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Palliative care service providers in Scotland, including pharmacists, will promote timely provision and use of ‘just in case’ (JIC) medicines for adults dying at home and residents in care homes, under proposals for a new palliative care delivery plan.
The ‘Palliative care matters for all’ draft strategy for 2025–2030 was published by the Scottish government on 2 October 2024, in response to rising palliative care needs in the country.
The strategy sets out plans to provide “more equitable access” to “timely and high-quality palliative care” by 2030, to improve community support by encouraging conversations around palliative care, and to provide opportunities for patients to plan for future changes in their life, health and care with their families and carers.
To achieve this, the government has proposed several action points, including working with primary care teams and community pharmacists to provide support and supply JIC medicines for pain and symptom management, as well as to provide clear information about the medicines for patients and their families.
Additional action points include updating the national guidance on “care around death”, promotion and development of effective models to deliver urgent palliative care, training and professional development for ambulance clinicians, raising public awareness and developing new educational resources for healthcare staff.
JIC medicines, also known as anticipatory medicines or end-of-life medicines, such as diamorphine and tramadol, are medicines (usually intravenous) kept in a patient’s home that are prescribed by a doctor or specialist nurse to administer if someone has sudden distressing symptoms, such as pain or agitation.
However, not all pharmacies stock JIC medicines on a routine basis, which can cause delays in treatment.
Paul Wilson, chair of the Scottish Palliative Care Pharmacy Association (SPCPA), commented: “Provision of JIC medication for palliative patients is established practice and has been a key goal for NHS Scotland since the ‘Living and dying well‘ document, [which was published] in 2008.
“The SPCPA welcomes the renewed acknowledgement and the broadening emphasis and support for the provision of JIC medicines in NHS Scotland.
“Appropriate and timely supply of JIC medicines can be hugely beneficial to the patient, their carers, other healthcare staff and the community pharmacies involved in their care and can contribute to patients being able to remain in the care setting of their choosing.
“There remain concerns and challenges around the supply of medicines in the ‘out-of-hours’ period and we, the SPCPA, will be working with our local health boards and community pharmacy colleagues to deliver on the care of our patients in all community settings,” he added.
Laura Wilson, director for Scotland at the Royal Pharmaceutical Society, said: “We are pleased to be able to feedback on the draft strategy and ensure the valuable contribution that pharmacists in all sectors make to palliative care will be reflected in plans for the future.”
Analysis of NHS data, published by The Pharmaceutical Journal in March 2024, revealed that a fifth of pharmacies in England have reduced their opening hours to save money, making access to medicines for palliative and end-of-life care difficult for those receiving this care at home
In September 2024, The Pharmaceutical Journal published a call for papers, inviting UK pharmacy professionals to share what they are doing in their local area to improve access to palliative and end-of-life care. The invitation closes on 16 December 2024.
