Guest Post: From a Concerned Pharmacist by Anon

So a boots pharmacist has been suspended from the register for falsely saying she had some more MURs than actually done.
It’s a shame that this has come to light, although I would say it had to happen at some point.
The pressure to do MURs is great. With category M prices making a mockery of the system, the NHSBSA being a total joke wrt accuracy of payments, the DOH in its negotiating practices, brand discount deals being “renegotiated” – revenue is becoming tighter and tighter.
So MURs are seen as a way of generating income. But they are also a service and here lies the problem for a pharmacist. Do fewer yet professional MURs or do more money generating but possibly less professional MURs.
Big chains will insist that the fees are more important and so a ‘pressure’ will be exerted on the pharmacist. Threats possibly employed if they aren’t done.
And so we pharmacists find ourselves caught between a rock and a hard place – to give a professional service and be paid or to just go for the money.
I find it morally distasteful that companies give not two hoots about their staff and their professionalism – you employ us to do a job, then leave us to do the job and stop micro-managing us. Who are you to tell us what to do when you aren’t anything to do with healthcare or have become so far removed from the coal face you have forgotten what it was like.
You cause heartache and despair amongst the very people you profess to care about – you cause us to go against our morals and professional ethics.
However, the pharmacist concerned has committed an offence.
The question will be asked “did you or did you not do all these MURs”
A second one may be asked “so you’re saying that some of these were falsely claimed”
The answer is yes and therefore a fraud has been committed.
There is no getting round this.
I trust that the powers that be look into this case more closely – the system is wrong, the system creates an atmosphere where you are deemed to not be a good pharmacist if you don’t do MURs, the system allows systematic abuse of highly qualified professionals by the management chain, for forcing professionals to claim the money by doing unprofessional deeds, for making professionals the scapegoats in search of money…
Shame on you! I truly wonder how you are able to sleep at night, but actually you won’t care – it won’t even enter your consciousness that what you do is morally wrong that you are driving professionals to despair and ‘managing the figures’ in order for you to tick boxes.

8 thoughts on “Guest Post: From a Concerned Pharmacist by Anon

  1. I believe the hearing also found that the pharmacist wasn’t placed under excessive pressure, but that she just couldn’t handle that level of pressure. As I have mentioned elsewhere, a pharmacist doing around 7000 items a month, with 44 hours open per week, will have on average around 90 seconds per item to get it clinically checked, labelled, reordered if necessary, dispensed, accuracy checked, bagged and handed out with appropriate counselling. Add into that extra time for dosettes, installment dispensing, OTC advice, EHC, methadone, needle exchange, nursing homes, consulting reference sources, contacting GPs, solving prescription related mysteries, phone calls, sourcing products, managerial tasks, pre-reg and staff training, pointless arguments with patients, broken computers/faxes/printers, drug reps and whatever else crops up. The additional planning, explanations to patients, consultations, record keeping and other paperwork added by MURs relentlessly being demanded by employers of pharmacists with increasing intensity may well present excessive pressure. Let down your employers, you’ll get even more pressure until you either lose your job, have a breakdown or move on to breaking the law or letting your professional standards slip. Break the law and you’ll get suspended/struck off, possibly go to prison, possibly lose your career and definitely lose your job. Let your professional standards slip and you’ll get suspended/struck off, possibly go to prison, lose your job/career, possibly get sued and worst of all (yet seemingly least important) possibly kill someone.

    Best option? Follow this advice:

  2. Medicare fraud and Medicaid kickbacks are prosecutable offenses, and grounds enough for losing ones’ license in the US as it is considered theft from the government.

    Once convicted of this type of crime, it’s very, very difficult to work anywhere as no pharmacy would be able to run on a cash-only basis. Everyone has some type of insurance which helps with the incredibly high prescription drug costs, because it is illegal to sell prescription drugs for two different prices.

    However, there is much debate about the number of prescriptions one might safely fill without error in the ‘States which hugely serves the basis of disgruntlement for pharmacists run ragged by big chain companies. Practically, this is the crux of the matter. Pharmacists feel they’re being asked to do too much to benefit the company’s bottom line without consideration of the nature of the work and pharmacist safety and this is because shops are run by businessmen and accountants (non-pharmacist managers).

    Do you have pharmacist management in the UK? Do you have a strong representation of pharmacist workforce in the central government. We don’t here. It seems as if physicians, politicians, and accountants run the whole show in the US, unless the pharmacy is an independent owner, and then there is a little more leeway about running things, but evidence of no fraud is just as important, if not moreso, when it’s a small operation..

