Background The local enhanced service for end of life care (EOL) was started by Worcestershire Primary Care Trust in 2009, with the aim of developing good practice and improving EOL care. GPs were asked to sign up to and fully adopt the Gold Standards Framework (GSF). Access to palliative care medications and proactive management of symptom control are key components of GSF, and to support this ‘just-in case’ boxes were launched in April 2010. It was anticipated that the use of the boxes would avoid the distress caused by poor access to medications in out of hours, by anticipating symptom control needs and enabling availability of key medications in the patient's home.

Outcomes To assess the success of this initiative a 6 month audit was undertaken between May and October 2010.

Results A total of 66 boxes were placed in patients' homes. Fifteen of those boxes were not used. No patients were transferred into the acute trust (one patient was transferred to a care home), meaning that 65 people remained in their own home at time of death, with 48 of those patients' end of life care being supported by provision of anticipatory medication. Only 6% of the responses reported any resistance to use of the boxes, either by the patient or their family. Provision of the boxes improved symptom control in 55% of the cases, and 89% of the boxes were reported as containing the most appropriate drugs. We estimate an approximate cost saving of, at least, £69,140 was made. This was calculated by multiplying the number of times the provision of the just-in case box prevented use of a further healthcare service by the average cost for that specific episode of care. This can be compared favourably to the cost of providing the drugs, being £3,346.