Supporting End of Life Care during COVID-19 in BLMK ICS (2020)

Luton CCG on behalf of BLMK commissioning collaborative

Project Summary

The COVID-19 pandemic has impacted the lives of millions of people worldwide. In BLMK (Bedfordshire, Luton and Milton Keynes) the CCGs operate as a commissioning collaborative with a single executive team. A single command and control structure oversaw the emergency response to COVID-19. End of life (EoL) care, including access to medicines at the end of life was a clinical priority action for the clinical cell in this structure.

This project describes the work of the BLMK CCGs MO teams to support the whole system in relation to end of life care during the COVID-19 pandemic. The project was only possible through the contribution of individuals within all MO teams (see attachment 1).

Broadly, access to medicines at the end of life can be categorised into:

1. Prescribing at the end of life
2. Supply of medicines 
3. Administration/Disposal of medicines

1. The nominated MO EoL lead Rafal Ali participated in the joint task and finish palliative care clinical sub group. The MO task was to lead on updating existing separate CCG clinical guidelines for end of life prescribing to produce a single guideline for use across BLMK health economy. The task and finish group comprised of all stakeholders. Two sets of guidance were needed – existing guidelines focused on predominantly planned deaths (eg cancer) occurring more in the out of hospital setting, featured injectable medicines. The second set of guidelines aimed to optimise use of oral medicines.
2. Two of the three CCGs within the ICS commission community pharmacies to provide on demand access to medicines used in end of life. In one CCG this is something the community pharmacies do informally. The medicines lists were updated with the new drugs identified during the pandemic , in particular oral medicines and stocks of injectable medicines were increased in light of anticipated increases in community deaths. Additional pharmacies offered to join the service in Luton and Milton Keynes. Updated information was published on websites. A community pharmacy WhatsApp group initially set up in Luton was adopted by other CCGs. An on-call EOL community pharmacy out of hours service was rapidly set up in Luton and MK and provided out of hours access to medicines for 2 months within ICS and bordering areas. Furthermore, local out of hours providers HUC (Beds and Luton) and MKUCC (Milton Keynes) ensured they held prepacks of oral medicines.
3. Administration/disposal of medicines - national guidance on the reuse of medicines in care homes was summarised into a SOP that was circulated to care homes. Governance: The MO teams across all 3 CCGS worked collaboratively through a number of mechanisms: weekly MO senior management, ICS care home network and at place teams meetings. MO was represented in several cells thus encompassing a matrix model and guidance were ratified at BLMK level.