Community pharmacies should routinely hold stocks of palliative care medicines, the Royal Pharmaceutical Society (RPS) has said in draft standards for the sector’s role in palliative and end-of-life care.
The ‘Palliative care “daffodil” standards for community pharmacy’, developed with the charity Marie Curie with input from the RPS’s community pharmacy expert advisory group, are now open for consultation until 1 December 2022.
The draft standards make a number of recommendations for how community pharmacy can support patients needing palliative and end-of-life care as well as for those caring for them. The suggestions take into account the experiences of those in the community pharmacy sector who are already involved in this area.
The standards say that one of carers’ primary concerns is “robust and timely medication supply”. To address this, the standards recommend that community pharmacists should “proactively manage” the medicines supply chain, including stock holding and signposting under local agreements.
Other recommendations include the development of multidisciplinary team working, so that pharmacy teams are “aware at an early stage of a patients’ status, potential support needs and their identified multi-disciplinary team members and how to access them”.
However, the standards point out that access to electronic health records and the ability to record pharmaceutical interventions and information gleaned from patients or their carers “remains limited”.
In August 2021, the ‘Community pharmacy contractual framework’ arrangements for 2021/2022 were agreed, in which the Pharmaceutical Services Negotiating Committee, NHS England and Improvement and Department of Health and Social Care committed to “exploring together how pharmacies can help improve access to palliative care medicines”.
In October 2022, the Pharmacy Quality Scheme guidance for 2022/2023 in England introduced a ‘Palliative and end-of-life care action plan’, which means pharmacies have until March 2023 to update their NHS profile to state if they routinely hold each of 16 end-of-life care drugs, including morphine, dexamethasone and oxycodone.
The guidance states that pharmacies that do not routinely hold these drugs must have a plan in place that would tell patients and their carers where these drugs could be obtained.
There is currently a varied picture of community pharmacy palliative care support across the UK.
In Scotland, a network of 27 community pharmacy palliative care pharmacists in Tayside carry stocks of palliative care medicines and provide specialist advice to other pharmacists and healthcare professionals.
In Nottinghamshire, 25 community pharmacies participating in a palliative care medicines stockist scheme have committed to keep the required medicines in stock.
In 2018, RPS Wales launched a palliative and end-of-life care policy which called for pharmacists to be embedded in all multidisciplinary teams delivering palliative care.
That same year, RPS Wales shared its own evidence with the Welsh Assembly, that community pharmacists are frequently not made aware if a patient has been placed on a palliative care register.
Darrell Baker, chair of the steering group for the palliative care standards, and former clinical director of pharmacy and medicines management at the Cardiff and Vale University Health Board, said: “It is vital for us to get as many views as possible through the consultation so that community pharmacy teams can work together to deliver the best quality of care to palliative and end-of-life patients and their carers.”