The MUR service is a structured review of a patient’s use of their medicines which aims to improve the patient’s knowledge, understanding and use of their medicines. It supports patients to gain the maximum benefit from their prescribed medicines by taking them safely and effectively.

The service consists of a single consultation, which usually takes place at the community pharmacy. Before receiving the service, the patient will be asked to sign a form to confirm that they consent to participate in the service, and for information to be shared with their GP as necessary.

It will involve a discussion between the patient and the pharmacist covering all medicines they are taking (including non-prescribed medicines), checking and supporting adherence, identifying and taking steps to resolve any problems, and answering any questions the patient has about their medicines. The patient may also be given healthy living advice and/or be signposted to other services if appropriate. At least 70% of all MURs undertaken by each pharmacy must be for patients who fall within one or more of the national target groups. These groups are:

• patients taking a high-risk medicine (on a nationally agreed list)
• patients with respiratory disease
• patients recently discharged from hospital who have had changes made to their
• medicines whilst in hospital
• patients at risk of or diagnosed with cardiovascular disease and regularly being prescribed at least four medicines.

NOTE: The community pharmacy framework contract, which was published on 22 July 2019 jointly by the Department of Health and Social Care (DHSC), NHS England and the Pharmaceutical Services Negotiating Committee (PSNC) revealed that medicines use reviews (MURs) will be phased out over the next two years

Stoma appliance customisation service

Appliance use review service

The NMS was introduced in October 2011 and is designed to support patients who have been newly prescribed a medicine for a long-term condition. Four conditions/therapy areas are included in the service:

• chronic obstructive pulmonary disease (COPD)/asthma
• type 2 diabetes
• hypertension
• antiplatelet/anticoagulant therapy

The service is split into three stages:

• Patient engagement: patients may be recruited to the service by prescriber referral or opportunistically by the community pharmacy. Before receiving the service, the patient will be asked to sign a form to confirm that they consent to participate in the service, and for information to be shared with their GP as necessary. The pharmacy will dispense the prescription and provide initial advice as normal
•  Intervention: this will usually take place 7 – 14 days after patient engagement, at a time and using a method agreed with the patient, which could be face to face or by telephone. The pharmacist will assess the patient’s adherence, identify problems and determine the need for further information and support
• Follow up: this usually occurs 14 – 21 days after the intervention to discuss how the patient is managing with their medication.

In line with the ambitions set out in the NHS Long Term Plan, this service is expected to relieve pressure on urgent and emergency care, by referring patients to a consultation with a community pharmacist where otherwise they would have attended a GP out of hours appointment or A+E having run out of regular medicines or requiring support with low acuity/
minor illness.The service will also help to tackle elements of existing health inequalities by providing urgent access to patients who are not registered with a GP.The CPCS is being introduced as an Advanced Service:

• To support the integration of community pharmacy into the urgent care system, and to divert patients with lower acuity conditions or who require urgent prescriptions, releasing capacity in other areas of the urgent care system.
• To offer patients who contact NHS 111 the opportunity to access appropriate urgent care services in a convenient and easily accessible community pharmacy setting on referral from an NHS 111 call advisor and via the NHS 111 Online service.
• To reduce demand on integrated urgent care services, urgent treatment centres, Emergency Departments, walk in centres, other primary care urgent care services and GP Out of Hours (OOH) services, and free up capacity for the treatment of patients with higher acuity conditions within these settings.
• To appropriately manage patient requests for urgent supply of medicines and appliances.
• To enable convenient and easy access for patients and for NHS 111 call advisor referral.
• To reduce the use of primary medical services for the referral of low acuity conditions from NHS 111 and the need to generate urgent prescriptions.
• To identify ways that individual patients can self-manage their health more effectively with the support of community pharmacists and to recommend solutions that could prevent use of Urgent and Emergency Care services in the
  future.
• To ensure equity of access to the emergency supply provision, regardless of the patient’s ability to pay for the cost of the medicine or appliance requested.
• To increase patient awareness of the role of community pharmacy as the ‘first port of call’ for low acuity conditions and for medicines access and advice.
  To be cost effective for the NHS when supporting patients with low acuity conditions