it looked more like money for old rope.

And what does the whole exercise cost us?

According to the official stats, the number of MURs is soaring. Between 2006-07 and 2007-08 MURs roughly doubled to over a million. Which at 28 quid a pop comes in at around £30m - a considerable sum in these straightened times. Especially when you remember that pharmacies in England and Wales already earn getting on for £1bn pa from the NHS just for dispensing fees (ie not including the cost of the drugs):

Which is presumably why the commissars have imposed a limit on how many MURs an individual pharmacy can conduct - 400 pa.

But how does that work exactly? Who decides which punters are going to get MURRED? Sharon told Tyler she could tell immediately he didn't really need a MUR because he wasn't a batty old lady. But she went ahead and did it anyway.

And come to that, isn't the whole shebang open to massive fraud? How can the commissars possibly tell that the MUR has actually taken place? Tyler signed nothing, and Sharon retained the tickbox form.

Oh, guess what - the whole shebang is open to massive fraud. And it turns out there is a massive fraud investigation underway. The NHS's own Counter Fraud Service (oh yes, the NHS needs one of its very own) is on the case, and has already discovered that the payment system was set up by a particularly unworldly four year old:

"Pharmacists declare to NHS Prescription Services how many MURs they have performed during the month when they send their monthly FP10s for processing, and they are paid £28 for each one. They do not submit MUR forms or disclose patient names in support of their declarations, although they do send GPs lists of patients whom they declare have received MURs."

There is no procedure for checking that the claims marry up with what the GPs have been told. Still less is there a procedure for checking whether the MURs have actually taken place. Fraud is almost certainly rife.

Needless to say, the pharmacists are squawking. It seems they don't want to be investigated, and they reckon the case cannot proceed because of "patient confidentiality concerns". So the entire investigation is now on hold while m'learned friend is consulted - no doubt at further considerable taxpayer expense.

Now, just imagine you're a pharmacist. You'd probably be knocking off as many of these £28 "consultations" as you could possibly manage, before the opportunity disappears. You'd also be ticking patient boxes like fury to get some kosher records on file ahead of Inspector Knacker's forthcoming visit.

Let's hope they still have time to make sure Tyler doesn't get any more of those elephant pills.

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