Palliative pharmacists are responsible for helping to manage pain levels, ensure comfort, and provide reassurance in the final days of a person’s life. In this article, we explore the important role of palliative pharmacy, prescribing best practices, and why there’s a growing requirement for this type of care.
Key takeaways
- Palliative pharmacy focuses on medicines optimisation at the end of a person’s life to manage pain, ensure comfort, and prevent the risk of adverse side effects or interactions
- The responsibilities of a palliative pharmacist include the management of pain and other symptoms, medication reviews, multidisciplinary collaboration, and providing education and support to patients and their loved ones
- Prescribing in palliative care can be handled by qualified pharmacists who have gained independent prescriber status. Anticipatory prescribing and deprescribing are also often required
- Joining a professional pharmacy network like UKCPA provides palliative pharmacists with opportunities to connect and share knowledge with other healthcare professionals, and continue with their education and development throughout their career
What is palliative pharmacy?
Palliative pharmacy is a specific type of pharmacy that focuses on optimising and delivering medication at the end of a person’s life. Palliative pharmacists work within the community, and across health and social care settings, to dispense medicines and ensure patients are as comfortable as possible in the final stages of their lives.
The growing requirement for palliative pharmacy care
A growing number of patients will require palliative pharmacy care over the next two decades, Marie Curie forecasts. The charity published a report in July 2023 titled How many people need palliative care?, which reviewed UK end-of-life care data from 2017 to 2021.
The data showed that of the people who died in 2021, 600,000 required palliative care—approximately 90% of all those who died that year. The report predicted that if 90% of people continue to need end-of-life care in their final days, over 730,000 patients will require palliative pharmacy care by 2048, marking a 25% increase.
However, Marie Curie highlighted that the total number of people requiring this type of care is likely to be even higher in reality, as the report does not take into account the changing demographics or increased comorbidities of the country’s ageing population.
Regardless of the exact figure, these findings demonstrate the need for greater palliative pharmacy integration within community care teams to ensure patients receive the highest standard of care in the final stages of their life.
What does a palliative care pharmacist do?
The role of a palliative care pharmacist is specialised and varied, and it can be incredibly rewarding. Put simply, the role of a palliative pharmacist is to make people comfortable in the final stages of their life, and provide their loved ones with reassurance that they are not in pain. This knowledge can have a significant impact during the subsequent grieving process.
The day-to-day roles and responsibilities of a palliative care pharmacist include:
- Pain management: managing symptoms, but particularly pain, is a key aspect of palliative and hospice pharmacy. Pharmacists play an important role in dispensing medicines, working alongside other healthcare teams to administer these. Those with an independent prescribing qualification will also be able to prescribe drugs without authorisation from a GP, speeding up access to medications
- Medication reviews: the medication a patient is prescribed at the end of their life may differ from their previous prescriptions. Pharmacists need to carry out medication reviews to detect potential high-risk interactions, and assess whether managed deprescribing is necessary
- Multidisciplinary collaboration: palliative pharmacy teams provide vital support to the wider palliative care team, working closely with doctors, community nurses, and hospice staff to provide comfort and care
- Supporting patients and their loved ones: pharmacy professionals are responsible for educating patients and their carers on medication use, alongside providing reassurance on side effects and pain levels at end of life
- Community presence: palliative pharmacists often work across varied settings, including hospitals, care homes, hospices, and in people’s homes
Prescribing in palliative care
Prescribing pain medication and other drugs to manage symptoms at end of life is an integral part of palliative care. Pharmacy professionals play a key role in this by dispensing medications, and by educating patients and their loved ones on administration methods or potential side effects.
