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Cutting antibiotic scripts curbs consultation rates

Prescribing weekend supplies of diamorphine and other palliative care drugs is safe and can significantly improve patient care, a new pilot study reports.

Researchers said GPs could use the 'just in case' boxes of medication to provide pain relief to dying patients without having to be called out at weekends.

Their study found the boxes appeared to reduce hospital admissions and out-of-hours calls and were popular with GPs and patients - despite some nervousness over the 'Shipman issue'.

Over the six-month pilot, reported online in the Pharmaceutical Journal, GPs at three surgeries issued 23 'just in case' boxes to patients in their last weeks of life, 16 of which were used.

There were only two calls to out-of-hours doctors and one to an out-of-hours pharmacist, which the researchers said was far fewer than usual.

Dr Rob Newby, a GP in Letchworth, Hertfordshire, whose practice took part in the pilot, said: 'It's a great idea. It's about anticipating problems rather than reacting to them. It gives patients the confidence to know that if there are problems the out-of-hours service will have the right drugs and protocol.'

Dr Newby said the pilot could be rolled out across the country 'with the caveat that you need specific protocols and good communication between patients and carers and medical professionals'.

The boxes typically contained five ampoules each of four palliative care drugs (see left), accompanied by strict protocols requiring administration by a palliative care nurse or a doctor.

Pilot co-ordinator Clare Amass, palliative care pharmacist at the Garden House Hospice in Letchworth, said GPs were generally supportive, although one had refused to prescribe a box. 'It possibly is a Shipman issue. People are concerned about what is prescribed,' she said.

Dr Nick Brown, cancer lead at Kennet and North Wiltshire PCT and a GP in Chippenham, said the scheme could ensure access to medication under the Government's Carson out-of-hours standards.

'It's very useful where you have 24-hour nursing care. The new pharmacy contract means many pharmacies are open less often,' he added.

Contents of a 'just

in case' box

-Diamorphine for pain

-Midazolam for agitation

-Cyclizine, haloperidol or levomeprozamine

for nausea or



or hyoscine hydrobromide for respiratory secretions

-Lorazepam tablets were also included

for agitation, for administration by

the carer

By Nerys Hairon

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