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REMEDY : BNSSG referral pathways & Joint Formulary

BNSSG Adult Joint Formulary
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16. Palliative Care Guidelines

First line drugs Second line drugs Specialist drugs Secondary care drugs
Recommended in both primary and secondary care Alternatives (often in specific conditions) in both primary and secondary care Where a specialist input is needed (see introduction for definition) Prescribing principally within secondary care only


  • There is information in the BNF on prescribing in palliative care and in the St Peter's Hospice clinical guidance to support the clinical management of palliative care patients. 
  • Several recommendations in this chapter involve the use of medications outside of their product license i.e. ‘off-label'. This increases the prescriber's responsibility. Please contact Pharmacy for further information.
  • New guidelines and resources for anticipatory prescribing in BNSSG  launched on 1.3.23
    • The Community Palliative Care Drug Chart and the supporting EMIS protocol have undergone a significant revision to implement new clinical guidelines and to improve patient safety.
    • Policy, resources and launch webinars are available here Clinical Guidelines - St Peter's Hospice (
    • A summary of key changes and instructions for GPs who may need to update the anticipatory drugs chart protocol in EMIS are available via Teamnet.
  • Opioid conversion guidelines produced by Bristol and Weston Palliative Care Collaborative: Guidelines on the management of cancer pain in adults with life limiting illness which includes advice on starting and changing opioids plus easy opioid conversion tables (Updated 2022) are available from this link under "1. Local Clinical Guidelines".
  • Hospice 24 hour telephone advice: St Peter’s Hospice: 0117 9159430; Weston Hospice: 01934 423900
  • Information about palliative care can also be found on the Remedy End of Life Care page


National Guidance on symptom control (including EOLC) during COVID-19:


NHS England Community pharmacy Specialist Medicines LES

A number of pharmacies across the South West are providing the NHS England Enhanced Service for the Availability of Specialist Medicines. By providing the Specialist Medicines Enhanced Service, pharmacies are required to ensure that the specialist medicines are available at all times during their opening hours and on any bank or public holidays on which they open.
Pharmacies currently providing the service can be found here and the medication they hold can be found here. For more information on the NHS England LES please click here. Please note the medication list is subject to change during the pandemic and may need to be revised as guidance and/or availability of medicines changes.
It is advised to always ring the pharmacy to check current stock and opening times.