Home FAQs
Further information on MURs is also available via links on the main Advanced Services homepage.
Conducting MURs off the Premises
Though the MUR service was designed to be provided in the pharmacy, it is possible to conduct MURs in other venues.
The PCT is required to give consent to carrying out consultations off the pharmacy premises, and this consent can be for:
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a specific premises (e.g. a specific room in a local surgery); or
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a specific premises or a category of premises for a category of patients (e.g. a care home for care home residents); or
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specific premises for a specific patient (e.g. in a patient's own home).
MURs can also be provided exceptionally by telephone, but only where the PCT gives its approval for a particular patient, and on a particular occasion. The Directions require a telephone MUR to be carried out such that no-one can overhear the consultation.
A PCT may have produced their own form on which pharmacy contractors can request permission to conduct MURs off the pharmacy premises and by telephone. If a PCT form is not available, pharmacy contractors can use PSNC's PREM2 Application for consent to conduct MUR away from pharmacy form. Click on the links below to download a copy:
Application for consent to conduct MUR away from pharmacy (PREM2) (PDF document)
Application for consent to conduct MUR away from pharmacy (PREM2) (MS Word Document)
Electronic MUR Forms
Many contractors and pharmacists want to record MURs electronically, rather than using paper triplicate forms. This approach can often improve the efficiency of providing the MUR service and is popular with GP practices, many of whom are now operating on a 'paperless' basis.
A number of the pharmacy software suppliers have developed (or are in the process of developing) additions to their PMR systems which allow the electronic production of MUR forms.
Microsoft Word e-form templates are also available to record the details of an MUR electronically and to print out copies for the patient and the GP. These can be accessed in the online publications database.
Data security
If contractors are using one of these methods to produce electronic MUR forms, they need to give very careful consideration to ensuring the security of the confidential patient information contained within the form.
Some GP surgeries have requested that pharmacies provide them with electronic/PDF copies of MUR forms.
PSNC has requested that NHS Connecting for Health (CfH) provide advice to the profession on whether it is acceptable to email the MUR forms from an email account outside of the NHS email system (Contact).
To ensure the confidentiality of data, we advise contractors to wait for guidance to be issued before putting in place arrangements for sending MUR forms by e-mail.
A short term alternative to e-mail could be for electronic copies of MUR forms to be saved to a CD-ROM or other memory device such as a USB memory stick and then be taken to the GP surgery or be delivered there using a secure method.
PSNC is continuing to press the Department of Health to ensure that the transmission of electronic MUR forms is prioritised within the CfH programme.
General FAQs
When can contractors start providing the Advanced services?
As long as the contractor meets the two accreditation requirements (premises and pharmacist) MUR provision can commence as soon as the Essential services are being provided by the pharmacy.
Do I need to do all the Essential services before I can provide MURs?
Yes. It is a requirement to provide all Essential services that are operating locally before providing Advanced services. The Repeat Dispensing service may roll out slowly across some areas, due to the need for GPs and PCTs to engage in the process; before a pharmacy moves to provide Advanced services it will need to be in a position to provide the Repeat Dispensing service, even if this type of prescription is not being issued locally.
How do I let my PCT know that I am starting to provide Advanced Services?
Once both the pharmacy premises meet the requirements for Advanced services 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 PCT. Click here for more information on notifying your PCT.
What is the difference between MURs and Prescription Interventions?
There is only one service, but the trigger is different. A Prescription Intervention is triggered by a significant issue that arises during the dispensing of a prescription; the MUR is a routine review. 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. For more information click here.
The Secretary of State 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.
Is it necessary to complete the same documentation for MURs and Prescription Intervention MURs?
Yes.
How long do I need to keep a copy of the MUR record?
A copy of the record should be kept for as long as the PCT require. However, unless a PCT states otherwise, a recommendation from the Department of Health is that two years would generally be sufficient.
