Pharmacists should be at the ‘heart of palliative care’, says RPS

Pharmacy teams should be ‘fully integrated’ into palliative and end of life care so that patients can access the medicines, support and joined up care they need, the Royal Pharmaceutical Society (RPS) has said in a new policy report.

The report called for several reforms, underpinned by a need for improved information sharing and access to patient records across the multidisciplinary team.

These reforms included embedding pharmacists in all multidisciplinary palliative care teams to provide expertise on medicines, including prescribing and deprescribing. And Integrated Care Boards (ICBs) or Health Boards ‘must commission’ a lead paediatric palliative care pharmacy role in each country or region, it recommended.

Patients requiring end of life care should have the ability to ‘automatically share their health status when being included on a general practice palliative care register and to share advance care plans with their multidisciplinary team, including pharmacists at a community pharmacy of their choice,’ the report said.

It also highlighted the need for a single patient record – as promised in the government’s 10 Year Health Plan – which is particularly important in the final stages of life when changes can be rapid.

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Community pharmacists have a role to play in signposting patients to health, social care and third sector support, it added, alongside speaking to patients about the medicines they are prescribed.

The report said: ‘At present, community pharmacists are not routinely informed when a patient they have cared for has died, which can result in medicines being inadvertently delivered to a family’s home following death.’

RPS president Professor Claire Anderson said: ’Patients and their families should not have to spend their final months navigating fragmented care.

‘Pharmacists are central to helping people stay comfortable and supported at the end of life, but too often they are working without access to vital information or key systems.’

She urged the wider NHS, and those involved in end of life care, to follow these recommendations and ensure people receive safe, timely and compassionate care during the last phase of life.

Dr Sarah Holmes, chief medical officer at Marie Curie, added: ‘Pharmacists have the skills and accessibility to make care faster and easier to access for patients and their families; they’re an essential part of end of life and palliative care.

‘As a leading palliative and end of life charity, we have long called for better integration between services, so we welcome this call for urgent reform. Dying people need access to care that is within reach for them - right on their doorsteps - and pharmacists along with the wider NHS play a vital role in providing this.’

Shifting palliative care to community

It comes as a separate independent expert panel report, commissioned by the Health and Social Care Committee (HSCC), also recognised pharmacy’s role in palliative care.

The report, on England’s palliative and end of life care services, published on 28 November, highlighted the ‘vital element of care’ pharmacists provide but also said that shifting palliative care into the community would be challenging, due to current funding approaches and the fact that there are ‘no 24/7 pharmacies’ in some regions.

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‘The Government’s overarching strategy for the NHS, for more services to be delivered in neighbourhood or community settings rather than in hospitals, applies strongly to palliative and end of life care.

‘However, spending on primary and community health care accounts for 11% of health expenditure for people in their last year of life, while hospitals receive 81% of the spending,’ it said.

The report concluded that the NHS workforce is ill-equipped to meet the needs of people at the end of life due to insufficient education and training, staff shortages, and the lack of a nationwide framework for how ICBs should commission palliative care services.

It comes as the Terminally Ill Adults (End of Life) Bill, or the assisted dying bill, is making its way through Parliament. This bill would allow terminally ill adults in England and Wales with fewer than six months to live to apply for an assisted death, with the approval of two doctors and a panel that includes a social worker, legal figure and psychiatrist.

The bill was supported by MPs on its final reading in the House of Commons in June and it is now in its final stages in the House of Lords.

However, peers have proposed more than 900 changes and this week the government's chief whip in the Lords has announced an additional 10 days to scrutinise the bill, between 9 January and 24 April.

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Health secretary Wes Streeting voted against the bill, with the quality of end of life care being one of the reasons he cited for this decision.

A HSCC report on the issue in February 2024 also said more should be done to improve ‘patchy’ palliative care.

In January, England’s chief medical officer told MPs that frontline healthcare staff would need additional training to be able to fully support patients should the assisted dying bill pass.