Foundation trainees need experiential placements in hospices to help manage an ageing population

Advancing treatments in healthcare mean the UK’s patient population is living longer than ever, inevitably leading to multiple comorbidities that require complex care in managing polypharmacy^​1​.  

As such, the need for pharmacy input within the hospice setting is becoming critical. Pharmacy staff are experts in medication administration, interactions and pharmacodynamics; and are therefore well placed to contribute to a multidisciplinary hospice team. 

There is considerable opportunity for pharmacists to be involved in hospice care, specifically the ability to positively affect patient outcomes and become valued members of the team^​2​. These opportunities include recognising drug–drug interactions, titrating medication doses, deprescribing, and reducing symptoms and side effects. 

Through first-hand experience working in palliative care, it is clear that pharmacist input has a profound impact on patients with life-limiting illnesses. Getting the prescribing right at such a vital point in a patient’s journey can have long-lasting effects, not only on the patient but on their families too. Prescribing processes can easily go wrong and, importantly, could impact a patient’s journey and trust in the healthcare system. 

This makes pharmacy education in hospice care vitally important; however, the provision of education in palliative and supportive care within UK pharmacy curricula is currently minimal. Results of our scoping review of 14 universities showed that none offer experiential learning placements within hospices, and none have previously been reported in the foundation training year. This means the understanding of hospice care is lacking in trainee pharmacists owing to minimal hospice training — just as palliative care services are starting to proliferate following amendments to the Health and Care Act in 2022. 

Service commissioning

The Health and Care Act 2022 introduced a legal duty for integrated care boards (ICBs) in England to commission palliative care services as it considers “appropriate as part of the health service”, ensuring a more consistent and equitable approach to providing support for individuals with life-limiting illnesses. This includes the provision of palliative care for people of all ages, aiming to address regional disparities in service availability and improve end-of-life care access and quality. 

Improving access to end-of-life care is crucial to ensure that patients receive timely and appropriate care, which pharmacists can contribute to through both active clinical interventions in relation to medicines use at the end of life, such as dose and formulation changes. 

The legislation could mean that more community pharmacy services become available, aimed at improving continuity of care and reducing hospital readmissions, such as the NHS Discharge Medicines Service and the Pharmacy Quality Scheme incentive for community pharmacies to stock 16 palliative care medications. By integrating pharmacy services in primary care, we can alleviate the burden on other healthcare sectors. 

Historically, pharmacy staff are taught a linear approach to the pharmacological treatment of conditions, meaning that they can often fail to see the patient as a person. Now, we are encouraged to use a holistic approach to patient care, while also focusing on non-pharmacological interventions. With the care required in the palliative patient cohort, it is vital that pharmacy staff are aware of this. The importance goes hand in hand with the changing landscape for pharmacists, with qualification also meaning prescribing capabilities in new pharmacists from 2026. We need to educate our future pharmacists that sometimes deprescribing is just as important as prescribing for our patients.  

Benefits of experiential learning

Experiential learning placements, where foundation trainee pharmacists learn through hands-on experience and reflection, have shown to contribute to positive training outcomes^​3​.

This has been demonstrated through the introduction of a five-day hospice placement for foundation trainees at Newcastle upon Tyne NHS Foundation Trust. In the three years between 2021 and 2024, 24 Newcastle Hospital trainee pharmacists completed the experiential learning placement — 8 pharmacists per year — at the inpatient unit at St Oswald’s Hospice, a 15-bed facility for people with specialist palliative care needs, symptom control and/or end-of-life care^​4​.

Questionnaires completed by the trainees before and after the placement showed an increase in confidence in aspects of patient care and medicines management. For example, prior to the placement 60% (n=14) of the trainees did not feel confident about having discussions with patients with life-limiting illnesses, which reduced to 20% (n=5) after completing the placement. 

Also, only 40% (n=10) of trainees understood the financial responsibilities of a pharmacist’s role before the placement, which nearly doubled to 80% (n=19) after. Financial responsibilities include managing drug budgets, non-formulary or unlicensed items and procurement. 

When asked about how confident the trainees felt in ensuring safe prescriptions for patients with compromised organ function, only 20% (n=5) said they felt confident prior to the placement but this increased to 60% (n=16) after. 

The results also showed that the placement helped to improve the confidence of trainees in understanding a pharmacist’s contribution to hospice care.

This was a small-scale study, so it was not possible to determine if the change in confidence levels was significant or to draw conclusions about how the placement would go on to impact patient care or pharmacy practice. However, the findings have indicated that educational placements in hospice settings are viable in pharmacy education.

There are some limitations to offering an experiential placement in a hospice during the foundation year. Limited capacity within the foundation training year means that the placement length was only five days, so trainees were only able to gain an oversight into the workings of a hospice and how pharmacy staff can contribute. A longer placement would allow the trainees to have a more ‘hands-on’ approach and understand the patient journey further. 

Nevertheless, the feedback demonstrated through the questionnaires and from the hospice staff has been positive and we are keen to continue and adapt the placements to reflect the changes to the initial education and training of pharmacists^​5,6​. We are planning to offer further placements in a hospice and, with discussions around multisector placements becoming mandatory from 2027/2028, we could see the hospice becoming a vital learning environment for pharmacy trainees^​5​.