Can a patient have more than one MUR in 12 months?A patient cannot have more than one MUR service consultation in a period of twelve months, unless in the opinion of the pharmacist the patient’s circumstances have significantly changed to justify one or more further MUR consultations during a twelve month period. Primary Care Trusts have a duty to audit and monitor the provision of the Advanced services, and because there is a statutory restriction on the frequency of MUR consultations, pharmacy contractors who do provide more than one MUR to a patient in a 12 month period should make a record of the rationale for the repeat, so that this can be justified to the PCT.
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?
No. A prescription intervention requires a full MUR to be conducted following the requirements laid down in the Secretary of State Directions.
The nationally agreed service specification states that an MUR can be conducted with patients on multiple medicines.
When you perform a prescription intervention type MUR do you only have to review the medicines that have highlighted the need for the intervention?
No. A prescription intervention requires a full MUR to be conducted on all the patient's medicines, following the requirements laid down in the Secretary of State Directions.
Can I perform a prescription intervention MUR for a patient having problems with their OTC medicines?
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.
Can you perform a prescription intervention type MUR for a patient who has not received their prescribed medication from your pharmacy for the last three months?
Yes you can, as the three month rule does not apply to prescription interventions. N.B. this is not currently the case in Wales.
Can my PCT tell me which patients I have to target for MURs?
PCTs have the right to provide advice to contractors on which groups of patients they should target for MUR. Contractors have to 'have regard' to this advice. PSNC recommends that contractors follow PCT guidance wherever possible; if it is proving difficult to recruit sufficient patients from the target group the contractor may then wish to target other patient groups for MURs.
Can the PCT specify that only patients receiving a certain number of medicines are eligible to receive MURs?
No, the PCT cannot deviate from the service specification and, providing the patient meets the description of being a patient taking multiple medications, he or she is eligible for the service.
Does an MUR count if there are not recommendations to the patient's GP at the end of the process?
Yes it does. The MUR is focussed on developing the patient's understanding of their medicines. There does not always have to be a change in the patients medication as a result of the MUR.
Can I do an MUR for patients in a Care Home I supply with medication?
Yes you can, as long as your PCT 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.
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.
Can a GP prevent me from conducting MURs for his patients?
No. Clearly community pharmacies and GPs should try and work together to ensure patient benefits are maximised from the MUR service, but a GP cannot prevent a patient from receiving an MUR.
Can the PCT insist on pre-vetting premises prior to commencement of MURs?
No. The pharmacy must notify the PCT when it is ready to commence providing MURs. The pharmacy must send a copy of the pharmacist's MUR certificate of accreditation to the PCT. Once this has been done the pharmacy can commence undertaking and claiming payment for MURs carried out on the premises.
Can the PCT require me to use the PREM1 form?
The PSNC form PREM1 may be used to notify the PCT that the pharmacy wishes to commence the MUR service. Use of the form is not mandatory.
Can children have an MUR?
The MUR needs to be conducted with the patient in order to comply with the Secretary of State 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.
I have just been accredited to provide MURS, but I am still waiting for my certificate to arrive, can I start performing MURs?
No. A condition of the directions for providing the MUR and prescription intervention service is that the pharmacist has an MUR certificate and that a copy of the certificate is supplied to the PCT prior to entering into an arrangement to provide MUR services.
I am a locum pharmacist working in different PCT areas; do I have to notify each PCT before providing an MUR?
The pharmacy contractor has the responsibility to provide the PCT 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 PCT 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 PCT to do so. Because the pharmacy contractor has the obligation to notify the PCT and produce a copy of the MUR certificate, many pharmacy contractors may prefer to submit the copy certificate themselves, to avoid the PCT later finding the pharmacy contractor in breach.If a locum works in a new PCT at short notice, for example, then the pharmacy contractor or locum could fax a copy of the certificate to the PCT.
Consultation areas/rooms
What are the requirements for consultation areas required for the MUR service?
The contractor needs to provide a consultation area which meets the following three stipulations only:
the area is clearly signposted as a private consultation area.
Contractors self-certify to their PCT that their consultation area meets these requirements. Compliance with the requirements can be checked by PCTs at a later date.
