(also known as accessing palliative care medicines over Bank Holiday weekends)
It’s the time of year where pharmacy staff in all sectors are trying to plan for the holiday period ahead. The challenge of ensuring you have enough stock to cover the needs of patients in your working area – whilst dealing with supply issues, reduced wholesaler deliveries and patients needing emergency supplies is a hard balance to find.
In the specialist palliative pharmacy world, accessing medicines for community patients is a constant trial for us to manage. As pharmacists we have insights into the challenges for community pharmacists who will have small CD cupboards limiting the amount of stock they can keep, making sure FP10s are written legally and that there are no concerns about diversion when they often are not familiar with the prescriber name or signature from out-of-hours services and there is no telephone number to contact them on – all whilst being aware there is a patient at the end who needs medicines and a relative standing in the waiting area desperate to get home to them.
We understand the challenges for the specialist palliative care staff, GPs, the community and district nurses – we try and plan and have significant discussions, ensure we consider Gosport recommendations by not making plans to suit services but tailored and individualised to the patient, and think about access to injections for when the patient may need them – and as always the best laid plans can be thwarted. Unexpected changes, sudden deterioration, and scenarios where the patient has refused to have any injections in the home for fear they signify “death” mean that we need services to access these medicines in a timely fashion when needed.
Across Birmingham, Solihull, Sandwell, Dudley and Wolverhampton there is a scheme called SPCD (Specialist Palliative Care Scheme) which is commissioned by the ICB/ICS and provided by Midlands and Lancashire Commissioning Support Unit (MLCSU). It has 30 pharmacies across the areas, holding an extended list of medicines for palliative care which supports the change in where care is being provided and how management of patients has changed significantly over the last few years. This scheme is a continuing work in progress and a result of many years of collaboration, engaged group members working and communicating towards to a common goal of no patient suffering unnecessarily at home. It adapts to changing practices, medicine supply issues and learning from incidents.
The scheme is not perfect, but it is better than before, and we continue to review it frequently. We still have issues with the opening hours of pharmacies especially as many 100-hour pharmacies reduce down their opening times alongside a depleted community pharmacy workforce. What happens outside of community pharmacy opening hours to avoid a patient having to attend A&E remains a thread that needs work. The thought of adding to NHS bed pressures, the financial implication of an unwanted admission and ultimately the psychological cost, to the patient and family of having to go back to hospital when many do not want to, is always at the forefront of our minds.
Each year I receive emails from commissioners exploring how much it costs each patient to have a stock of essential palliative care medicines in the home. Whilst I can put a value on the usual list of medicines that we ask to be supplied in the hope that it will cover symptom needs, the reality is there is no cost on the reduced anxiety it can bring to a patient and their loved ones knowing there are injections there if needed, or reducing the risk of a loved one racing around across the city trying to find medicines and missing the last breath.
The only way to understand the issues in your area is to learn from the incidents that are reported. Engage with your local teams, find out what’s in place, what is needed, who needs to be involved to look at this. And most importantly get a pharmacist to be a key member of this work.
You can find this December’s Specialist Palliative Care Drugs Supply here and General information on Bank Holiday Community Pharmacy Opening over Christmas and New Year can be found here NHS England — Midlands » Bank Holiday pharmacy opening times.
Specialist Palliative Care Drugs Supply PDF
Michelle Aslett
Specialist Palliative Care Pharmacist – Marie Curie Hospice West Midlands
michelle.aslett@mariecurie.org.uk