Common end-of-life symptoms
Common symptoms that palliative pharmacy teams are required to manage include:
- Pain
- Muscle spasms
- Agitation
- Delirium
- Seizures
- Breathlessness
- Dehydration
- Dysphagia
Palliative care prescribing best practices
There are some key considerations for pharmacists working in palliative care, which will inform decisions regarding prescribing and administration for each patient. These include:
- Frequent reviews: regular medication reviews are important to ensure continued efficacy and avoid adverse side effects
- Route of administration: the best route of drug administration will depend on each patient’s individual needs, but oral administration should be tried first, before subcutaneous routes are explored. Non-oral routes will be necessary if an individual is experiencing certain symptoms, such as vomiting or dysphagia
- Regular dosing: keeping medication topped up is an important aspect of palliative care pharmacy, due to the focus on preventing pain rather than relieving it. Regular dosing helps to maintain a consistent level of medication in the body to ensure the highest levels of comfort possible
- ‘Just in case’ prescribing: also known as anticipatory prescribing, this approach ensures medication is available at home or out of hours to keep patients comfortable when healthcare professionals are not present
- Monitor signs of toxicity: palliative pharmacists need to be aware of potential signs of opioid toxicity in end-of-life patients being treated for pain. Signs of toxicity can include confusion or hallucinations, which may indicate the need for prescriptions to be reviewed and optimised
- Accurate recordkeeping: palliative pharmacy teams are required to keep detailed, up-to-date documentation specifying drugs and exact doses administered
Anticipatory prescribing in palliative care
Anticipatory or ‘just in case’ prescribing is an important part of palliative pharmacy. It involves making sure drugs are available for patients ‘just in case’ as they reach the end of their life, by prescribing medication to manage pain and other symptoms in advance.
Anticipatory prescribing in palliative care prevents delays in accessing medication, and means patients can be kept comfortable even when the end-of-life care team is not present. Just-in-case kits may be assembled by palliative pharmacists for a patient’s loved ones to keep close to hand in the event that symptoms worsen.
The role of deprescribing in palliative care pharmacy
Deprescribing is another important part of palliative pharmacy, and focuses on the managed withdrawal of medications that are no longer serving the patient’s needs, or that may risk interaction with end-of-life treatments.
Palliative or hospice pharmacists need to carry out a medicines review as soon as a patient comes under their care to reflect their changing needs. The review will identify drugs that are no longer providing a benefit, and the pharmacy team will need to discuss the decision to withdraw these with the patient or their loved ones.
The Daffodil Standards
Pharmacy teams providing end-of-life support within their community can sign up to ’The Daffodil Standards’ scheme, developed by the RPS and Marie Curie. It’s free for palliative pharmacy teams to sign up to the standards, which provide a framework for the continuous improvement of palliative care provision.
Clinical pharmacists working in general practice can work towards these standards to improve end-of-life care, provide enhanced support to carers, and continue to deliver quality care following a patient’s death. Pharmacy teams are encouraged to self-assess how well they currently meet each of the standards, before committing to ongoing improvements.
What does the future hold for palliative pharmacy?
With the number of people requiring palliative pharmacy expected to increase significantly over the coming years, the field will need to continue to evolve to meet changing requirements. Improved integration between pharmacists and wider healthcare teams will be essential, while further advancements in technology are also likely to impact end-of-life care.
An end to the palliative pharmacy postcode lottery
End-of-life charity Hospice UK published a report in June 2025 titled Bringing Care Closer to Home, calling for improved access to palliative care in remote communities across the UK. The report highlights that people living in remote, rural or island communities often face delays in accessing vital palliative medication, which can lead to increased anxiety and distress for patients and their loved ones at an already challenging time.
Hospice UK is therefore calling for hospice providers to work more closely with remote communities to understand their unique needs, and to ensure greater collaboration between hospice pharmacy teams, social care providers, GPs, and community nurses. This would provide a more joined-up approach to end-of-life community care, making it as seamless as possible for families to access.
Improved pharmacist integration in end-of-life care
Pharmacy teams need to be fully integrated into palliative care delivery to ensure patients and their loved ones receive consistent, quality care at end of life, the Royal Pharmaceutical Society (RPS) stated in November 2025.
Professor Claire Anderson, RPS President, explained: “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.”
With this in mind, the RPS is calling for greater integration of pharmacists into end-of-life community care teams to support faster access to controlled drugs. The body also wants to see specialist paediatric palliative care pharmacist roles created in every region.
Dr Sarah Holmes, Chief Medical Officer at Marie Curie, commented: “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.”
Join UKCPA for support throughout your pharmacy career
Join UKCPA for ongoing support throughout your palliative pharmacy career. Our clinical pharmacy network offers opportunities to share your experiences and best practices with fellow professionals via forum discussions, and play a key role in shaping the future of the field. Attend networking events to connect with other healthcare professionals, and contribute towards greater cross-department integration.
When you become a UKCPA member, you’ll also be able to join dedicated communities focused on specific areas of end-of-life pharmacy, including pain management, community health, and critical care.
Access all of this and more for less than £3 a week when you join UKCPA today.
