271 IJPP 2008, 16: 271–276 © 2008 The Authors Received April 23, 2008 Accepted May 20, 2008 DOI 10.1211/ijpp.16.4.0010 ISSN 0961-7671 Fast Track Medicines Use Review: adoption and spread of a service innovation Alison Blenkinsopp, Christine Bond, Gianpiero Celino, Jackie Inch and Nicola Gray Abstract Background Research has shown that implementation of community pharmacy Medicines Use Review and Prescription Intervention (MUR) in the first year of the service in England and Wales was less extensive than anticipated. Several barriers to MUR becoming accepted and embedded in the National Health Service (NHS) were identified. Objective To evaluate progress in the provision of the MUR service in England and Wales in its sec- ond year (April 1, 2006–March 31, 2007) compared with the first year; and to analyse trends from available national data from the third year of provision in 2007–2008. Methods The analysis drew on the following data sources: routine data on provision of MURs for community pharmacies in a stratified random sample of 31 primary care organisations in England and Wales, and national datasets on MUR provision from the Pharmaceutical Services Negotiating Committee and NHS Information Centre. Outcome measures The percentage of community pharmacies providing the MUR service, the numbers of MURs provided in 2006–2007 at pharmacy and primary care organisation level, and the extent of, and variation in, provision. Key findings The percentage of community pharmacies providing the MUR service increased from 38 to 67.2%. Overall, 62 559 MURs were provided (a more than four-fold increase on the previous year), representing 13.8% of the possible maximum. The mean number of MURs provided (per pro- vider) increased from 36 to 85. For existing providers the mean number increased from 36 to 111 (median 78, range 0–423). For new providers the mean number was 52 (median 17, range 1–401). More than half (52%) of the pharmacies in the sample claimed for fewer than 50 MURs. Overall, 82% of MURs were provided by multiples and this percentage was lower among new providers (62%) than existing providers (89%). Thirty-three (8.1%) existing MUR providers had no recorded MURs in the second year: almost two-thirds of these (64%) were independents. Eleven pharmacies (1.5%) provided the maximum number of 400 MURs per year: all but one were branches of multi- ples. Of the pharmacies not yet providing MURs, 78% were independent. Conclusions Both numbers of MURs and numbers of providers of MUR services increased markedly during the service’s second year. Those newly providing the service in the second year claimed for more than twice as many MURs as did those who had been ‘new providers’ the previous year. Over- all just over half of all providing pharmacies claimed for the equivalent of one MUR a week or fewer. Therefore the extent of ‘successful adoption’ of MURs is debatable. Differences in the level of provision continued between independent and multiple pharmacies in terms of both adoption of the service and the number of reviews conducted. As in the previous year, independent pharmacies were less likely to provide the MUR service and when they did the numbers conducted were lower than those provided by multiples. The Medicines Use Review and Prescription Interventions service (MUR) was introduced in 2005 as the first ‘advanced’ service in the new National Health Service (NHS) Community Pharmacy Contractual Framework (CPCF) 1 for England and Wales. The MUR was intended as a review focusing on the patient’s use and understanding of their medicines and usually to be conducted in the pharmacy. An MUR aims “with the patient’s agreement, to improve his knowledge and use of drugs by in particular – (a) establishing the patient’s actual use, Introduction a Medicines Management, School of Pharmacy, Keele University, b Webstar Health, Harrow and c Department of General Practice and Primary Care, University of Aberdeen, UK a Alison Blenkinsopp, Professor of the Practice of Pharmacy b Gianpiero Celino, director b Nicola Gray, research associate c Christine Bond, Professor of Primary Care Pharmacy c Jackie Inch, research fellow Correspondence: Alison Blenkinsopp, Professor of the Practice of Pharmacy, Medicines Management, School of Pharmacy, Keele University, Keele, Staffs ST5 5BG, UK. E-mail: a.blenkinsopp@ keele.ac.uk Acknowledgments: We would like to thank the NHS Prescription Pricing Division and Local Health Boards for supplying the data for our analysis. The Pharmacy Practice Research Trust funded the evaluation of the Community Pharmacy Contractual Framework of which this work formed part. We would like to thank Professor Amanda Lee, Professor of Medical Statistics in the Department of General Practice and Primary Care at the University of Aberdeen for statistical advice.