Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, what assessment his Department has made of the potential impact of controls on stocking (a) palliative care medicines and (b) controlled drugs on the (i) adequacy of access to medication for patients in care homes and (ii) levels of wastage.

Under the Enhanced health in care homes framework, every care home must be aligned to a primary care network (PCN) and must have established protocols between the PCN, the care home, and system partners, such as local general practices and pharmacies, for information sharing, shared care planning, use of shared care records, and clear clinical governance.

Pharmacies are expected to maintain a reasonable stock holding to meet their legal obligations to dispense all prescriptions, including to patients in care homes, with reasonable promptness, recognising that it is not feasible for a pharmacy to maintain stock of every medicine. The Pharmacy Quality Scheme rewards community pharmacy contractors that deliver quality criteria, one of which is the Palliative and End of Life Care scheme. Participating pharmacy contractors must declare if they intend to routinely stock 16 critical end of life medicines, including controlled drugs such as morphine and midazolam and/or parenteral haloperidol, and must have an action plan in place to support local access. This enables palliative medicines to be quickly sourced when prescribed.

Most care homes with nursing can hold stocks of controlled drugs and will not require a licence to access medicines containing controlled drugs for patients who need them. This is because care homes run by public authorities or charities are exempt from the need for a Home Office controlled drug licence. Care homes without nursing cannot store controlled drugs unless they are prescribed for individual residents.

The Government seeks to have a coordinated approach to prevent wastage as much as possible, to improve inefficiencies and reduce costs for the taxpayer. PCNs are required to ensure that Structured Medication Reviews (SMRs) for high-risk cohorts, such as care home patients, are implemented. SMRs are an evidence based comprehensive review of a person’s medication, their views, concerns, and safety. The use of SMRs can reduce harmful polypharmacy and medicine wastage.