News 22nd Apr 2016

Pharmacists Forced to Exploit the NHS


The TI-UK blog features thought and opinion from guest writers as well as TI staff. Any opinions expressed by external contributors do not necessarily reflect the views of Transparency International UK.

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Last week the pharmacy chain Boots was accused of exploiting an NHS scheme to boost profits.

The NHS scheme in question is the Medicines Use Review (MUR), an advanced service offered by pharmacies. An MUR involves a pharmacist giving professional advice to patients taking multiple prescription medicines and it is targeted at high risk groups, such as individuals with respiratory disease. Each MUR costs the NHS £28, which goes directly to the pharmacy.

It is alleged that managers at Boots have been forcing their pharmacists to provide MURs to patients who do not need them, staff members and even themselves, in order for their stores to profit. One internal email from a senior manager seen by the Guardian states “each one we don’t deliver is a lost £28.

This is alarming. As the NHS is under extreme financial pressures it is very worrying that the biggest pharmacy chain in the UK could be prioritising profits at the expense of our public health system, by making their pharmacists provide unnecessary services.

While the reimbursement of unnecessary or non-delivered services is an example of fraud, we include this type of abuse in our corruption analyses. This is because in many health systems it is prevelant and the effects are just as impactful as other corruption risks. For example, a European study in 2013 identified this risk as a widespread issue in Western Europe. As health systems like the UK’s do not require patients to pay for treatment or verify the bill, it can be expensive to develop effective surveillance systems to counter the risk.

The allegations in this case have been strengthened by the response. While a Boots spokesperson said “we make it clear to our colleagues that these services should not be undertaken inappropriately,” the amount of letters received by the Guardian from pharmacists in response to the original article, what the letter editor described as “the largest haul of mail he has ever received about a single article,” suggests this is a systemic problem in Boots and the wider pharmacy profession.

What makes this case even more concerning is that since 2010 serious concerns have been raised regarding the vulnerability of MURs to abuse. A report that year found that some MURs were “bordering on fraudulent”, with pharmacists admitting that conducted MURs could be of “limited value” to patients. Clearly this is a schemein which the reimbursement of unnecessary services is a high risk.

In response to these allegations two things must happen to ensure that systemic corruption risks are minimised, NHS funds are better protected and patient health is prioritised:

  • The pharmacy regulatory, the General Pharmaceutical Council, must conduct an investigation into the alleged practices concerning MURs and review the standards it issues to pharmacies regarding the use of NHS schemes and the commercial targets imposed on pharmacists.
  • The Department of Health should review the potential for abuse of the MUR service and make every effort to reduce any fraud and corruption risks.

To have an effective health system it is crucial that not only services and treatments provide good value for money, but that patients trust healthcare professionals and the institutions they represent. Unfortunately these allegations do serious harm to both.

Michael was the Programme Officer for TI's Pharmaceuticals and Healthcare Programme.