  3. In the UK, a pharmacy must have a “Responsible Pharmacist” (RP) on duty, who is usually the only pharmacist in the store. This pharmacist is legally responsible for pretty much anything in the pharmacy while they are working, including anything done or said by any member of staff, any prescriptions handed out that were checked by another pharmacist on a previous day and so on. These laws are heavily enforced, such as in the case of Elizabeth Lee, a pharmacist who made an honest dispensing error (gave propranolol instead of prednisolone, patient died, pharmacist charged with manslaughter, found no responsibility for patients death, changed to medicines supply offence) and received a 3 month suspended jail sentence. That was three years ago and despite just about the entire profession calling for a change in the law to decriminalise non-negligent one-off dispensing errors, that change has never come. Because the RP is legally responsible, the company can push them as far as they like. If anything goes wrong, the pharmacist is responsible and gets sacked and possibly a GPhC disciplinary hearing. The company can wash their hands, except maybe to openly blame the pharmacist, make a token compensation payment if it is a patient complaining and possibly even sue the pharmacist to recover the compensation they have given out.

    While membership of pharmacist unions such as the Pharmacist Defence Association (PDA) and the Guild of Healthcare Pharmacists is increasing, we still don’t have a great deal of power to change anything. Our profession here has so many aspects that make no sense, but we can’t seem to unite and change these things. The PDA has been fighting some good fights against the big chain pharmacies who mess around employees, but still a lot of these companies seem to have a workforce who unilaterally hate their employer with all their heart. I mean, Boots has its own union for its own staff…a union run by your employer, that’s mad!

    So no, we don’t have good representation. In fact, I doubt we’re ever thought about in government as any more than an afterthought. Pharmacists walk a very thin line, trying to balance what are often directly contradictory obligations to management, patients, the law, the NHS, professional responsibility and last and very much least, their own wellbeing. Many of us never see a lunch break and I have even been expected to work as the only pharmacist (and therefore as RP) in a busy city centre pharmacy from midday til midnight with no break other than eating while working.

    I’m not sure what pharmacy is like in the US, but I am certainly glad for the NHS here at least. The unfortunate problem is that pharmacists are often given services to take the load off doctors. While I have no objection to this in theory, in practice pharmacists have a lot less time than doctors to carry out these services. Very few pharmacies will have 2 pharmacists on duty, so things get really hectic. If we could just have some kind of rule relating how busy the pharmacy is to a minimum number of staff, things might be a lot better.

    1. Thanks for explanation, Calum. We really have so much similarity between countries in the profession of pharmacy, despite the fact that our main commonality is the language.It’s incredible. JP Plagakis, Redheaded Pharmacist, ‘Angry’ and ‘Angriest’, and Dave Stanley (DrugMonkey) devote a major portion of their blog to this issue in the US, and with advent of a newer type of health insurance program nationwide that will soon be available, the matters discussed will not go away with regard to what sort of entities pile the work on pharmacists without regard to adequate staffing or even concern for decent working conditions.

  4. Its a real shame that pharmacists end up an afterthought. It may be a wasted golden opportunity for the US to (finally) provide universal healthcare to a high standard and utilise the potential pharmacists have for patient care.

    As I mentioned, I’m unbelievably grateful for the NHS as it means I’ll never have to worry about paying for treatment if I get hit by a bus or get cancer or need dialysis or a transplant. Free prescriptions for all in Scotland means people can get the medication they need rather than what they can afford. The fact, however, that this is a system run for the benefit of its users means that we should be making the best use of our available resources. But a mixture of disproportionate strengths of representation for the various professions combined with public/government ignorance of pharmacists’ roles and working conditions combined with pharmacy being run by private companies working in their own interest (and, unlike most other NHS services, often being run by massive multinational corporations and not healthcare professionals) have led to pharmacies being overloaded and somewhat directionless. Consider that I have heard many tales of supermarkets taking technicians and dispensers away from the pharmacy to use when the checkouts are understaffed! One technician I met was the last member of support staff left with the pharmacist and refused on patient safety grounds to let the store manager put them on checkouts. The manager went totally mental and the technician nearly got the sack!

    Imagine a walk-in doctor’s surgery with no appointment system; on demand telephone consultations; all drugs dispensed on site; a medicines information counter and hotline for patients and professionals; a counter selling medicines, toiletries, household products, sandwiches, medical devices and anything else to make a profit; medication services for nursing homes; a walk-in smoking cessation service; medicines wholesaling; flu vaccination clinics and medication review clinics. Now imagine there’s one doctor working in this surgery. The doctor is also the practice manager. And sometimes the convenience store across the road takes all the surgery receptionists/support staff away to man their tills. Bet that doctor would get a fucking lunch break!

    I’m totally not bitter…

  5. all far to true! and working for a company that seems to be in a ‘merge’ (i use this term lightly) with the US.. I only hiss my breath through clenched teeth to await what the future holds!

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