RCGP calls on Home Secretary to 'urgently relax' rules on controlled medication for patients at the end of life during COVID-19

Publication date: 23 April 2020

Patients are experiencing 'unnecessary' pain and distress in the last days of their lives during the COVID-19 pandemic due to laws restricting the use of controlled drugs, the Royal College of GPs has warned today.

In a letter to Home Secretary Priti Patel, the College says that the NHS also risks running out of essential medications unless there is a temporary ‘urgent relaxation' of the legal restrictions that mean controlled drugs - such as morphine which is used to help control severe breathlessness and pain in patients - can only be given to named patients, and then destroyed if not used. 

In the letter, RCGP Chair Professor Martin Marshall acknowledges that the law governing the use of controlled drugs is 'reasonable' in normal times, but that during the current pandemic, 'the increased number of patients with end-of-life-care needs is leading to delays in administering drugs to patients whose COVID-19 symptoms develop rapidly.'

He continues: "We are aware of incidences where this has caused significant and unnecessary distress and pain to patients at the end of their lives and their families.

"We are hearing that the requirement for these named prescriptions, combined with localised shortages of drugs and the pressure on clinical staff, means that in some cases patients who are sadly near the end of their lives can wait hours before receiving these medications. Furthermore, unnecessary wastage during this time may result in some people not being able to have the essential drugs to relieve suffering from end of life symptoms, at all. 

"The Royal College of GPs is therefore calling for an urgent relaxation of these measures which would allow stocks of medication to be managed and used more effectively, safely repurposing drugs that haven't been used for individuals and have been stored correctly – currently required by law to be destroyed – to allow medical professionals to make the most ethical use of these crucial drugs during the pandemic."

The College is also calling for hospital pharmacies to be able to dispense prescriptions from non-hospital prescribers, such as GPs and hospices – currently not possible without a contract or licence. It says that this would allow for easier sourcing of necessary drugs and relieve pressure on pharmacies in the community.

Prof Marshall continues: "Our proposals are for changes to regulations which would allow the more efficient and ethical supply of these drugs during this difficult time, while seeking to guarantee patients dignity at the end of their lives."

He notes that proposals put forward by the Home Secretary in her recent letter to the Advisory Council on the misuse of drugs 'would not allow for the supply of these controlled end of life drugs where a patient's symptoms rapidly developed.'

He is calling on the Home Secretary to use the emergency powers allowed through the Coronavirus Act 2020 to effectively manage consequences of the COVID-19 pandemic, writing: "We believe that relaxing these measures would be a proportional and sensible adjustment to make for the duration of this crisis."

Commenting on why the College felt it was necessary to write the letter, Prof Marshall said: "Patients rely on medication at all stages of their lives, but when they are at or nearing the end of their lives, the medication they receive is vital for ensuring they remain comfortable at what is often a very distressing time.

"We have already raised with the Government the need for temporary measures to allow more effective use of existing stocks of medicine, and we need to see this urgently - bureaucracy must not be a barrier when patients are in pain or distress and at their most vulnerable.

"We're in unprecedented times, and this calls for unprecedented measures. More people are becoming seriously ill and we want to ensure we are able to give them the care they need and deserve. What we are proposing is a sensible and proportional way of facilitating this during COVID-19."

Dr Adrian Tookman, Clinical Director, Marie Curie Hampstead Hospice, said: "Watching someone you love die is hard enough, but thinking that person is also in pain and distress makes it worse. For those left behind it may mean that they find it harder to process their grief and find vital closure.

"As the nation's end of life care charity, Marie Curie fully supports the Royal College of GP's proposed change in regulations and we urge the government to cut the red tape to make this happen urgently.

"In these challenging times we must try and avoid a potential crises and preserve precious medications that are key for relieving painful and distressing symptoms in patients who are dying. Changing the rules will help GPs and hospices get better access to the medication they need to support dying people, while ensuring that vital medication doesn't get destroyed and wasted unnecessarily."

Further Information

RCGP Press office: 020 3188 7494/7633/7574/7575
Out of hours: 0203 188 7659

Notes to editor

The Royal College of General Practitioners is a network of more than 53,000 family doctors working to improve care for patients. We work to encourage and maintain the highest standards of general medical practice and act as the voice of GPs on education, training, research and clinical standards.

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