Can I escort patients through the dispensary to a consultation area which is not accessible directly from the public area, or if I have no suitable consultation area, can I use the dispensary for MURs?
The Code of Ethics does not specifically prohibit access to the dispensary by members of the public, but the principles of confidentiality of sensitive information and the security of medicines are both matters that must be taken into consideration. The Code of Ethics requires pharmacists to decide for themselves whether their services meet the general principles. Therefore, when considering whether it is appropriate to escort a patient through the dispensary to a consultation area, a pharmacist would have to be satisfied that the patient would not be able to take medicines from the dispensary and that whilst passing through the dispensary, the patient would not see anything (for example the computer screen, prescriptions or records) or overhear any conversation between dispensary staff, from which information could be obtained about another patient. Consideration would also need to be given to the disruption that may be caused to the dispensing process. The risks are even greater if the MUR is conducted in the dispensary, with the added problem of staff being able to overhear the MUR. For these reasons it is unlikely to be appropriate to use the dispensary as a consultation area.
Can PCTs require extra facilities in a consultation area?
PCTs obviously have the right to determine premises requirements related to the commissioning of Enhanced services, however they would need to be reasonable in relation to the services to be provided. PCTs are not however able to vary the nationally agreed requirements for Advanced services.
The new contract funding for Advanced services incorporated an allowance for premises. If a PCT wishes to negotiate for additional requirements, to support Enhanced services, LPCs may wish to negotiate premises funding with them.
Is there funding for the consultation areas required for MURs?
The cost of consultation areas has been included in the costings for MURs.
Is it really necessary to have a consultation area in my pharmacy?
Think carefully about this - the requirements do not need much space. If it is impossible to fit in a consultation area you can seek PCT consent to do them elsewhere.
Does a consultation area have to provide visual privacy?
No. The Advanced Service Directions 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.
Does a consultation area need to be a closed room?
It is only necessary that the requirements specified above are met; it is unlikely that a closed room would be necessary in most pharmacies to meet these requirements. Additionally the use of closed rooms presents a number of problems for pharmacists, particularly in relation to the current supervision requirements and also in relation to personal safety issues for both the pharmacist and patient.
If closed rooms are used, the installation of windows (with appropriate screening for use when visual privacy is required) could be considered.
The NHS Security Management Service has issued guidance on safety and security issues related to lone-working (Not Alone - A Guide for the Better Protection of Lone Workers in the NHS). PSNC has also issued guidance on Chaperone Policies in pharmacies.
Can the PCT stop me from using a consultation area that is unsuitable for wheelchair access?
A pharmacy 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 PCT will be needed to use alternative premises).
Could a consultation area be upstairs?
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 PCT and agree how patients who could not manage the stairs would be dealt with.
What do contractors need to take into consideration with regards to consultation areas and provision for disabled access to these areas?
Those contractors providing Advanced services must ensure that they do not discriminate against people with disabilities. If your consultation area really cannot be designed in such a way as to permit access to a person with a disability, for example, wheelchair access, then an alternative means of accessing the MUR by those patients must be planned. This might include carrying out the MUR in the public area of the premises, at times when it is closed to the public (e.g. lunchtimes, immediately after closing, half-days or on Saturdays if the premises close on Saturdays). The Secretary of State Directions specifically include consent for a consultation to be carried out in the retail area when the premises are closed, so long as the confidentiality provisions are complied with. In exceptional cases, the PCT can consent to the MUR being carried out elsewhere or by telephone. If the telephone is used for MURs, the consent of the PCT is required for each consultation, and the pharmacist is required to ensure that the telephone call cannot be overheard.
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?
The Secretary of State Directions require the consultation to be carried out in an acceptable location, and patient consent to carry out the MUR elsewhere is not effective.
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 PCT may consent to the consultation being carried out in the patient's home or by telephone.
Fees and funding issues
Why are the numbers of MURs that each pharmacy can undertake capped each year?
