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Latest Uploads from the End of Life
Partnership Team
October 2018

Webinar: Improving End of Life Care

Topics and presenters: “Think Delirium” Dr Paula Powell and “ Identification Project” Dr Andrew Fletcher

2 October 2018,

1.00pm – 2.00pm

August 2018
May 2018
The 'Blue Booklet' is being relaunched on 18th June 2018. There have been some significant changes that will have an impact on your practice. Please click here for more information.
December 2017
 Diamorphine/Morphine National Shortage
The MMT has been made aware that there are national shortages of injectable diamorphine and morphine, with all pharmacy contractors and wholesalers affected to varying degrees. To minimise the difficulty in obtaining parenteral opioids for palliative care, please can prescribers and dispensers work together as described below.
·         Whenever possible, prescribe in anticipation of need, allowing sufficient time for the patient / carers to obtain medicines from their usual pharmacy through the normal supply chain (which may be next-day supply).
·         Prescribers are asked to liaise with local community pharmacies to determine what stocks of injectable opioids are available to prescribe. Some pharmacies may have some strengths of diamorphine available, others may only have stocks of alternative medicines (e.g. injectable morphine). Prescribers and dispensers will need to work together to make the most appropriate decisions for patients while these shortages continue.
·         Please prescribe each palliative care item on a separate prescription form in case different pharmacies need to dispense them.
·         Attached is a document from another area that has been circulated previously with clinical advice on managing opioid shortages, including dose conversions.
·         Selected pharmacies across NHS Eastern Cheshire CCG, NHS South Cheshire CCG and NHS Vale Royal CCG provide the Think Pharmacy Urgent Palliative Care Medicines Service, where a limited formulary stock of palliative care medicines is held for provision at short notice. The service specification, formulary and list of providers can be viewed on the Community Pharmacy Cheshire and Wirral site see:
·         All pharmacies providing the Think Pharmacy Urgent Palliative Care Medicines Service are being asked to review their stock holding. If unable to obtain diamorphine as per the formulary stock holding, we are asking them to obtain morphine sulfate 10mg/1ml solution for injection (10 ampoules) and Morphine sulfate 15mg/1ml solution for injection (10 ampoules).
·         Selected pharmacies in each CCG have also been asked to obtain a supply of oxycodone injection for patients with a specific clinical need (e.g. impaired renal function or CNS side effects with other injectable opioids). The selected pharmacies are: Asda Pharmacy, Crewe; Lloyds Pharmacy in Sainsbury’s, Cumberland street, Macclesfield; and Boots, Witton Street in Northwich. These pharmacies are open during the Christmas and New Year Bank holidays (see the published rotas at ). The pharmacies have been requested to obtain stocks of oxycodone 10mg/1ml solution for injection (5 ampoules) and oxycodone 50mg/1ml solution for injection (5 ampoules). Prescribers and pharmacies may need to be aware of this arrangement to refer patients / carers onwards to a pharmacy with stock.
·         Local hospices may be contacted for advice:  St Lukes (Winsford) phone 01606 555489 and East Cheshire Hospice (Macclesfield) phone 01625 666999.
·         In exceptional circumstances when community pharmacies have exhausted all other avenues to obtain supplies, local Acute Trusts may be able to provide some support. Please phone Mid Cheshire Hospitals NHS Trust pharmacy on 01270 612260 or East Cheshire Trust pharmacy on 01625 661 266 for further information.
I am sorry for the brevity of this information – it is not possible to map the changing stock holdings across the patch and it is important to highlight the issue so that local liaison can take place to support patients, particularly around this period of extra pressure in the system because of the holidays.
Also attached is the NHS Directed rota list for the 3 CCGs, the details of the pharmacies who provide the Think Pharmacy Urgent Palliative Medicine Service and/or Think Pharmacy Minor Ailments Service during these times are listed in a column after the opening times.
March 2017
New referral form launched for Eastern Cheshire Specialist Palliative Care Teams including East Cheshire Hospice
February 2017
Cheshire EPaCCS Consent Statement Feb 2017
February 2017 Click here for an update on the National Recommended Summary Care Plan for Emergency Care and Treatment (ReSPECT) document
16th December 2015 NICE publishes new guidelines for end of life care
15th December 2015 CYCLIZINE SHORTAGE ALERT for advice re using alternatives anti-emetics in palliative care see here
Following on from the Care Plan for End of Life Interim Evaluation (January 2015) there is now a new version of the Care Plan for End of Life which will be officially launched on Monday 24th August 2015. Copies of the new document can be found here
The Health Service Journal September 2014 published article on the End of Life Partnership read it here
The End of Life Partnership launch their new website
August 1st 2014 sees the launch of the unified DNACPR policy across South, Vale Royal & Eastern Cheshire CCG's, Mid Cheshire Hospital Foundation Trust, East Cheshire NHS Trust, St Lukes Hospice, and East Cheshire Hospice. Care Homes are also being encouraged to adopt the policy.
4th July 2014 Care Plan for End of Life is officially launched across the locality. See here for relevant documentation and for details of training.
June 26th 2014 One Chance to get it right - response to the Liverpool Care Pathway Review is published
For the latest news concerning the Care Plan for End of Life click here
The End of Life Care Plan Consultation has now ended. Read this statement to find out what the emereging themes were and how we responded. Also detailing the next steps.
News re: The End of Life Partnership - Coming together of The End of Life Service Model, Cheshire Hospices Education, and Cheshire Living Well, Dying Well Partnership.
Work streams currently being led by the team include:
  • Revision of the Out of Hours Deaths Protocol
  • Homeless Project
  • Styal Prison Education Programme
  • GP Education Programme - further dates to be confirmed
  • Rapid Discharge Pathway review and re-launch
  • Six Steps Residential Care Homes Project
  • GSF Care Homes Project
  • Unified DNA-CPR Policy
  • LCP Review Task and Finish Group

For further information on any of the above projects or relating to other end of life matters please contact the End of Life Service Model Team.


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New/Recent Uploads
NEW Resources to support you in delivering the 'Five Priorities for Care of the Dying'
Professional Leaflet to guide the delivery of the five priorities
Prompts for Practice- to support professionals in their delivery of the five priorities
NEW EPaCCS South CCG presentation (includes emis web screen shots)
NEW The Association for Palliative Medicine Ethics Committee Consideration of the Court of Appeal Judgement 17 June 2014Janet Tracey: Must patients be told about DNACPR orders? (July 2014)
NEW End of Life Care & MND - Patient Information Book
NEW East Cheshire Hospice Spring 2014 Newsletter
NEW Leadership Alliance for the Care of Dying People 2nd Interim Statement March 2014
NEW January 2014 Interim Statement from Leadership Alliance for the Care of Dying People
NEW ERISS Information Leaflet produced by NWAS
NEW Western Cheshire content (under development)
NEW Organ & Tissue Donation Page Created (we need resources/info to add to this please)
NEW Enabling Care Priorities - An Advance Care Plan example for use with patients who lack capacity and where best interests are being considered