Boots has been accused of boosting its profits by telling staff to abuse a patient medication scheme which costs the NHS £66.5 million a year.
Evidence seen by The Guardian suggests the UK’s biggest pharmacy chain has ordered some staff to carry out medicine-use reviews (MURs) for people who do not need them.
The reviews are intended for patients who fall into key groups, including those discharged from hospital, those taking high-risk medicines, people with respiratory disease, and those with heart disease who are prescribed four or more medicines.
NHS England, which supports the scheme, said pharmacy contractors for MURs are required to keep full records which can be checked during monitoring visits.
The scheme runs on trust, with pharmacies expected to faithfully record patients given MURs.
The NHS caps the number of MURs per pharmacy at 400 per year but critics suggest some pharmacies see this as a target to bump up profits.
The health service pays £28 for every MUR. There were 2.38 million reviews across England’s pharmacies in 2014/15, worth £66.5 million, official figures show.
Pharmacies in England that run MURs each carried out 340 of the reviews on average over the last year.
If a pharmacy performs the maximum 400 MURs, it will earn £11,200, which could net Boots £30 million every year.
The Guardian said it has seen a 2008 email from a senior manager at Boots which says: “I personally don’t want colleagues to feel ‘brow-beaten’ but we do need to deliver our targets of 400 MCUs (medicine check-ups – another name for MURs) per store this financial year for two reasons: Delivering 400 MCUs is a measure of Excellent Patient Care. The company can make £28 profit for each MCU, so each one we don’t deliver is a lost £28.”
One Boots pharmacist in the Midlands told The Guardian he was directed by his managers to carry out an MUR on a man with dementia, and on himself.
His manager also began an MUR but walked out before completion. The store still entered the review on its records.
Another Boots pharmacist in north-west England remembered a staff away day at which he and his colleagues were told: “400 MURs is an expectation now. We don’t need to tell you that.”
Boots pharmacists responding to a Pharmacists’ Defence Association (PDA) union survey also reported being “pressurised into conducting MURs whether or not patients are eligible to receive the service” and “Boots keeps asking me for more MURs”, the Guardian reported.
PDA general secretary John Murphy said: “Pharmacists at Boots are clearly being forced to treat MURs as a profit-making scheme for the company.
“Either they stick to their ethical standards and ensure that the right people get the service irrespective of their financial targets or they satisfy their employer by achieving their profit objectives and keep their job.”
An NHS England spokesman said: “All patients deserve to get the best possible outcome from their medicines. That’s why NHS England is supporting the principles of medicines optimisation, which is a person-centred approach to medicines use, and includes reducing medicines wastage, helping patients to avoid taking unnecessary medicines and improving medication safety.”
Advice to pharmacists on the Pharmaceutical Services Negotiating Committee website says: “Claims made by pharmacy contractors for MURs are paid on trust.
“However, NHS Protect have confirmed that as with other systems where remuneration is paid based on a self-declaration, the NHS has monitoring arrangements in place to detect fraudulent activity.”