This is so we do not go over budget for the MUR service, for example due to some pharmacies carrying out vast numbers of reviews. The MUR cap is reviewed each year by PSNC and the Department of Health.
Is MUR funding ring fenced?
It is paid from the agreed contract funding and paid centrally, by the PPD; payment is not dependent on PCTs.
Is the fee the same for MUR and the Prescription Intervention Service?
Yes, because it is the same service!
Does this maximum number of MURs increase each year?
The Directions permit a pharmacy to provide 400 MURs during the year 1st April to 31st March, provided the arrangements to provide MURs have been made before 1st October (this means that the pharmacy must declare to the PCT that it has an acceptable location for performing MURs, and submit copies of the pharmacists MUR certificates). The limit is 200 if the arrangements are made on or after 1st October.
The maximum number of MURs is considered by PSNC and the Department of Health as part of the annual remuneration negotiations, and if changes are agreed, details will be published on this website and in Community Pharmacy News.
When will I be paid for providing an MUR?
You declare how many MURs you have provided during the month on the FP34(C) submission form. The PPD will make the payment for these MURs at the same time as the payment is made for the month in questions prescriptions.
Can the PCT vary the numbers of MURs a pharmacy can undertake to a number below the limit specified nationally?
The ceiling on MURs has been agreed nationally. PCTs cannot reduce the ceiling. If PCTs wish to increase the numbers of MURs pharmacies can undertake they must contract for the additional numbers locally as an Enhanced service.
If the PCT claims the pharmacy does not comply with the essential service requirements, can it withhold payments for MURs undertaken or claw back payments already made?
The only sanction available to a PCT that wishes to withhold payments or reclaim payments where it 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.
Training and accreditation
Will local training qualify for MUR accreditation?
Pharmacists have to be accredited to provide MURs. To gain accreditation they must successfully undergo a competency assessment which will be conducted by a higher education institution. Training before taking a competency assessment is not mandatory, but many pharmacists may wish to refresh their skills prior to assessment. Local training could be provided to develop the skills of pharmacists before they undertake a competency assessment.
I did a diploma last year - why do I need to undertake a competency assessment?
Simply to verify that you have the skills and knowledge needed. You should have no problem passing a competency assessment. You may want to ask if your Diploma university are carrying out competency assessments.
Will locums qualify to provide MURs - will I have to pay them more?
Any pharmacist will be able to undertake a competency assessment. You could employ an accredited locum to undertake your MURs. It is up to you how much you pay them.
Do I have to complete a course before completing an assessment?
No, the courses that are available will help you update and refresh your skills, but you can take the assessment whenever you feel competent. If, for example, you have already been involved in clinical medication reviews it is likely that you will already have the skills and knowledge necessary to conduct a medicines use review and so you can take the assessment without completing any course.
Click here for more information on training courses and accreditation options for MURs.
Clinical governance
Some of my housebound patients would like me to conduct an MUR at their home. When I asked the PCT 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?
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 the PCT could require a CRB check.
The MUR form has a box to tick to say that the patient has consented to information being shared with their GP; does the patient have to provide written consent (i.e. sign a form)?
Before commencing an MUR, the pharmacist needs to explain the service to the patient; this should include the issue of sharing of information with the patient's GP and with the patient's agreement potentially other people, such as carers. The patient must consent to this process before proceeding with the MUR and a record of this must be made in the appropriate part of the MUR form, but a patient signature does not need to be collected.
If on a monitoring visit the PCT decides that the essential service requirements are not met, what action follows?
The PCT will notify the pharmacy, informally or formally, of the areas of non-compliance. If the non-compliance is substantial and clear, the PCT may advise the pharmacy not to undertake further MURs until the problems have been rectified. In such circumstances, if the pharmacy does not accept that it is non-compliant with the requirements, the pharmacy should request formal written notification of the defect to be remedied if the PCT has not already produced a report in the course of the monitoring exercise. The pharmacy 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 pharmacy should not provide further MUR services until it has remedied the defect notified by the PCT.
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