Demonstrate our worth by funding clinical interventions in the community

In the seven years since the NHS community pharmacy contract for England was launched, much has been said and written on the subject of medicines use reviews. One could almost be forgiven for forgetting that the official title of the advanced service described in the contract is the “medicine use review and prescription intervention service”.

The prescription intervention aspect is described as “the response to a significant adherence problem that subsequently leads to an MUR”. Although there are many occasions where adherence could act as a trigger for an MUR, this narrow definition of a prescription intervention service needs to be revisited. Community pharmacists make interventions daily, but most of these will not fall within the definition under the 2005 contract. They may include recognising that a child has been prescribed an inappropriate dose of an antibiotic, that someone recently started on opioids has become constipated and that a patient taking warfarin has been prescribed an interacting medicine. The intervention can involve many facets, such as eliciting more information from the patient, suggesting an over-the-counter remedy, contacting the prescriber and providing education. These examples are not about adherence and they do not require an MUR. They are clinical interventions and the failure to include these as an advanced service is illogical.